Hip Exam

Question 1

Hip exam - Look

Answer 1

• Patient standing: quadricep/hamstring/muscle mass
• Gait: pace, symmetry, gross gait abnormalities, walking aids, note an altalgic, stiff, or trendelenburg gait
• Patient lying on the couch: local inspection of the hip for erythema or skin changes, swelling over greater trochanter, bruising, scars, attitude of limb

Question 2

Hip exam - feel

Answer 2

• Greater trochanter
• Groin (mid-point and laterally)

Question 3

Hip exam - Move

Answer 3

• Flexion 100-130 degrees (passive and active)
• Internal rotation 15 degrees (passive only)
• External rotation 40 degrees (passive only)
• Adduction 15 degrees (passive only)
• Abduction 45 degrees (passive only)

Question 4

Suspected abductor muscle weakness

Answer 4

Trendelenburg test

• This assesses hip abductor muscle strength (gluteus medius, gluteus minimus and tensor fascia lata)
• Abductor weakness may be seen in variety of conditions such as osteoarthritis, developmental dysplasia of the hip or slipped upper femoral epiphysis)
• With the patient standing, ask the patient to put their hands on yours for balance
  and ask them to raise in each leg one at a time
• The leg in contact with the floor is the one being assessed
• Positive test:
  
  • If the abductor muscles are weak the standing leg will move into adduction
    and you will notice the pelvis moves down on the unsupported side
  • If one side only has weak hip abductors a Trendelenburg gait may be seen, if both sides are weak, a waddling gait is seen

Question 5

Hip exam - Suspected limb length discrepancy

Answer 5

True limb length

• With the patient supine measure from the ASIS to the tip of the medial malleolus
• True shortening may be seen in fractures, missed congenital hip discoloration, Perthes or slipped upper femoral epiphysis

Apparent limb length

• With the patient supine measure from the xiphisternum to the medial malleolus
• Apparent shortening may occur with a spinal scoliosis or a fixed flexion deformity of the hip

Question 6

Suspected fixed flexion deformity

Answer 6

Thomas’ test

• Identifies a fixed flexion deformity (incomplete extension) at the hip
• Contralateral hip flexes when one is flexed
• Should be aware of this test but will not be expected to demonstrate it at an undergraduate level