Hip Examination

Question 1

What should you look for on general inspection?

Answer 1

General signs of discomfort

Orthoses, walking aids

Signs of fever (sweating, flushed skin, shivering) - bone and joint infections

Rapid weight loss (associated with metastatic bone and soft tissue tumours)

Signs of rheumatoid arthritis (hand and finger deformities)

Skin rashes (psoriasis)

Question 2

What should you look for on inspection of both hips from front, side and back (patient standing)?

Answer 2

Mal-alignment of legs

Wasting of gluteal muscle bulk

Swelling, redness, deformity or scars around the hips

Question 3

What does palpation of the hip involve?

Answer 3

Ask if they are currently in pain

Feel the greater trochanter (will detect inflammation of the overlying bursa (trochantertic bursitis or greater trochanteric pain syndrome)

Feel the temperature

Question 4

What is crepitus of the hip joint a sign of?

Answer 4

Degenerative joint disease

Question 5

What movements in the hip do you need to test?

Answer 5

Flexion

Abduction/ adduction

Internal/ external rotation

Extension

Question 6

What does Thomas Test check for?

Answer 6

Flexion contracture of the hip seen in arthritis and in neuromuscular disorders

Question 7

How do you measure apparent limb length?

Answer 7

Distance from the umbilicus to the medial malleolus

Question 8

How do you measure true limb length?

Answer 8

Distance from ASIS to medial malleolus

Question 9

What is a positive Trendelenburg Sign?

Answer 9

If standing on one leg, the pelvis drips to the side opposite to the standing leg

Question 10

What might a positive Trendelenburg Sign indicate?

Answer 10

Weakness of hip abductors on the side of the stance leg

Question 11

For completeness, what else should you offer?

Answer 11

Examination of the lumbar spine

Examination of the knee

Examination of the lower limbs neurologically

Examination of gait

Examination of contralateral hip