Hip examination Flashcards
(22 cards)
How to complete hip examination?
Examine spine and knees
Neurovascular examination of LL
Review any available imaging
Hip examination special tests?
Trendelenburg’s test
Thomas’s test
How to perform Trendelenburg’s test and why?
Trendelenburg’s test is used to screen for hip abductor weakness (gluteus medius and minimus).
- With the patient upright, stand in front of them and ask them to place their hands on your forearms or shoulders for stability.
- Position your fingers on each side of the patient’s pelvis at the iliac crest.
- Ask the patient to stand on one leg and observe your fingers for evidence of lateral pelvic tilt.
- Repeat the assessment with the patient standing on the other leg.
Positive Trendelenburg’s test?
If the patient’s hip abductors are functioning normally the pelvis should remain stable or rise slightly on the side of the raised leg.
If the pelvis drops on the side of the raised leg it suggests contralateral hip abductor weakness (this is known as Trendelenburg’s sign).
How to perform Thomas’s test and why?
Thomas’s test is used to assess for a fixed flexion deformity (i.e. an inability for the patient to fully extend their leg).
- With the patient positioned flat on the bed, place a hand below their lumbar spine with your palm facing upwards (this helps to prevent the patient from masking a fixed flexion deformity by increasing lumbar lordosis).
- Passively flex the hip of the unaffected leg as far as you are able to and observe the contralateral limb.
- Repeat the assessment on the contralateral hip.
Results of Thomas’s test?
The test is positive (abnormal) if the affected thigh raises off the bed, indicating a loss of hip joint extension. This would suggest a fixed flexion deformity in the affected hip.
This test should not be performed on patients who have had a hip replacement as it can cause dislocation.
LOOK aspect of hip examination?
Observe gait cycle - assess symmetery or turning, note signs of discomfort
FRONT: scars, pelvic tilt, quadriceps wasting
SIDE: lumbar lordosis, knee flexion, foot arches
BACK: scoliosis, iliac crest alignment, gluteal muscle bulk
FEEL aspect of hip examination
Palpate greater trochanter - tenderness ?trochanteric bursitis
Measure - umbilicus to medial maleous
Compare joint temperature
Normal range of motion of hip flexion
120
MOVE aspect of hip
- Active flexion
- Passive flexion
- Passive internal rotation (hold foot, move leg out)
- Passive external rotation
- Passive hip abduction
- Passive hip adduction
TURN PRONE - Passive hip flexion
Normal range of hip internal rotation
40 degrees
Normal range of hip external rotation
45 degrees
Normal ROM for hip adduction
30 degrees
Normal ROM abduction
45 degrees
Hip extension ROM
10 to 20 degrees
What does a positive Thomas’ test suggest?
Loss of extension in hip
Fixed flexion deformity
What should you ask for, in addition to pain and consent, before moving the patient’s hip?
Ask if the patient has had a hip replacement (if so internal rotation, adduction and flexion greater than 90° should be avoided due to the risk of joint dislocation).
Causes of leg length discrepancy?
Leg length discrepancy: may be congenital or acquired (e.g. fracture, degenerative joint disease, surgical removal of bone, trauma to the epiphyseal endplate prior to skeletal maturity).
Causes of pelvic tilt?
Pelvic tilt: lateral pelvic tilt can be caused by scoliosis, leg length discrepancy or hip abductor weakness.
How can assesing a patients shoes in an MSK examination be helpful?
Assess the patient’s footwear: unequal sole wearing is suggestive of an abnormal gait.
Hip examination: leg length assement?
Apparent leg length
To assess apparent leg length, measure and compare the distance between the umbilicus and the tip of the medial malleolus of each limb.
True leg length
To assess true leg length, measure from the anterior superior iliac spine to the tip of the medial malleolus of each limb.
Apparent vs true leg discrepancy?
Leg length should be formally assessed to differentiate between a true leg length discrepancy and an apparent discrepancy caused by other abnormalities (e.g. a leg appears shorter secondary to lateral pelvic tilt).
