Hip Exam

Question 1

Tredelenburgs Gait

Answer 1

Unilateral hip abductor weakness - trunk lurches towards opposite side of the pathology to maintain balance

Question 2

Waddling gait

Answer 2

Bilateral hip abductor weakness -overuse ofcircumductionto compensate for gluteal weakness

Question 3

Difference between true and apparent leg length

Answer 3

True is from the anterior superior iliac spine to tip of medial malleolus
vs
Apparent umbilicus to tip

Question 4

What does Thomas Test look for

Answer 4

Fixed flexion deformity
The test ispositive(abnormal) if theaffected thigh raises off the bed, indicating aloss of hip joint extension.

Question 5

Contraindications to Thomas Test

Answer 5

This test shouldnot be performedon patients who have had ahip replacementas it can causedislocation.

Question 6

Tredelenburgs test

Answer 6

Hipabductorweakness(gluteus medius and minimus).
If thepelvisdropson the side of the raised legit suggestscontralateralhipabductorweakness(this is known as Trendelenburg’s sign).

Question 7

Further Investigations after Hip Exam

Answer 7

Neurovascular exam of lower limbs
Spine and Knee exam
Further imaging if indicated

Question 8

Look during a hip exam

Answer 8

• Perform a briefgeneral inspectionof the patient, looking for clinical signs suggestive of underlying pathology:
• Body habitus:obesity is a significant risk factor for joint pathology due to increased mechanical load (e.g. osteoarthritis).
• Scars:may provide clues regarding previous lower limb surgery.
• Wasting of muscles:suggestive of disuse atrophy secondary to joint pathology or a lower motor neuron injury.
• Look forobjectsorequipmenton or around the patient that may provide useful insights into their medical history and current clinical status:
• Walking aids:the ability to walk can be impacted by a wide range of knee, hip and ankle pathology.
• Prescriptions:prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications (e.g. analgesia).
• Muscle wasting
• Scars
• Flexion Abnormalities
• Pelvic Tilt
• Quadriceps wasting

Question 9

How to examine gait and what to assess

Answer 9

• Ask the patient towalk to the end of the examinationroom and thenturnandwalkbackwhilst you observe their gait paying attention to:
• Gait cycle:note any abnormalities of the gait cycle (e.g. abnormalities in toe-off or heel strike).
• Range of movement:often reduced in the context of chronic joint pathology (e.g. osteoarthritis, inflammatory arthritis).
• Limping:may suggest joint pain (i.e. antalgic gait) or weakness.
• Leg length:note any discrepancy which may be the cause or the result of joint pathology.
• Turning:patients with joint disease may turn slowly due to restrictions in joint range of movement or instability.

Question 10

What can tenderness of the hip indicate

Answer 10

trochanteric bursitis

Question 11

Common hip pathologies

Answer 11

OA
RA
Ankylosing Spondylitis
Bursitis
FNOF