Hip Examination

Introduction0/7

• Greetings
• Hand wash
• Verify the patient's identity using at least two or three details
• Explanation
• Consent
• Asking if there are any pain
• Asking for dominant footConsider asking which side is the patient's kicking foot if they are a sportsperson

Inspection0/11

• Exposing both legs
• Inspect while standingCheck for general lower leg alignment, scars or sinuses, asymmetry between sides
• Gait
  • AntalgicIndicative of pain
  • Short-leg
  • Abductor weakness ( Trendelenberg )Patient cannot keep the opposite hip 'up' when standing on the affected leg. Caused by weakness of the standing leg's gluteus medius.
• Ask the patient to lie supine
  • Comment on positione.g., shortened and externally rotated (unopposed iliopsoas) in #NOF
• Leg lengthA leg may look short without actually being short e.g. A person with a fixed adduction of the right hip had to hitch up his pelvis in order to uncross his legs making the right leg appear shorter
  • ApparentMeasure from umbilicus to medial malleolus
  • RealMeasure from ASIS on same side to medial malleolus

Palpations and look for tenderness0/8

• Iliac crest
• ASIS
• AIIS
• GT
• Pubic symphysis
• Ischial tuberosity
• Warmth/TemperatureUse back of hands and compare sides
• Soft tissue contours

Movements0/16

• Active
  • AdductionNormal range: 30 deg. Cross one limb over the other and observe the point when the pelvis starts to tilt
  • AbductionNormal range: 45 deg. Ensure ASISs are level, fix pelvis by stabilising opposite iliac crest
  • FlexionNormal range: 130 deg
  • ExtensionNormal range: 10 deg. Performed in prone position
  • IRNormal range: 40 deg. Test in neutral and 90 deg flexion. Rotate internally watching patellae
  • ERNormal range: 50 deg. Test in neutral and 90 deg flexion. Rotate externally watching patellae
• Passive
  • Adduction
  • Abduction
  • Flexion
  • Extension
  • IR (Lift legs by ankles and rotate internally watching patellae)
  • ER (Lift legs by ankles and rotate externally watching patellae)
  • FABERFlexion, abduction, external rotation
  • FADIRFlexion, adduction, internal rotation (anterior impingement/quadrant test)

• Adductor squeeze testExaminer places fist between knees at 60 degrees hip and knee flexion and patient adducts bilaterally against the fist (suggestive of osteitis pubis if positive)
• Trendelenburg testPatient stands unassisted on each leg in turn and lifts the other leg by bending the knee. Normally the weight-bearing hip is held stable by the abductors and the pelvis rises on the unsupported side; if the hip is unstable or very painful the pelvis drops on the unsupported side. Positive Trendelenburg seen with hip subluxation/dislocation, hip abductor weakness, shortening of femoral neck
• Thomas' testUsed to unmask fixed flexion deformity hidden by excessive lumbar lordosis. Both hips are flexed simultaneously to their limit and holding the non-test knee in this position the test limb is lowered gently. If there is a flexion deformity at the hip the knee will not rest on the couch
• Wash hands