Musculoskeletal - Hips

Question 1

General clinical signs + objects/equipment on general inspection

Answer 1

Body habitus, scars, muscle wasting
Walking aids, prescriptions

Question 2

Clinical signs on anterior, lateral, and posterior inspection

Answer 2

Anterior
- Scars, bruising, swelling
- Quad wasting
- Leg length discrepancy
- Pelvic tilt
Lateral
- fixed flexion
Posterior
- scars
- muscle wasting (glutes/hamstrings)

Question 3

Components of gait to observe

Answer 3

Gait cycle
Range of movement
Limping
Leg length
Turning
Trendelenburg’s gait* (unilateral hip abductor weakness)
Waddling gait (bilateral hip abductor weakness)
Assess footwear

Question 4

Trendelenburg’s gait?

Answer 4

Abnormal gait due to unilateral weakness of hip abductor muscles (superior gluteal nerve lesion or L5 radiculopathy)
- hip drops towards the contralateral side (Trendelenburg’s sign)

Question 5

Apparent + true leg length measurements

Answer 5

Apparent = measure from umbilicus to each medial malleolus
True = measure from each ASIS to medial malleolus

Question 6

Thomas’s test technique

Answer 6

Hand under lumbar spine, passively flex the unaffected leg as far as it will go + observe contralateral limb. Repeat on other side.

Positive if affected thigh raises off bed = loss of hip extension.
Don’t perform on pts with hip replacements = dislocation

Question 7

Trendelenburg’s test

Answer 7

Stand patient, place fingers on each iliac crest, ask pt to stand on one leg and observe fingers for movement, repeat on other leg

Positive if pelvis drops on the side of the RAISED leg = contralateral hip abductor weakness