Hip Examination

Prepare patient

  • Introduction
  • Position supine on bed

General Principles of Joint Exam

  • Check if any pain, then look, feel, move, measure & compare with other side, & assess function.

Look

  • General inspection
    • Obvious other joint disease

Hips

  • Compare posture of both legs – any rotation, contractures Leg lengths
    • True leg length (ASIS to medial malleolus)
    • Apparent leg length (umbilicus to medial malleolus)
    • If difference between true lengths suggests likely hip disease on shorter side o
    • If difference between apparent lengths only then pelvis tilted

Feel

  • Joint tenderness – just distal to midpoint of inguinal ligament
  • Level of greater trochanters – should be equal – thumbs on ASIS & index/middle fingers can feel greater trochanter tips posteriorly.

Move

  • Movements:
    • Passive:
      • Flexion (120 deg with knee flexed and examiner holds other leg down keeping pelvis on bed)
        • Thomas’ test – Fully flex both hips to straighten pelvis, if a leg cannot be extended fully (whilst the other hip remains fully flexed) then there is a fixed flexion deformity.
      • Internal rotation (45 deg)
      • External rotation (45 deg) – cross leg with calf over opposite knee/thigh o
      • Abduction (50 deg)
      • Adduction (45 deg)
  • Trendelenberg test – stand on one leg & opposite hip should elevate unless proximal myopathy or hip disease.

Function

  • Gait: Watch for abnormalities, limp, walking aid
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