Examination of the Hip Flashcards
What is the general structure of the examination of the hip?
Stand the patient-look for scars, swelling deformity
Walk the patient-Look at the gait
Trendelenberg’s test-Look, sound side sags
Lie the patient down
Square the pelvis-Look and feel
Thomas’ Test- Move, eliminate lumbar lordosis, look for fixed flexion of the hip
Range of motion-move, flexion, internal/external rotation, abduction, adduction
Special test- Neurovascular examination
How to intro a hip examination?
When examining the hip, the patient should be wearing their underpants but should remove
their trousers, socks and shoes.
• Wash your hands
• Introduction, identification and consent
What is involved in the inspection element of the hip exam?
With the patient standing, inspect the patient from the front for pelvic tilt, joint deformities (e.g. fixed flexion) and wasting of the quadriceps muscles; inspect from
the side for an exaggerated lumbar lordosis, which may suggest a fixed flexion deformity of the hip; and inspect from behind for wasting of the gluteal muscles and for scoliosis, which may be primary or may be secondary to a pelvic tilt. Look at the patient’s stance.
• Position the patient supine on the couch with their hips and knees extended. Inspect for scars in the groin, anterior and lateral thighs. If possible, roll the patient onto each side to inspect the gluteal regions.
• Assess symmetry. Is there a leg length discrepancy?
o To measure apparent leg length, use a tape-measure and measure from the xiphisternum to the medial malleolus of each leg. (This is ‘apparent’ length as it will be influenced by pelvic tilt as well as the true length of the legs)
o To measure true leg length, measure from the anterior superior iliac spine (ASIS) to the medial malleolus
o If there is a true leg length discrepancy, assess whether this originates in the tibia or the femur, as follows:
▪ Position the patient with their knees bent up to a right angle and their heels flat on the bed.
▪ Inspect from the side.
▪ Place your hand across both tibial tuberosities. If there is femoral shortening, your hand will dip down towards the shortened side.
▪ Place your hand across both suprapatellar regions. If there is tibial shortening, your hand will dip down towards the shortened side
What is involved in the palpation stage of the hip exam?
Ask the patient whether they have any pain or tenderness in their hips
• Assess the temperature using the dorsum of your hand in the upper thigh and the
greater trochanter. Compare both sides.
• Palpate the greater trochanter for trochanteric bursitis
What is involved in assessing the range of motion in the hip?
Check the active range of motion (ROM) of flexion, abduction and adduction of each
hip. The normal ranges are flexion 115-125°, abduction 40-50°, adduction 15-25°.
• Check the passive ROM of flexion, abduction and adduction at each hip.
• Check the passive ROM of internal and external rotation at each hip. First check with
the lower limb fully extended at the hip and knee. This is referred to as ‘internal and
external rotation in extension’. Then check with the hip and knee both flexed at 90°.
This is referred to as ‘internal and external rotation in flexion’. (Normal ranges are
internal rotation in extension = 30-40°; external rotation in extension = 40-50°; internal
rotation in flexion = 25-40°, external rotation in flexion = 25-50°.)
• In a young patient assess the active ROM of extension with the patient lying prone.
Normal range is 10-30°.
What are the special tests for the hip exam? What do they involve?
Thomas’s test: Assess for a fixed flexion deformity of the contralateral hip by flexing
the ipsilateral hip fully. Place your hand between the patient’s lumbar spine and the
bed to check for full correction of the lumbar lordosis then observe the contralateral
hip. This manoeuvre will cause the patient with a fixed flexion deformity of the
contralateral hip to raise their leg off the bed.
• Assess the patient’s gait: A waddling gait may be associated with hip pain or
proximal muscle weakness. An antalgic gait reflects pain on weight-bearing.
Note: Gait may be assessed at the beginning of the examination along with stance
• Trendelenburg’s test: Ask the patient to stand on one leg to assess the abductor muscle strength of that hip. In a negative (normal) test, the pelvis remains level or even rises on the contralateral side as the patient contracts their abductors (gluteus medius, gluteus minimus, tensor fascia latae and sartorius). In a positive test, the pelvis will dip on the contralateral side.
How do you complete a hip exam?
- Examine the patient’s lumbar spine and the ipsilateral knee joint.
- Perform a neurological and vascular examination of the patient’s lower limb. (In the OSCE, unless you are given specific instructions to perform this assessment, you should simply state to the examiner that you would do so).
- Thank the patient
- Request them to redress
- Wash your hands
