Hip Examination

Intro

  • Wash hands, Introduce self, Check patient name and DOB/CHI, Explain procedure and gain consent

Look

  • General: age, mobility, mobility aids, trauma etc
  • Standing:
    • Posture, asymmetry, muscle wasting, scars, deformity (also look at the back for scoliosis and the gluteal muscles
    • Trendelenburg’s test
      • Look at the patient’s ASIS and ask them to stand on one leg (you may want to be ready to support them)
      • Normally the gluteals will contract so that the contralateral (unsupported) leg rises to balance.  If the contralateral side dips, the abductor muscles are weak on the side they are standing.
  • Gait:
    • Speed, limp, arm swing, abnormal gaits e.g. Trendelenburg (wide-based waddle); antalgic
  • Lying
    • Look at leg length, comparing symmetry and rotation, scars, sinuses, skin changes etc
    • Measure apparent (xiphisternum/umbilicus to medial malleolus: if unequal, spinal or pelvic problem) and true leg length (from ASIS to medial malleolus: if unequal, true limb shortening e.g. fracture)

Palpate/Feel

  • Start on normal side
  • Bony landmarks (where possible) e.g. greater trochanter, ASIS, pubic rami
  • Temperature and skin etc

Move

  • Do all movements actively (except rotation) then passively
  • Test leg movement roughly by rolling the legs gently on the bed
  • Flexion (130°); (NB Extension is not routinely tested on the couch);
  • Test Abduction (45°) and adduction (30°)
    • NB Abduction/adduction is not always tested actively
  • Test Internal rotation passively by flexing the hip and knee to 90° and rotating the leg so that the knee points inwards (vice verse for external rotation)
    • Internal rotation lost early in osteoarthritis

NB Some practitioner’s will still perform Thomas’ test for fixed flexion deformity.  However, in Tayside, at least, it is becoming less routine and is no longer part of the hip examination.

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