Hip exam

Question 1

What are you looking for on inspection in a hip exam?

Answer 1

From the front, sides, and back:
- scars
- muscle wasting
- bruising
- leg length discrepancy
- pelvic tilt
- flexion abnormalities

Question 2

What are you looking for in the patient’s gait in a hip exam?

Answer 2

• Abnormalities in gait cycle
• Reduced range of movement
• Limping (antalgic gait)
• Difficulty turning
• Trendelenburg’s gait
• Waddling gait

Question 3

How do you palpate the hip joint in a hip exam?

Answer 3

• Ask the patient if they have any pain in their hips
• Compare the temperature of each hip joint (for septic arthritis)
• Palpate the greater trochanter (tender = trochanteric bursitis)

Question 4

How do you perform Trendelenburg’s test?

Answer 4

• ask the patient to stand in front of you with their hand on your shoulders for stability
• place a finger on each iliac crest and ask them to stand on one leg
• observe any lateral tilt (contralateral hip abductor weakness)

Question 5

How do you assess the range of movement in a hip exam?

Answer 5

Active (patient moves independently):
- flexion (120)
- extension (180)
- abduction (45)
- adduction (25)
Passive (move for patient):
- as above
- internal rotation (40)
- external rotation (30)
- extension when lying prone (15)

Question 6

What are the special test needed in a hip exam?

Answer 6

Thomas’s test:
- place your hand under their lumbar spine
- passively flex one hip as far as possible
- in a fixed flexion deformity the other leg will lift of the bed
Leg length assessment:
- measure the apparent leg length form the umbilicus to the medial malleolus
- measure the true leg length from the ASIS to the medial malleolus

Question 7

How do you complete a hip exam?

Answer 7

• Examine the lumbar spine and knee joint
• Perform a neurovascular examination of the lower limbs