REMS Hip

Question 1

What do you inspect the hips/legs for?

Answer 1

• Gluteal muscle wasting
• Scars
• Flexion deformities
• Swelling
• Asymmetry
• Leg length discrepancies (lengthening/shortening)

Question 2

How is apparent leg length measured?

Answer 2

From the xiphoid sternum to the medial malleolus

Question 3

How is true leg length measured?

Answer 3

From the ASIS to the medial malleolus

Question 4

What do you inspect generally for?

Answer 4

• Discomfort
• Walking aid
• Posture

Question 5

What do you feel for?

Answer 5

• Tenderness over the greater trochanter
• Temperature changes
• Tenderness over hip joint
• Compare both sides and assess patient’s face for pain

Question 6

What can tenderness over the greater trochanter indicate?

Answer 6

Bursitis

Question 7

What can tenderness over the hip joint indicate?

Answer 7

Acute synovitis

Question 8

What are the principles of movement in REMS hip?

Answer 8

Perform active and passive motion combined with gently guiding the patient’s leg as they move it actively then pushing it a little further if possible passively

Question 9

How is hip flexion tested?

Answer 9

Passively bend the knee to 90 degrees and assess full hip flexion

Question 10

How is internal and external rotation assessed?

Answer 10

Passively been the knee to 90 degrees and place one hand

Question 11

How is abduction and adduction rotation assessed?

Answer 11

• To assess abduction place on hand on the opposite iliac crest and grasp the ankle with the other
• Move the leg laterally until the pelvis tilt is detected
• Adduction is assessed by moving the leg medially with the pelvis fixed on the same side

Question 12

How is extension assessed?

Answer 12

The patient lies face down on the couch; lift each leg in turn

Question 13

What are the other special tests to perform?

Answer 13

• Thomas’s test

- Trendelenburg’s test

Question 14

What is a positive trendelenburg test?

Answer 14

• When the pelvis drops below the horizontal on the non-weight bearing side
• Seen in gluteal muscle weakness or in an unstable hip joint (dislocation or femoral neck fractures)

Question 15

How is Thomas’s test performed?

Answer 15

With the patient lying supine, place one hand under their spine to eliminate the lumbar lordosis
Passively flex one hip and watch for any movement in the contra-lateral hip
If the other hip rises off the couch this is suggestive of a fixed flexion deformity