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Phase 2b Sheffield Medicine > Hip Examination > Flashcards

Hip Examination Flashcards

1
Q

What should you do before starting a hip exam?

A

● Adequately expose the patient’s legs, provide blanket if necessary.
● Position the patient standing for the initial inspection of the lower limbs.
● Ask the patient if they have any pain before proceeding with the clinical examination.

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2
Q

What clinical signs may be observed during a general inspection of the patient during a hip exam?

A

● Body habitus
● Scars
● Wasting of muscles

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3
Q

What may obesity be suggestive of when performing a general inspection during a hip exam?

A

● Obesity is a significant risk factor for joint pathology due to increased mechanical load (e.g. osteoarthritis).

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4
Q

What may scars be suggestive of when performing a general inspection during a hip exam?

A

● May provide clues regarding previous lower limb surgery.

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5
Q

What may wasting of muscles be suggestive of when performing a general inspection during a hip exam?

A

● Suggestive of disuse atrophy secondary to joint pathology or a lower motor neuron injury.

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6
Q

What objects of equipment may be seen around the patient when performing a general inspection in a hip exam?

A

● Walking aids: the ability to walk can be impacted by a wide range of knee, hip and ankle pathology.
● Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications (e.g. analgesia).

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6
Q

What clinical signs would you make note of when performing the anterior inspection during a hip exam?

A

● Scars
● Bruising
● Swelling
● Quadricep wasting
● Leg length discrepancy
● Pelvic tilt

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7
Q

What would scars be suggestive of on anterior inspection during a hip exam?

A

● Note the location of scars as they may provide clues as to the patient’s previous surgical history or indicate previous joint trauma.

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8
Q

What would bruising be suggestive of on anterior inspection during a hip exam?

A

● Suggestive of recent trauma or surgery.

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9
Q

What would swelling be suggestive of on anterior inspection during a hip exam?

A

● Note any evidence of asymmetry in the size of the hip joints that may suggest unilateral swelling (e.g. effusion, inflammatory arthropathy, septic arthritis).

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10
Q

What would quadricep wasting be suggestive of on anterior inspection during a hip exam?

A

● Note any asymmetry in the bulk of the quadriceps muscles which may be due to disuse atrophy or a lower motor neuron lesion.

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11
Q

What would leg length discrepancy be suggestive of, on anterior inspection during a hip exam?

A

● May be congenital or acquired (e.g. fracture, degenerative joint disease, surgical removal of bone, trauma to the epiphyseal endplate prior to skeletal maturity).

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12
Q

What would pelvic tilt be suggestive of on anterior inspection during a hip exam?

A

● Lateral pelvic tilt can be caused by scoliosis, leg length discrepancy or hip abductor weakness.

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13
Q

What clinical signs would you make note of when performing a lateral inspection during a hip exam?

A

● Flexion abnormalities

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14
Q

What would flexion abnormalities be suggestive of on a lateral inspection during a hip exam?

A

● Fixed flexion deformity at the hip joint may suggest the presence of contractures secondary to previous trauma, inflammatory conditions or neurological disease.

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15
Q

What clinical signs would you make note of, when performing a posterior inspection during a hip exam?

A

● Scars
● Muscle wasting

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16
Q

What would scars be suggestive of on posterior inspection during a hip exam?

A

● Again look for scars indicative of previous trauma or surgery.

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17
Q

What would muscle wasting be indicative of on posterior inspection during a hip exam?

A

● Inspect for any asymmetry in the muscle bulk of the posterior compartment of the thigh and the gluteal region suggestive of disuse atrophy or a lower motor neuron lesion.

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18
Q

How would you get the patient to move so you are able to inspect all 4 views of the patient at the hip and lower limb, during a hip exam?

A

● Ask them to turn in 90º increments when prompted.

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19
Q

What would you ask the patient to do when about to observe gait during a hip exam?

A

● Ask the patient to walk to the end of the examination room and then turn and walk back whilst you observe their gait.

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20
Q

What may you note about a patients gait cycle during a hip exam?

A

● Note any abnormalities of the gait cycle (e.g. abnormalities in toe-off or heel strike).

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21
Q

What may you note about range of movement during gait observation in a hip exam?

A

● Often reduced in the context of chronic joint pathology (e.g. osteoarthritis, inflammatory arthritis).

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22
Q

What may limping suggest when assessing a patients gait during a hip exam?

A

● May suggest joint pain (i.e. antalgic gait) or weakness.

23
Q

What may you note about leg length when observing a patients gait during a hip exam?

A

● Note any discrepancy which may be the cause or the result of joint pathology.

24
Q

What may you observe when a patient turns when observing gait in a hip exam?

A

● Patients with joint disease may turn slowly due to restrictions in joint range of movement or instability.

25
Q

What is Trendelengurg’s gait?

A

● An abnormal gait caused by unilateral weakness of the hip abductor muscles secondary to a superior gluteal nerve lesion or L5 radiculopathy.

26
Q

What is Waddling gait?

A

● An abnormal gait caused by bilateral weakness of the hip abductor muscles, typically associated with myopathies (e.g. muscular dystrophy).

27
Q

Why may you assess the patients footwear during gait observation in a hip exam?

A

● Unequal sole wearing is suggestive of an abnormal gait.

28
Q

After you have assessed gate what is the next step in a hip exam?

A

● Inspection with the patient lying on the bed

29
Q

What topics would you make note of when inspecting a patient lying on the bed during a hip exam?

A

● Scars
● Swelling
● Bruising
● Quadriceps wasting
● Hip joint asymmetry
● Fixed flexion deformity

30
Q

What areas should you palpate for temperature during a hip exam?

A

● Assess and compare hip joint temperature using the back of your hands.

31
Q

What would increased joint temperature indicate during a hip exam?

A

● Increased temperature of a joint, particularly if also associated with swelling and tenderness may indicate septic or inflammatory arthritis.

32
Q

Where should you palpate during a hip exam?

A

● Palpate the greater trochanter of each leg for evidence of tenderness, which may suggest trochanteric bursitis.

33
Q

How would you assess apparent apparent leg length discrepancy during a hip exam?

A

● To assess apparent leg length, measure and compare the distance between the umbilicus and the tip of the medial malleolus of each limb.

34
Q

How would you assess true leg length discrepancy during a hip exam?

A

● To assess true leg length, measure from the anterior superior iliac spine to the tip of the medial malleolus of each limb.

35
Q

What is the difference between apparent and true leg length discrepancy?

A

● Apparent discrepancy - a leg appears shorter secondary to lateral pelvic tilt
● True discrepancy - a leg is truly shorter than the contralateral side

36
Q

If a patient has a known issue with a particular leg, which leg should be assessed first in a hip exam?

A

● The ‘normal’ leg

37
Q

What is active movement?

A

● Active movement refers to a movement performed independently by the patient.

38
Q

What active movements should you get a patient to carry out during a hip exam?

A

● Active hip flexion
● Active hip extension

39
Q

What is a normal range of movement for active hip flexion and extension?

A

● 120°
● 180° - patient should be able to lie their leg flat upon the bed

40
Q

How would you instruct a patient to perform active hip flexion during a hip exam?

A

● Ask the patient to flex their hip as far as they are able – “Bring your knee as close to your chest as you can.”

41
Q

How would you instruct a patient to perform active hip extension during a hip exam?

A

● Ask the patient to extend their leg, so that it is flat on the bed – “Straighten your leg out so that it is flat on the bed.”

42
Q

What is passive movement?

A

● Passive movement refers to a movement of the patient, controlled by the examiner.

43
Q

What is the normal range of movement for passive hip flexion and how would you perform this movement during a hip exam?

A

● 120°
● Whilst supporting the patient’s leg, flex the hip as far as you are able, making sure to observe for signs of discomfort.

44
Q

What is the normal range of movement for passive hip internal rotation and how would you perform this movement during a hip exam?

A

● 40°
● Flex the patient’s hip and knee joint to 90° and then rotate their foot laterally.

45
Q

What is the normal range of movement for passive hip external rotation and how would you perform this movement during a hip exam?

A

● 45°
● Flex the patient’s hip and knee joint to 90° and then rotate their foot medially.

46
Q

What is the normal range of movement for passive hip abduction and how would you perform this movement during a hip exam?

A

● 45°

  1. With the patient’s legs straight and flat on the bed, use one of your hands to hold the ankle of the hip being assessed and place your other hand over the contralateral iliac crest to stabilise the pelvis.
  2. Move the patient’s ankle laterally to abduct the hip until the pelvis begins to tilt.
47
Q

What is the normal range of movement for passive hip adduction and how would you perform this movement during a hip exam?

A

● 30°

  1. With the patient’s legs straight and flat on the bed, use one of your hands to hold the ankle of the hip being assessed and place your other hand over the contralateral iliac crest to stabilise the pelvis.
  2. Move the patient’s ankle medially to adduct the hip until the pelvis begins to tilt.
48
Q

What is the normal range of movement for passive hip extension and how would you perform this movement during a hip exam?

A

● 10-20°

  1. Ask the patient to lie in a prone position.
  2. Use one hand to hold the ankle of the leg being assessed and place the other hand on the ipsilateral pelvis.
  3. Lift the leg to extend the hip joint and assess the range of hip joint extension.
49
Q

What is Thomas’s test used to assess?

A

● Thomas’s test is used to assess for a fixed flexion deformity (i.e. an inability for the patient to fully extend their leg).

50
Q

How would you perform Thomas’s test during a hip exam?

A
  1. 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).
  2. Passively flex the hip of the unaffected leg as far as you are able to and observe the contralateral limb.
  3. Repeat the assessment on the contralateral hip.
51
Q

What would a positive Thomas’s test indicate during a hip exam?

A

● 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.

52
Q

When should you NOT perform Thomas’s test on a patient?

A

● This test should not be performed on patients who have had a hip replacement as it can cause dislocation.

53
Q

What is Trendelenburg’s test used to assess?

A

● Trendelenburg’s test is used to screen for hip abductor weakness (gluteus medius and minimus).

54
Q

How would you perform Trendelenburg’s test during a hip exam?

A
  1. With the patient upright, stand in front of them and ask them to place their hands on your forearms or shoulders for stability.
  2. Position your fingers on each side of the patient’s pelvis at the iliac crest.
  3. Ask the patient to stand on one leg and observe your fingers for evidence of lateral pelvic tilt.
  4. Repeat the assessment with the patient standing on the other leg.
55
Q

What would a normal and abnormal finding be with Trendelenburg’s test and what would it indicate during a hip exam?

A

● If the patient’s hip abductors are functioning normally the pelvis should remain stable or rise slightly on the side of the raised leg.

● If the pelvis drops on the side of the raised leg it suggests contralateral hip abductor weakness (this is known as Trendelenburg’s sign).

56
Q

What further assessments and investigations could be performed after the conclusion of a hip exam?

A

● 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).

Phase 2b Sheffield Medicine (17 decks)

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