Examination Of The Hip

Question 1

1

Answer 1

Wash your hands
Intro

Question 2

2

Answer 2

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.

(Do gait here)

Question 3

3

Answer 3

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

Question 4

4

Answer 4

Assess symmetry. Is there a leg length discrepancy?

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)

Question 5

5

Answer 5

To measure true leg length, measure from the anterior superior iliac spine (ASIS) to the medial malleolus

Question 6

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Answer 6

If there is true leg length discrepancy, assess whether this originates in the tibia or 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

Question 7

7

Answer 7

Palpatition (feel)

-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

Question 8

8

Answer 8

Palpate the greater trochanter for trochanteric bursitis

Question 9

9

Answer 9

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°

Question 10

10

Answer 10

Check the passive ROM of flexion, abduction and adduction at each hip and feel for crepitus

Question 11

11

Answer 11

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°.)

Question 12

12

Answer 12

In a young patient assess the active ROM of extension with the patient lying prone. Normal range is 10-30

Question 13

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Answer 13

Thomas’s test - assesses for a fixed flexion deformity of the contralateral hip

Question 14

14

Answer 14

Trendelenburg’s test - Ask the patient to stand on one leg to assess the abductor muscle strength of that hip

Question 15

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Answer 15

Gait (assess at the start)

Question 16

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Answer 16

-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)
-Completion