Hip exam

Question 1

What should you look for in general inspection of the hip exam?

Answer 1

Walking frame/stick
Wheelchair
Fractures
Scars
Deformity

Question 2

What should you look for on inspection of the hip exam?

Answer 2

Anterior inspection:
- leg length discrepancy
- pelvic tilt
- swelling
- scars
- bruising
- quadriceps wasting

Lateral inspection:
- symmetry
- lumbar lordosis
- knee flexion
- scars

Posterior aspect:
- scars
- muscle wasting
- scoliosis (spine twists and curves to the side)
- iliac crest alignment

Assess gait by asking pt to walk back and forth.
- antalgic gait (limping)
- waddling gait

Trendelenbury test
- place two hands on the bed, and lift one leg back at a time. Check for the crests of the pelvis staying aligned.
- positive test is when the pelvis drops on the side of the lifted leg.

Question 3

What do you do after inspection of the hip?

Answer 3

Leg length discrepancy

For both legs, measure length from the ASIS (anterior superior iliac spine) to the medial malleolus.

Question 4

What do you need to palpate for in the hip exam?

Answer 4

Feel temperature of the joint compared to surrounding tissue.

Palpate the greater trochanter (trochanteric bursitis).

Question 5

What movements are tested in hip exam?

Answer 5

Check active then passive movement.

Flexion (bring your knee close to your chest)

Internal rotation (keep knee 90 deg and move leg outwards)

External rotation (keep knee 90 deg and move leg inwards)

Passively do:
- abduction (move straight leg away from the body)
- adduction (move one foot across the other)

Extension (ask pt to lie on their front and lift their leg up active and passive)

Question 6

What special tests do you perform in a hip exam?

Answer 6

Thomas’ test
Straight leg raise

Question 7

What is Thomas’ test?

Answer 7

Tell pt to lie on their back towards the edge of the bed.

Place one hand under their back while you passively flex their leg.

Positive test: when affected thigh raises off the bed.

Question 8

What causes positive Trendelenbury test?

Answer 8

Abductor muscle paralysis
Upward displacement of the greater trochanter
Absence of a stable fulcrum

Question 9

What is straight leg raise?

Answer 9

Pt lies flat.

Passively lift knee/keep leg straight (flex) until pain detected.

Dorsiflex the ankle and ask if pain is detected.