Hip Examination Flashcards
What may cause quadriceps wasting in a hip exam?
- Disuse atrophy
- LMN lesion
What may cause leg length discrepancy in a hip exam?
May be congenital or acquired
What may cause pelvic tilt in a hip exam?
Lateral pelvic tilt can be caused by scoliosis, leg length discrepancy or hip abductor weakness
What may cause flexion abnormalities in a hip exam?
Fixed flexion deformity at the hip joint may suggest the presence of contractors secondary to previous trauma, inflammatory conditions or neurological disease
What may cause Trendelenburg’s gait?
Unilateral weakness of the hip abductor muscles secondary to a superior gluteal nerve lesion or L5 radiculopathy
What may cause a waddling gait?
An abnormal gait caused by bilateral weakness of the hip abductor muscles, typically associated with myopathies
Why do you palpate the hip joint?
- Palpate the greater trochanter for tenderness
- May suggest trochanteric bursitis
What are the two things to assess in a leg length assessment?
Apparent leg length & true leg length
How do you assess an apparent leg length?
Measure and compare the distance between the umbilicus and the tip of the medial malleolus
How do you assess a true leg length?
Measure from the anterior superior iliac spine to the tip of the medial malleolus
What is the normal range of movement of hip flexion?
120 degrees
How do you assess active hip flexion?
‘Bring your knee as close to your chest as you can’
What is the normal range of movement of active hip extension?
180 degrees (leg is lying flat)
How do you assess active hip extension?
‘Straighten your leg out so that it is flat on the bed’
What is the normal range of movement of passive hip internal rotation?
40 degrees
How do you assess passive hip internal rotation?
Flex the hip and knee joint to 90 degrees and rotate their foot laterally
How do you assess passive hip external rotation?
Flex the hip and knee joint to 90 degrees and rotate their foot medially
What is the normal range of movement of passive hip external rotation?
45 degrees
What is the normal range of movement of passive hip abduction?
45 degrees
What is the normal range of movement of passive hip adduction?
30 degrees
What is the normal range of movement of passive hip extension?
10-20 degrees (done in a prone position)
What is Thomas’ test used to assess for?
A fixed flexion deformity (inability for the patient to fully extend their leg)
What does a positive Thomas’ test show?
- The affected thigh has raised off the bed
- Indicates a loss of hip joint extension
- Sugessts a fixed flexion deformity in the affected hip
What is Trendelenburg’s test used for?
Used to screen for hip abductor weakness
What muscles cause hip abductor weakness?
Gluteus medius and minimus
What is a normal result of Trendelenburg’s test?
The pelvis should remain stable or rise slightly on the side of the raised leg
What is an abnormal result of Trendelenburg’s test?
If the pelvis drops on the side of the raised leg
What further assessments/investigations should be completed after hip exam?
- Neurovascular exam of lower limbs
- Examination of lumbar spine and knee joint
- Further imaging
