Hip examination Flashcards
In what general order should you perform the hip examination?
Look: Anterior, lateral, posterior
Feel
Move
Resisted movements
Special tests: Thomas, Trendelenburg
What abnormalities should you look for in the hips of standing patient, from the anterior view?
Scarring
Bruising
Skin discolouration or changes
Pelvic tilt
Leg length discrepancy
Swelling near hip joints
Quadriceps bulk wasting
Hip symmetry
Give 3 common causes of pelvic tilt?
Scoliosis
Hip abductor muscle weakness
Leg length discrepancy
What abnormalities should you look for in the hips of standing patient, from the lateral view, and what is the most important finding?
Most important: Fixed flexion deformity
Scarring
Bruising
Skin discolouration or changes
Swelling near hip joints
Quadriceps bulk wasting
What abnormalities should you look for in the hips of standing patient, from the posterior view, and what are the 3 most important findings?
Most important: Gluteal region and thigh muscle wasting, pelvic tilt, leg discrepancy
Scarring
Bruising
Skin discolouration or changes
Swelling near hip joints
Quadriceps bulk wasting
When the patient is lying supine, what abnormalities should you look for in both hips?
Scarring
Bruising
Skin discolouration or changes
Pelvic tilt
Leg length discrepancy
Swelling near hip joints
Quadriceps bulk wasting
Hip symmetry
When looking at the patient supine, what does a shortened and externally rotated leg indicate?
Neck of femur fracture due to illiopsoas muscle contracting and pulling femur up and out
When the patient is supine, what should you feel first on their hips?
Palpate temperature of each hip joint and compare both
Use back of hands
After feeling temperature of the hip joints, what anatomical structure should you palpate and why?
Palpate greater trochanter for tenderness
Tenderness can indicate greater trochanteric bursitis
After palpating the greater trochanters, what should you examine regarding leg length discrepancy, and what can it indicate?
Apparent and true leg length
Compare each leg, should be the same
Discrepancy can indicate pelvic tilt
How do you measure apparent leg length?
Between the umbilicus and the tip of the medial malleolus
How do you measure true leg length?
Between anterior superior iliac spine and the tip of the medial malleolus
What signs in 3 other joints indicate pelvic tilt?
Higher side: Shoulder drops
Lower side: Knee rotates, Foot arch drops
How do you test active hip flexion?
Ask patient to bring knee as close to chest as possible
(normal angle 120 degrees)
How do you test active hip extension?
Ask patient to straighten leg out so that it is flat on bed
(normal angle 180 degrees)
How do you test passive hip flexion?
support and move patient leg as close to their chest as possible
Keep your hand on the lateral side of hip that is being tested, to stabilise pelvis
How do you test passive hip extension?
Ask patient to lie prone, put one hand on ipsilateral hip and lift ankle with other hand
Normal degrees 10-20
How do you test passive hip internal rotation?
Flex patient hip and knee joints to 90 degrees, rotate foot laterally (out, to side)
(normal angle 40 degrees)
How do you test passive hip external rotation?
Flex patient hip and knee joints to 90 degrees, rotate foot medially (inwards)
(normal angle 45 degrees)
How do you test passive hip abduction?
Hold leg on side that is being assessed, put other hand on contralateral iliac crest to stabilise pelvis, move leg laterally until pelvis starts to lift
(normal angle 45)
How do you test passive hip adduction?
Hold leg on side that is being assessed, put other hand on contralateral iliac crest to stabilise pelvis, move leg medially until pelvis starts to lift
(normal angle 30)
How do you test resisted hip flexion, and what 3 muscles are being tested?
Passively flex hip to 90 degrees then let patient maintain own position, push on distal end of femur and tell patient to resist
Iliopsoas, rectus femoris, sartorius
How do you test resisted hip external rotation, and what 6 muscles are tested?
Passively flex hip to 90 degrees then let patient maintain own position, show the patient external rotation and say that you will try and pull their lower leg outwards so they need to resist
piriformis, obturator internus, obturator externus, gemellus superior, gemellus inferior, and quadratus femoris
How do you test resisted hip internal rotation, and what 2 muscles are tested?
Passively flex hip to 90 degrees then let patient maintain own position, show the patient internal rotation and say that you will try and push their lower leg inwards so they need to resist
Gluteus medius, gluteus minimus
How do you test resisted hip abduction, and what 2 muscles are tested?
Stand at end of bed, position patient’s leg in slight abduction, cup under their ankle and ask patient to push leg into your hand whist you push against them
Gluteus medius and minimus
How do you test resisted hip adduction, and what 5 muscles are tested?
Cup one hand around ankle so that foot points straight at ceiling, use other hand to push outwards on medial aspect of lower leg (abduct) and tell patient to resist
gracilis, pectineus, adductor brevis, adductor longus, adductor magnus
How do you test resisted hip extension, and which 5 muscles are tested?
Patient lying prone
Passively extend leg then ask patient to hold position, put one of your hands on back to stabilise pelvis and erector spinae muscles, use other hand to push down on leg and tell patient to resist
gluteus maximus and the hamstrings (long head of the biceps femoris, the semitendinosus, and the semimembranosus), extensor head of adductor magnus
Which special test can you use to indicate a fixed flexion deformity of the hip?
Thomas’ test: Ask patient to lie flat on back, put your hand under lumbar spine with palm up, flex hip
Positive: affected thigh raises off bed when normal side is flexed
What special test can you use to indicate hip abductor weakness (gluteus medius, minimus)?
Trendelenburg’s test: Ask patient to put their hands on yours, one at a time stand on one leg only
Positive: Pelvis drops on unaffected side
