Hip Examination Flashcards
What can cause quadricep wasting?
Quadriceps wasting: note any asymmetry in the bulk of the quadriceps muscles which may be due to disuse atrophy or a lower motor neuron lesion.
What can cause leg length discrepancy?
Leg length discrepancy: may be congenital or acquired (e.g. fracture, degenerative joint disease, surgical removal of bone, trauma to the epiphyseal endplate prior to skeletal maturity).
Describe trendelenburg and waddling gait and explain their underlying causes
Trendelenburg’s gait and waddling gait
During the leg lift and swing phase of the gait cycle, all of the body’s weight is placed on the limb that is still in contact with the ground. In this phase, the hip abductor muscles (gluteus medius and minimus) on the opposite side to the raised leg contract to prevent the pelvis from dropping on the side of the raised leg.
If a patient has unilateral hip abductor weakness, the pelvis will drop toward the contralateral side when the leg on that side leaves the ground (i.e. if there is left hip abductor weakness, the pelvis will drop towards the right whenever the right foot is lifted off the ground). It’s important to remember that the pelvis falls on the contralateral side to the weakness. This sagging of the pelvis secondary to hip abductor weakness is known as Trendelenburg’s sign. Unilateral hip abductor weakness is typically caused by a superior gluteal nerve lesion or L5 radiculopathy.
Trendelenburg’s gait refers to the gait in an individual with unilateral hip abductor weakness, which is typically described as ‘lurching’ in nature. As the pelvis sags towards the unaffected side, the trunk lurches towards the opposite side in an effort to maintain balance.
If an individual has bilateral hip abductor weakness, they typically present with a waddling gait, caused by the overuse of circumduction to compensate for gluteal weakness. Bilateral hip abductor weakness is typically associated with myopathies (e.g. muscular dystrophy).
What can cause tenderness at the greater trochanter?
trochanteric bursitis.
Describe Thomas’s test
Thomas’s test
Thomas’s test is used to assess for a fixed flexion deformity (i.e. an inability for the patient to fully extend their leg).
- With the patient positioned flat on the bed, place a hand below their lumbar spine with your palm facing upwards (this helps to prevent the patient from masking a fixed flexion deformity by increasing lumbar lordosis).
- Passively flex the hip of the unaffected leg as far as you are able to and observe the contralateral limb.
- Repeat the assessment on the contralateral hip.
Interpretation
The test is positive (abnormal) if the affected thigh raises off the bed, indicating a loss of hip joint extension. This would suggest a fixed flexion deformity in the affected hip.
This test should not be performed on patients who have had a hip replacement as it can cause dislocation.
Describe trendelenburg’s test
Thomas’s test
Thomas’s test is used to assess for a fixed flexion deformity (i.e. an inability for the patient to fully extend their leg).
- With the patient positioned flat on the bed, place a hand below their lumbar spine with your palm facing upwards (this helps to prevent the patient from masking a fixed flexion deformity by increasing lumbar lordosis).
- Passively flex the hip of the unaffected leg as far as you are able to and observe the contralateral limb.
- Repeat the assessment on the contralateral hip.
Interpretation
The test is positive (abnormal) if the affected thigh raises off the bed, indicating a loss of hip joint extension. This would suggest a fixed flexion deformity in the affected hip.
This test should not be performed on patients who have had a hip replacement as it can cause dislocation.
What further investigations/examinations will you do?
Neurovascular examination of both lower limbs.
Examination of the joints above and below (lumbar spine and knee joint).
Further imaging if indicated (e.g. X-ray and MRI).
