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