Hip examination

Question 1

How would you begin the examination?

Answer 1

1. Wash hands
2. Introduce self
3. Identify patient
4. Gain consent and ask if in any pain or any joint replacements
5. Expose from waist down but keep on underwear to see hip - chaperone?

Question 2

How would you do inspection?

Answer 2

Standing first: inspect from front, side and back
Assess gait
Supine with hips and knees extended: Inspect anterior, and lateral thighs and roll patient if possible to inspect gluteal regions

Question 3

What would you look for on inspection of the patient?

Answer 3

Pelvic tilt, joint deformities, muscle wasting, asymmetry, exaggerated lumbar lordosis, gait (posture, armswing, stride length, turning, asymmetry)

Question 4

What would you do once patient is lying down on sofa?

Answer 4

Inspection and measure leg lengths to check for leg length discrepancy

Question 5

What is the apparent leg length?

Answer 5

From the xiphisternum to medial malleolus

Question 6

What is true leg length?

Answer 6

From the ASIS to the medial malleolus

Question 7

What do you do if there is a true leg length discrepancy?

Answer 7

Assess if originates from tibia or femur:
knees bent at 90 degrees with heels in line and inspect from side
Place hand across both tibial tuberosities and hand will dip downwards if femoral shortening
Place hand across suprapatellar regions and hand will dip downwards if tibial shortening

Question 8

What do you assess on palpation?

Answer 8

Assess temperature

Palpate ASIS and greater trochanter - ask if in any pain and watch face

Question 9

What movements do you assess actively?

Answer 9

Flexion, extension, abduction, adduction - look at range of motion
Flexion (bring knees to chest - maybe also straight leg raise)
For abduction and adduction - feel contralateral hip to stop it coming off the bed

Question 10

What movements do you assess passively?

Answer 10

Flexion, extension, abduction and adduction

Internal and external rotation (leg straight and flexed at knee)

Question 11

What are the 4 things you do while the patient is standing?

Answer 11

1. Inspect from all sides
2. Assess gait
3. Extension of hip with hands on a wall - hold hips and stand on contralateral side to stop them rotating)
4. Trendelenburg’s test

Question 12

What special test would you do while the patient is lying down and how would you do this?

Answer 12

Thomas’s test: Place hand under lumbar spine and ask patient to bring one knee to their chest. Watch other leg to see if it flexes - this is fixed flexion deformity in the leg which should be straight.
Feel for flattening of the lumbar spine into your hand as they do this - this is normal

Question 13

How would you do Trendelenburg’s test and what does this test for?

Answer 13

Face patient and place hands on their ASIS. Ask them to hold onto your arms/shoulders for balance and get them to stand on one leg with other leg behind them (should be done for 30 secs but not in OSCE)
Watch for pelvic tilt towards the side with the raised leg
This suggests weakness in the hip abductors on the side that they are standing on.

Question 14

How would you finish the exam?

Answer 14

1. Thank the patient
2. Ask them to redress
3. Wash hands

Question 15

What would you say to complete the exam?

Answer 15

Examine lumbar spine and knees

Perform neurovascular examination of lower limbs