Hip Examination

Question 1

1. General Inspection

Answer 1

Walking aids
Specialist shoes
Signs of pain
Body habitus 
Systemically well

Question 2

2. Look

Answer 2

General look on walking, willingness to weight bear
Gait
Alignment/deformity
Skin changes
Wasting 
Swelling

Question 3

3. Gait

Answer 3

Antalgic, trendelenberg, foot drop, stiff hip

Question 4

4. Alignment/deformity

Answer 4

Alignment of pelvis
Spine: 
Fixed flexion deformity - lumbar lordosis, knee flexion
Scoliosis
Hip rotationj(feet)

Question 5

5. Skin changes

Answer 5

Scars (arthroscopy, hip replacement)
Erythema
Bruising
Nodules

Question 6

6. Wasting

Answer 6

Quadriceps
Gluteal mucscles

Good muscle bulk?

Question 7

7. Swelling

Answer 7

Effusion
Inflammation
Bursitis

Question 8

8. Trendelenberg Test

Answer 8

Test leg is standing leg
Positive = drop in hip of lifted leg

Causes:
Pain - inhibition of movement
Nerve damage (superior gluteal)
Muscle wasting disease

Question 9

9. Leg length

Answer 9

Apparent - midline to medial malleolus
True - ASIS to medial malleolus

No discrepancy if malleoli meet level

If both are different - bone difference
If only apparent is different - pelvic deformity

Question 10

10. Feel

Answer 10

Temperature
Greater trochanter
ASIS
Along inguinal ligament

Question 11

11. Move

Answer 11

Flexion: Active - knee to chest, passive - gently take hip further
ABduction - passive (place forearm across asis)
ADduction
Internal/external rotation - hip and knee 90° flexion

Question 12

12. Special Tests

Answer 12

Thomas’s Test
Test for fixed flexion deformity of opposite hip
Positive = hip comes off bed (tightening or shortening of hip flexors -OA)

Question 13

13. Joint Above

Answer 13

Lumbar Spine - Straight Leg Raise
Normal = >60° without pain
Pain =spine examination

Question 14

14. Neurovascular

Answer 14

Dorsalis pedis, posterior tibial
Common peroneal - toes towards you, top of foot
Tibial - plantar flexion, bottom of foot
Femoral - knee extension, quadriceps