Hip Examination

Question 1

Introduction

Answer 1

WIPER QQ
-undress from the waist downwards, but keep your underwear on
-I’d like you to start standing, and then lie on the couch for the rest of the examination
-look, feel and move your hip, ask you to carry out some small tasks

Questions
-Do you have any existing hip problems, pain?
-Is your ability to carry out daily activities limited due to your hip?

Question 2

Inspection with the patient standing
- general inspection of surroundings
- general inspection of patient
- hip inspection

Answer 2

General inspection of surroundings
- walking aids
- abnormal sole wear patterns
- types of shoes

General inspection of patient
-body habitus

Leg inspection from all sides
-DWARFS (deformity, wasting, asymmetry, rashes, fasciculations, scars)
-joint angle deformity - fixed flexion?
-joint swelling - effusion, inflammatory, septic?
-leg length discrepancy
-pelvic tilt - scoliosis, leg length difference, hip abductor weakness

Question 3

Gait

-what are you looking for

Answer 3

Walk to end of room, turn and walk back

Range of movement and speed turning - reduced in chronic joint issues
Antalgic - pain, weakness
Trendelenburg - unilateral hip ABD weakness from SGluteal nerve/L5 issue
Waddling - bilateral hip ABD wekaness from myopathies

Question 4

Trendelenburg test

Answer 4

With patient standing
Please stand on 1 leg
-pelvic drop on contralateral side due to abductor weakness on that leg’s side
Repeat other side

Gluteus med, min weakness from supgluteal nerve/L5

Question 5

Palpation

-what are you assessing for

Answer 5

Ask patient to lie down

Temperature of hip joints
-high temp + swelling + tender = septic/inflammatory arthritis

Palpate - ASIS, PSIS, PIIS, greater trochanter
-greater trochanter tenderness - trochanteric bursitis

Leg length - Galeazzi test

• ask patient to bend knees with feet and hips in contact with couch
• difference in leg length - difference in leg height

Apparent leg length assessment
- umbilicus - tip of medial malleolus
- difference due to muscle or joint tightness

True leg length assessment
- ASIS - tip of medial malleolus
- genuine difference in bone length

Question 6

Movement

-active movements

Answer 6

Active flexion
- bring knee up to your chest as far as you can
- place hand under lumbar spine - detect masking of restricted hip joint mv by lower spine

Active ABD
-raise leg off bed, keep it straight and swing it away from your midline
Active ADD
-and swing it back to the center and over the other leg

Note

• ROM
• pain, discomfort

Question 7

Movement

-passive movements

Answer 7

Passive flexion, ABD, ADD
-take weight of patient’s ankle and knee and repeat mv

Passive int rotation
-flex hip and knee => lateral foot rotation
Passive ext rotation
-flex hip and knee => medial foot rotation

Note

• crepitus - OA
• discomfort, ROM

Question 8

Thomas’s test

• how would you do this
• what are you looking for

Answer 8

Assess for fixed flexion deformity => inability to fully ext leg

Ask if they have had a hip replacement - risk of dislocation

Patient flat on bed
Hand under lumbar spine - helps prevent increasing lumbar lordosis masking fixed flexion deformity
Passive hip flexion as far as possible - bend your knee and bring it up to your chest
Observe other leg

Positive - affected thigh lifts off bed even when gently pushed back down
Comment on angle of deformity

Question 9

Further examinations

Answer 9

Gait
Hip joint appearance
ROM

Neurovascular exam of LL
Joints above and below - lumbar, knee

Further imaging
-XRay, MRI