Hip examination

Question 1

What do you look for when inspecting from the front?

Answer 1

Scars
Pelvic tilt
Quadriceps wasting

Question 2

What can cause lateral pelvic tilt? (3)

Answer 2

scoliosis
leg length discrepancy
hip ABductor weakness

Question 3

What do you look for when inspecting from the side?

Answer 3

Lumbar lordosis
Knee flexion
Foot arches

Question 4

What do you look for when inspecting from behind?

Answer 4

Scars

Muscle wasting

Question 5

What do you look for on gait?

Answer 5

1. Gait cycle
2. Limping
3. Turning

Question 6

What are the 5 stages of the gait cycle?

Answer 6

1. Heel strike
2. Foot flat
3. Mid-distance
4. Heel-off
5. Toe-off
   (also check arm swing)

Question 7

What is the difference between a trendelenburg’s and waddling gait?

Answer 7

Trendelenburg’s gait = unilateral hip ABductor weakness

Waddling gait = bilateral hip ABductr weakness

Question 8

If a patient has pain over the greater trochanter what does this suggest?

Answer 8

Trochanteric bursitis

Question 9

How do you measure apparent leg length?

Answer 9

Umbilicus to tip of medial malleolus

Xiphisternum to tip of medial malleolus

Question 10

How do you measure true leg length?

Answer 10

ASIS to tip of the medial malleolus

Question 11

What do you say to the patient to check active hip flexion?

Answer 11

Bring your knee as close to your chest as possible

Question 12

What is the normal ROM of active hip flexion?

Answer 12

120 degrees

Question 13

What do you say to the patient to check active hip extension?

Answer 13

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

Question 14

What is the normal ROM of active hip extension?

Answer 14

180 degrees

Question 15

What is the normal ROM in PASSIVE hip flexion?

Answer 15

120 degrees

Question 16

What is the normal ROM in PASSIVE hip internal rotation?

Answer 16

40 degrees

Question 17

What is the normal ROM in PASSIVE hip external rotation?

Answer 17

45 degrees

Question 18

What is the normal ROM of PASSIVE hip ABduction?

Answer 18

45 degrees

Question 19

What is the normal ROM of PASSIVE hip ADduction?

Answer 19

30 degrees

Question 20

What is the normal ROM of PASSIVE hip extension?

Answer 20

10-20 degrees

Question 21

What are the special tests in hip exam?

Answer 21

Thomas’s test

Trendelenburg’s test

Question 22

What does Thomas’s test assess for?

Answer 22

Fixed flexion deformity

Question 23

In which patients should Thomas’s test not be performed on and why?

Answer 23

Those with hip replacement as it can cause dislocation

Question 24

What does Trendelenburg’s test assess for?

Answer 24

Hip abductor weakness (gluteus medius and minimus)

Question 25

What further assessments do you do to complete a hip exam?

Answer 25

1. Neurovascular examination of both lower limbs 2. Examination of the joints above (lumbar spine) 3. Examination of the joint below (knee joint) 4. Further imaging if indicated (X-ray and MRI)