Hip Flashcards
Movement hip
The hip joint is a ball and socket joint and can move in the following ways:
In the sagittal plane:
- flexion (about 120°): bending of the hip with knee flexed
- extension (about 15°): stretching of the hip
In the frontal plane:
- abduction (about 60°): lifting the laterally extended leg with hip extended
- adduction (about 30°): extension of the leg over the midline with hip extended
Around a longitudinal axis through the femoral shaft:
- exorotation: outwards rotation of the anterior side of the upper leg, realisable in
both an extended leg (about 45° is possible) and a flexed hip and knee (about 60° is
possible)
- endorotation: inwards rotation of the anterior side of the upper leg, realisable in
both an extended leg (about 35° is possible) and a flexed hip and knee (about 40° is
possible)
Inspection
Procedure
- Ask the patient to undress, leaving only the underwear on.
- Ask the patient to stand upright and inspect the ventral side, the dorsal side and then
both lateral sides from a distance of about 2 to 3 metres.
- You should preferably inspect in a cranial to caudal sequence.
- If necessary palpate in order to more accurately locate the position of a certain
structure.
- Assess the spontaneous posture first (‘individual baseline posture’) and then ask the
patient to extend the knees and to place the feet next to each other.
- Assess in turn all bony structures for shape and position (position of the separate
bony structures and joints, and their position in relation to each other), comparing
left and right.
Pay attention:
- torso and arms
- pelvis (tilt: palpate the reference points on both sides: iliac crest, anterior superior => about 10°
iliac spine) [Figure 5]
- legs: the femur should normally be endorotated with respect to the tibia (rotation
abnormalities of upper and lower leg; load?)
- knees: genu valgum (knock knees), genu varum (bow legs); position of the patella)
- feet: pes planovalgus (flat feet), pes cavus (high arch foot).
Gait pattern
Next ask the patient to walk and carefully observe the following:
- symmetry/asymmetry (torso rotation, Duchenne sign, Trendelenburg sign)
- stride length
- load on left and right leg (equal?)
- occurrence of a ‘snapping hip’
Active examination
person lays on table
flex knee all the way to chest and extend other knee against table
abduction with leg extended and toes pointing up (leg outward)
hold one leg up of patient and then ask for adduction of other leg (leg moves inward under the leg being held up)
roll leg inward and outward (make sure pelvis still against table)
leg at 90° and rotate it inward then outward
Passive examination
person lays on table
flex the leg towards chest
abduction leg (move leg outward)
adduction leg (hold on leg up and the other one move inward)
hold leg at 90° and rotate it inward and outward (endo and exorotation. note hip rotation is inverted, outward rotation of hip is leg moved outwards)
Muscle tests
person lays on table
knee bent, push knee towards yourself and they have to pull towards themselves
legs extended, push them together and they have to pull them apart
legs extended, pull them apart and the have to push them together
sit on table with legs hanging down
put conter pressure, ask to push leg in ward and outward
person lays on stomach
bend leg on shoulder at 90°, push on thigh and ask person to pull their leg up
selective test
person lays on stomach
bend leg on shoulder at >90° and <90°, push on thigh and ask person to pull their leg up
person lays on back
person bends leg outward, hold the knee and the ankle and ask the person try to cross leg over the other while you provide resistance
specific test
to test for duchenne and Trendelenburg
ask patient to stand up and lift one leg up 90°
torso tilts -> duchenne
hip sinks -> trendelenburg
Leg length
patient lays on back and lift leg while flexing compare on side and at plantar the length
do same on stomach
