Hip exam Flashcards
Which ligaments support the femoral head in the acetabulum?
- ischiofemoral (posterior)
- pubofemoral (anterior)
- iliofemoral (anterior)
Which muscles of the hip are found in the superficial and deep layers?
Superficial:
1. gluteal muscles: support hr hip during locomotion and medial rotation (gluteus medium and gluteus minimum)
Deep layer:
- piriformis: lateral rotation
- obturator: lateral rotation
- gemelli: lateral rotation
Where should an IM injection be administered in the lower limb/buttocks? why?
Upper lateral quadrants
to avoid damage to the sciatic nerve
What are the steps in examining the hip?
- introduction
- preparation
- look
- feel
- move
- special tests
- function
- summary + close
What is correct exposure of the patient when examining the hips?
thigh must not be obscured
What are you looking for when assessing the hips?
- symmetry - are the hips at the same height
- muscle bulk - gluteal muscles and quads in particular
- swelling - oedema and bursae
- skin - scars, redness, signs of other diseases
- gait - is it smooth and rhythmic? are they in pain (antalgic)?
What are you feeling for when assessing the hip joint?
- temperature
- feel the bony landmarks - femoral shaft to great trochanter, ASIS, pubic rami
- check for leg length (real + apparent)
- feel for any effusions
What movements do you perform when assessing the hip joint? How should these movements be assessed?
- Flexion + extension: for extension ask patient to push their leg into themed if they don’t want to roll onto their front
- Adduction + abduction: adduct the leg across the other to assess full range of movement
- internal + external rotation: ask the patient to bend their knee to 90°. (foot pointing outwards is internal rotation and foot pointing inwards is external)
1. active
2. passive (feel for crepitus)
3. resisted
What special tests are there to assess the hip?
- Thomas’ test (fixed flexion deformity)
- Straight leg raise (sciatic stretch test)
- Trendelenburg test (gluteal muscle weakness)
What is Thomas’ test? What is a normal and abnormal result?
- raise their head off the bed so that their back is flat
- passively flex one hip
- Normal result: the other hip should stay still
- Abnormal result: other hip raises off the bed = fixed flexion deformity
What is the straight leg raise? What is an abnormal result?
- passively lift the patient’s leg off the bed
- ask fi they have any shooting pains down the back fo their leg at any point
- if patient does have shooting pains (abnormal) = sciatic compression
* note the angle at which pain occurs
What is the trendelenburg test? What is an abnormal result?
- whilst supporting the patient’s hips, ask them to lift one leg off the floor
- Normal result: pelvis remains level
- Abnormal result: non-supported hip dips down
- repeat on other leg
*if there is an abnormal result = gluteal (medium + minimus) muscle weakness on the supporting leg
How do you assess function when examining the hip?
Assess the patient’s gait, ask them to walk to one side of the room, turn and walk back to original position
