Hip Examination Flashcards
State the 9 stages of the hip examination
- Introduction
- General inspection
- Gait
- Closer inspection (including lying down inspection)
- Feel
- Move
- Special tests
- Neurovascular assessment
- Completing the examination
What should you do in the introduction stage of your hip examination?
- Wash hands
- Introduce yourself
- Gain consent
- Ask if would like a chaperone
- Ask if any pain
- Expose
What should you do in the general inspection stage of your hip examination?
General inspection of pt
- Body habitus
- Scars
- Wasting of muscles
Inspection of surroundings
- Walking aids
- Prescriptions
What should you do in the gait stage of your hip examination?
Ask pt to walk to end of room, turn around and walk back. Asssess for:
- Gait cyce
- Range of movement
- Limping
- Leg length
- Turning
- Any specific gait e..g trendelenburg, waddling giat
What should you do in the closer inspection stage of your hip examination?
Inspect all aspects of hip by asking pt to turn in 90 degree increments:
- Anterior: scars, bruising, swelling, quads wasting, leg length discrepancy, pelvic tilt, sinuses
- Lateral: flexion abnormalities, sinuses
- Posterior: scars, muscle wasting, sinuses
Then ask pt to lay on bed and inspect hip joints once more or abnormalities listed above.
What should you do in the feel stage of your hip examination?
- Temperature of hip joints
- Palpation of greter trochanter
- Le
How do you differentiate between apparent and true leg length?
- Apparent: distance between umbilicus and tip of medial malleolus
- True: ASIS to tip of medial malleolus
What should you do in the move stage of your hip examination?
- Active movement
- Hip flexion
- Hip extension
- Passive movement
- Hip flexion
- Hip internal rotation
- Hip external rotation
- Hip abduction
- Hip adduction
- Hip extension
Explain how you will ask the pt to demonstrat active hip flexion and extension
- Hip flexion: place your hand under lumbar spine to detect any masking of restricted hip movement by pelvis & lumbar spine. Ask pt to bring their knee as close to their chest as they can
- Hip extension: ask pt to straighten their leg out so it is flat on the bed
Explain how you will elicit the following passive movements in the hip examination:
- Hip flexion
- Hip internal rotation
- Hip external rotation
- Hip abduction
- Hip adduction
- Hip extension
- Hip flexion: support pts leg and flex hip as far as yo are able to looking for signs of discomfort
- Hip internal rotation: flex hip & knee to 90 degrees then rotate their foot laterally
- Hip external rotation: flex hip & knee to 90 degrees then rotate their foot medially
- Hip abduction: with pts leg stragiht and flat on bed use one hand to hold ankle of hip being assessed and place other hand over contralateral iliac crest to stabilise pelvis; mvoe pts ankle laterally to abduct hip until pelvis begins to tilt
- Hip adduction: with pts leg straight and flat on bed use one hand to hold ankle being assessed and place other hand over contralateral iliac crest to stabilise pelvis. Move pts ankle medially to adduct hip until pelvis begins to tilt
- Hip extension: ask pt to lie in prone position, use one hand to hold ankle of limb being assessed and place other hand on ipsilateral pelvis. Lift leg to extend hip joint and assess range of hip extension
What should you do in the special tests stage of your hip examination?
- Thomas’s test (used to assess for fixed flexion deformity)
- Trendelenburg’s test (used to assess for hip abductor weakness)
Describe how to do the Thomas’s test
- Pt position flat on bed
- Place a hand below their lumbar spine with palm facing upwards (helps prevent a pt maskign fixed flexion deformity by increasing lumbar lordosis)
- Passively flex teh hip of the unaffected leg as far as you are able to and observe the contralateral limb
- Test is positive if the affected thigh raises off teh bed indicating loss of exension in hip- suggesting a fixed flexion deformity
Who should the Thomas test not be performed in?
Pts who have had hip replacement as causes dislocation
Describe how to do the Trendelenburg test
- Pt standing upright
- Stand in front of them
- Ask them to place hands on your forearms or shoulders for stability
- Position your fingers each side of the pts pevlic at iliac crest
- Ask pt to stand on one leg and observe your fingers for lateral pelvic tilt
- Repeat with pt standing on other leg
- If hip abductors normal pelvis should remain stable or slightly raised on side of raised leg
- If pevis drops on side of the raised leg it suggests contralateral hip abductor weakness
What should you do in the neurovascular assessment stage of your hip examination?
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What should you do in the completing your examination stage of your hip examination
- Thank pt
- Dispose of PPE
- Wash hands
- Summarise
- Further assessment & investigations:
- Neurovascular examination of both limbs
- Examination of lumbar spine and knee joint
- Further imaging e.g. x-ray
