hip examination Flashcards
what should be done on introduction
introduce yourself
seek consent
expose patient appropriately
ensure pt is comfrotable
ask if pt has any pain
what should be done at ‘look’
symmetry/alignment
deformity
scarring
skin changes
swelling
muscle wasting
what types of alignment/symmetry issues can there be
anterior/posterior pelvic tilt
leg length discrepancy - pelvis may tilt to one side when seen from the front
what type of deformities can be seen
fixed flexion deformity
spinla deformities - kyphosis and scoliosis
how to asses gait
inspect footwear for symmetrical soles or special footwear
assess stride length
gait cycle
gait cadence
pathological features - antalgic gait, foot drop, trendelenburg gait
how to perform the trendelenburg test
stand in front of patient and ask them to place their hands on yours
ask them to lift one leg up by bending at the knee
observe patient for dipping towards the side that they have lifted their leg
may feel more pressure from patients hand in order to balance themselves
tests for contralateral abductor weakness - causes could be abductor weakness or lesions affecting superior gluteal nerve/L5 nerve root
what should be done at ‘feel’
ask person to lay on couch
palpate greater trochanter
palpate ASIS
what should be done at move
ask pt to perform active flexion of their hip
with hip in this position perform passive flexion to determine true range of motion
same position ask pt to perform internal and external rotation
lower leg to neutral and test adduction and abduction
how should pt perform active flexion of the hip and normla ranges
ask them to bring thier knee towards their head whilst lying of the bed
normla range 110-120
normal ranges for internal and external rotation
internal 30-40
external 40-60
normal ranges for adducton and abduction
abduction 30-50
adduction 20-30
what special tests should be performed
assess leg length
perform thomas test
how to assess leg length
make sure ASIS are level and medial malleoli are together
crudely done by looking but can be measured
what is the thomas test and how to perform
assesses for occult, fixed flexion deformity of hip
have pt laid on bed
place hand below lower back
passively flex hip to max degree ensuring lower back is pushed against your hand
observe straight leg to see if hip joint is at 0 degrees or if leg is raised
how to test for neurovascular integrity
test power of muscles distal to hip - knee extension (femoral nerve), ankle dorsiflexion (deep peroneal and branch of common peroneal nerve), ankle plantar flexion (tibial and branch of sciatic nerve)
test sensation distal to hip - anteromedial thigh (femoral nerve), dorsum of foot (common peroneal), plantar surface of foot (tibial nerve)
palpate posterior tibial and dorsalis pedis pulses in the foot
