Hip Examination

Question 1

What may cause quadriceps wasting in a hip exam?

Answer 1

• Disuse atrophy

- LMN lesion

Question 2

What may cause leg length discrepancy in a hip exam?

Answer 2

May be congenital or acquired

Question 3

What may cause pelvic tilt in a hip exam?

Answer 3

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

Question 4

What may cause flexion abnormalities in a hip exam?

Answer 4

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

Question 5

What may cause Trendelenburg’s gait?

Answer 5

Unilateral weakness of the hip abductor muscles secondary to a superior gluteal nerve lesion or L5 radiculopathy

Question 6

What may cause a waddling gait?

Answer 6

An abnormal gait caused by bilateral weakness of the hip abductor muscles, typically associated with myopathies

Question 7

Why do you palpate the hip joint?

Answer 7

• Palpate the greater trochanter for tenderness

- May suggest trochanteric bursitis

Question 8

What are the two things to assess in a leg length assessment?

Answer 8

Apparent leg length & true leg length

Question 9

How do you assess an apparent leg length?

Answer 9

Measure and compare the distance between the umbilicus and the tip of the medial malleolus

Question 10

How do you assess a true leg length?

Answer 10

Measure from the anterior superior iliac spine to the tip of the medial malleolus

Question 11

What is the normal range of movement of hip flexion?

Answer 11

120 degrees

Question 12

How do you assess active hip flexion?

Answer 12

‘Bring your knee as close to your chest as you can’

Question 13

What is the normal range of movement of active hip extension?

Answer 13

180 degrees (leg is lying flat)

Question 14

How do you assess active hip extension?

Answer 14

‘Straighten your leg out so that it is flat on the bed’

Question 15

What is the normal range of movement of passive hip internal rotation?

Answer 15

40 degrees

Question 16

How do you assess passive hip internal rotation?

Answer 16

Flex the hip and knee joint to 90 degrees and rotate their foot laterally

Question 17

How do you assess passive hip external rotation?

Answer 17

Flex the hip and knee joint to 90 degrees and rotate their foot medially

Question 18

What is the normal range of movement of passive hip external rotation?

Answer 18

45 degrees

Question 19

What is the normal range of movement of passive hip abduction?

Answer 19

45 degrees

Question 20

What is the normal range of movement of passive hip adduction?

Answer 20

30 degrees

Question 21

What is the normal range of movement of passive hip extension?

Answer 21

10-20 degrees (done in a prone position)

Question 22

What is Thomas’ test used to assess for?

Answer 22

A fixed flexion deformity (inability for the patient to fully extend their leg)

Question 23

What does a positive Thomas’ test show?

Answer 23

• The affected thigh has raised off the bed
• Indicates a loss of hip joint extension
• Sugessts a fixed flexion deformity in the affected hip

Question 24

What is Trendelenburg’s test used for?

Answer 24

Used to screen for hip abductor weakness

Question 25

What muscles cause hip abductor weakness?

Answer 25

Gluteus medius and minimus

Question 26

What is a normal result of Trendelenburg’s test?

Answer 26

The pelvis should remain stable or rise slightly on the side of the raised leg

Question 27

What is an abnormal result of Trendelenburg’s test?

Answer 27

If the pelvis drops on the side of the raised leg

Question 28

What further assessments/investigations should be completed after hip exam?

Answer 28

• Neurovascular exam of lower limbs
• Examination of lumbar spine and knee joint
• Further imaging