Medically Fit For Exams
Medically Fit For Exams

Hip examination

  • Wash hands and introduce yourself
  • Explain the examination and gain consent
  • Undress the patient appropriately to see both hips fully

 

LOOK

  • Ask the patient to lay flat
  • Look for differences between sides
  • Look for scars, swelling and muscle wastage
  • Look and measure for leg length disparity
    • True length: measure from anterior superior iliac spine to medial malleolus of both legs

Causes of true LLD – proximal to greater trochanter

Distal to greater trochanter

#NOF

Fractures (femur/tibia)

Hip dislocation

Osteomyeltis

Arthritis

Septic arthritis

Slipped upper femoral epiphysis

Epiphyseal injury

Post hip arthroplasty

Polio

  • If discrepancy, ask patient to flex their knees with their heels together, to assess whether difference is above or below the knee
  • If it is above the knee, feel for the top of the greater trochanters (below and lateral to anterior superior iliac spine), to assess if it is proximal or distal to the trochanter
  • Apparent length: measure distance from umbilicus to medial malleoli
    • Often caused by pelvic tilt

 

FEEL

  • Ask the patient if they have any pain, and pay extra attention when palpating these areas – look at the patient’s face
  • Palpate around the hip joint, starting with the good side
  • Palpate over the greater trochanter – tenderness here suggests trochanteric bursitis

 

MOVE

  • Assess active movement first, starting with the good side
  • Ask the patient to flex their knees to 90 degrees, then to fully flex their hips, then to extend the knee and the hip simultaneously
  • Lift their leg up slightly, and ask them to abduct (normal is 45 degrees) and adduct (normal is 25 degrees)
  • Passively flex the knee and hip to 90 degrees, from here test internal rotation by moving the foot laterally, normal is 45 degrees
  • Also test external rotation by moving the foot medially, normal is also 45 degrees
  • Stabilise the pelvis with one hand, extend the leg and abduct (normal is 45 degrees) and adduct (normal is 25 degrees)
  • As the patient to roll on to their side to assess extension – ask them to move their leg backwards, and passively move it yourself

 

SPECIAL TESTS

  • Thomas’ test
    • Place one hand under the small of the back
    • Fully flex the hip opposite to the side you are testing until the lumbar spine touches your hand under their back
    • Look at the other leg, it should remain flat on the couch, if it lifts off the couch it suggests a fixed flexion deformity in the hip of that side
  • Trendelenburg’s test
    • Stand in front of the patient, with them standing up
    • Hold your hands facing up and ask them to hold on to your hands
    • Ask the patient to stand on one leg followed by the other
    • The pelvis should remain level
    • If the pelvis drops on the unsupported side, this suggests weakness of the hip abductors on the OPPOSITE side

 

STANDING and GAIT

  • Look at the patient standing still, assess for:
    • Pelvic tilt
    • Shoulder symmetry/parallel to ground
    • Alignment of hips, knees and ankles
  • Ask the patient to walk away from you, turn around briskly and walk back, assessing for:

 

NEUROVASCULAR ASSESSMENT

  • Palpate for dorsalis pedis (posterior tibial, popliteal and femoral if not present)
  • Assess sensation of dorsum and sole of foot (sciatic nerve branches), anterior and medial thigh and medial calf (branches of femoral nerve)
  • State that you would like to carry out a full neurovascular exam

 

OTHER JOINTS

  • Ask about pain in the spine and knees
  • State that you would like to carry out full examinations on these joints

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