What level of exposure is needed during the hip examination?
Patients bare below the waist except for underwear - but you will be palpating the groin later on in the examination so you need to explain it is important for the examination if they could expose their groin area (chaperone should be present)
When inspecting the lower limb what are you looking for ?
- Quadricep muscle bulk – Anteriorly (from the front),
- Gluteal muscle mass – Posteriorly (from the back),
- Hamstring muscle bulk – Posteriorly (from the back)
What group of muscles does the Trendelenburg's test, test?
During the Trendelenburg's test which leg is being assessed?
The leg in contact with the floor
What indicates a positive trendelenbergs test?
If the ABductors are weak, the standing leg will move into ADduction and the iliac crest on the contralateral side will move down. Hence positive test.
When inspecting the hip what are you looking for ?
- Skin changes - such as erythema, eczema or psoriasis
- Scars (traumatic or from surgery)
Why do you not look for effusions in the hip examination unlike the knee examination?
The hip is a deep joint (unlike the knee) and therefore you would NOT see an effusion, even if it were present.
What are the typical changes to the attitude of the affected limb following a extracapsular neck of femur fracture ?
External rotation (more than normal) - The iliopsoas muscle originates from the lateral aspect of the lumbar vertebrae, crosses the hip joint and the tendon inserts on the lesser trochanter. It produces a flexion and an external rotation action when contracting by pulling the lesser trochanter forward. This movement is resisted by other internal rotators acting on the hip joint. However, in hip fractures, the femoral head and lesser trochanter become separated, therefore, the external rotation pull on the lesser trochanter is not resisted. The effect is that the lower limbs lies in more external rotation than normal.
- Shortening of limb
Define what true limb length is and what is its landmarks ?
It is a measurement of only the actual length of the lower limb.
Landmarks are the anterior superior iliac spine (ASIS) and the tip of the medial malleolus.
Define what is meant by apparent limb length and what are its landmarks for measuring it ?
It is a measurement of not only the lower limb but the pelvis and lower spine.
The xiphisternum to the tip of the medial malleolus
If there is a discrepancy between left and right apparent limb length but the true limb length is normal where must the deformity lie?
pelvis or lower spine (such as a scoliosis)
What clinical problem is suggested by tenderness in the area of the greater trochanter ?
What clinical problem is suggested by tenderness in the area of the mid-point of the groin ?
Hip arthritis or fracture
During the MOVE part of the hip exam what do you assess?
- Internal rotation
- External rotation
What finding does a positive thomas test indicate?
Performed to look for a fixed flexion deformity of the hip, which is loss of hip extension.
Describe hwhat is done during thomas' test
With the examiner standing on the side to be examined, a hand is placed between the patient’s lumbar lordosis and couch. The patient is asked to maximally flex the contralateral hip and knee. The examiner’s hand will feel the lumbar lordosis occluding.
The examiner observes the ipsilateral thigh. If the thigh remains lying flat on the couch, there is no fixed flexion deformity and the test is negative. If the thigh leaves the couch as the lumbar lordosis is occluded, there is a fixed flexion of the hip joint."