Hip examination

Question 1

In the hip examination, what do we GENERALLY INSPECT?

Answer 1

Surrounding area:
Walking aids
Specialist shoes

Patient:
Signs of pain
Systemically well
Body habitus

Question 2

In the hip examination, what do we LOOK for?

Answer 2

Gait:
Antalgic
Trendelenburg's 
Waddling
Stiff hip
Foot drop

Inspection:
Overall alignment and willingness to weight bear
Symmetry
Deformity - alignment of pelvis and spine: scoliosis? excessive lumbar lordosis (fixed flexion deformity)? knee flexion (compensation for FFD)? abnormal arch? look at feet for hip rotation
Scars - arthroplasty? hip replacement?
Wasting - quadriceps? gluteals?
Swelling - effusion? inflammation? bursitis?
Skin changes - erythema? bruising?

Question 3

In the hip examination, what do we FEEL for?

Answer 3

Tenderness in:
Greater trochanter - trochanteric bursitis
ASIS
Mid-point of inguinal ligament

Question 4

In the hip examination, what MOVEMENT do we assess?

Answer 4

Active hip flexion
Passive hip flexion

Internal and external passive hip rotation

Passive hip abduction and adduction

Question 5

In the hip examination, what SPECIAL TESTS do we perform?

Answer 5

Leg length (informally)

If leg length discrepancy, then formally measure apparent and true leg length

Trendelenburg’s test

Thomas test

Question 6

In the hip examination, what JOINT ABOVE do we test?

Answer 6

Spine:

Straight leg raise

Question 7

In the hip examination, what NEUROVASCULATOR do we test?

Answer 7

Power:
Quadriceps (knee extension) - femoral nerve
Toe extension - common peroneal nerve
Plantarflexion - tibial nerve

Sensation:
Anteriomedial thigh - femoral nerve
Dorsum of foot - common peroneal nerve
Sole of foot - tibial nerve

Vascular:
Posterior tibialis & dorsalis pedis