Hip examination

Question 1

What would you look for in a knee examination? (patient lying down)

Answer 1

1. Age and general physical condition of patient
2. Mobility aids
3. Hips: symmetry, muscle wasting, scars, redness, swelling, fixed flexion, external rotation of the leg
4. Measure leg length with tape measure

Question 2

What scars can you see on the hips?

Answer 2

Arthroscopy
Arthroplasty
DHS

Question 3

What can fixed flexion be a sign of?

Answer 3

OA or other hip pathology

Question 4

What is external rotation a sign of?

Answer 4

Neck of femur fracture

Question 5

What would you feel for in a hip examination?

Answer 5

1. Temperature (anterior to hip joint, over lateral thigh)
2. Hip in neutral position, then palpate:
   a. ASIS
   b. Anterior joint line
   c. Greater trochanter

Question 6

What would you feel for in the anterior joint line?

Answer 6

Tenderness

Bony abnormalities

Question 7

What would you feel for in the greater trochanter?

Answer 7

Trochanteric bursitis

Question 8

How would you move the hip in a hip examination?

Answer 8

1. Assess ROM and pain on movement
2. Active movement: flexion, abduction, adduction, conjugate hip movement (circles)
3. Passive moment (ask for discomfort and watch their face)
   a. Flex both hip and knee to 90 degrees and internally AND externally rotate leg (move foot away from other leg and towards other leg)
   b. Legs straight, stabilise pelvis: abduction, adduction
   c. If possible roll patient onto their side and extend

Question 9

What movement is first limited in OA?

Answer 9

Hipp abduction

Question 10

What special tests would you perform with the patient lying down during a hip examination?

Answer 10

Thomas test for fixed flexion deformities like OA

Question 11

How would you look at the knees when the patient is standing up?

Answer 11

Look for deformities and muscle wasting and compare both sides

Question 12

What functional tests would you do for a hip examination?

Answer 12

Ask patient to walk across the room

Consider features of gait: symmetry and smoothness, normal heal strike, toe off and step height

Question 13

What special tests would you do with the patient standing up?

Answer 13

Trendelenburg test

Picks up ABductor instability due to pain, weakness, developmental dislocation of the hip or slipped upper femoral epiphysis

Question 14

How would you test the neurovascular integrity of the hip?

Answer 14

Sensation on dorsal foot and sole of foot

dorsalis pedis and posterior tibial pulses, CRT

Question 15

How would you conclude a hip examination?

Answer 15

I would like to examine the other hip

I would like the examine the knee and lumbar spine, then go on to perform a full musculoskeletal assessment

Investigations: x-ray, CT hip, joint aspiration

Question 16

What are indications for a total hip replacement?

Answer 16

1. OA
2. RA
3. displaced intracapsular NOF in the young