Musculoskeletal (Hip)

Question 1

What should you look for on inspection of a standing patient?

Answer 1

Inspect stance
Inspect from the front - pelvic tilt, joint deformity, wasting of quadriceps
Inspect from the side - lumbar lordosis (exaggerated may indicate flexion deformity of hip)
Inspect from the back - wasting of gluteals, scoliosis

Question 2

What should you look for on inspection of a supine patient?

Answer 2

Scars, wasting, skin changes

Symmetry - ‘apparent’ leg length by xiphisternum to medial malleolus; ‘true’ leg length by ASIS to medial malleolus

Question 3

How do you assess a leg length discrepancy?

Answer 3

Position patient with knees bent ant right angle and heels flat on bed
Inspect from the side
Place hand across both tibial tuberosities - femoral shortening then hand will dip to affected side
Place hand across suprapatella regions - tibial shortening then hand will dip to affected side

Question 4

What are you looking for on palpation?

Answer 4

Ask if patient has pain/tenderness in hips
Asses temperature of bones and joints
Palpate the greater trochanter for bursitis

Question 5

How do you assess the range of motion?

Answer 5

Check active range of motion - flex/abd/add of hips
Check same motions but passive (if necessary) + internal/external rotation with hips/knee extended then flexed)
Can check hip extension when patient is standing

Question 6

What special tests are there?

Answer 6

Thomas’s test - test for fixed flexion deformity of contralateral hip by flexing ipsilateral hip fully
Trendelenburg’s test - ask patient to stand on one leg to assess the abductor muscle strength of that hip - normal test, hips will remain level; positive test, hips will dip on contralateral side
Gait assessment - waddling = hip pain, proximal muscle weakness; antalgic = pain on weight bearing

Question 7

How do you complete the test?

Answer 7

Examine lumbar spine and ipsilateral knee joint

Perform neurovascular assessment of patients lower limb (or state in OSCE)