Examination of the Hip Joint

Original Author: Mike Bath
Last Updated: September 23, 2016
Revisions: 8

Introduction

  • Introduce yourself to the patient
  • Wash your hands
  • Briefly explain to the patient what the examination involves
  • Ask the patient to remove their bottom clothing, exposing the hip
    • Offer the patient a chaperone, as necessary

Always start with inspection and proceed as below unless instructed otherwise; be prepared to be instructed to move on quickly to certain sections by the examiner.


Inspection

Whilst the patient is standing

  • Assess patient gait
    • Trendelenburg gait, a waddling gait caused by loss of abductor medius and minimus action, can occur following superior gluteal nerve damage or poor abductor repair following hip surgery
    • Antalgic gait produced from weight bearing on painful leg, shortening the stance phase on the affected limb
    • High-stepping gait or out swinging gait can be caused by damage to the common peroneal nerve, resulting in a foot drop
  • Assess muscle bulk with the patient standing

Ask the patient to lie supine on the bed

  • Assess for scars, symmetry, swellings, and skin changes
  • Measure leg length with a tape measure. This assesses whether there is an actual leg length discrepancy and whether there is any pelvic tilt present to compensate for this
    • True leg length = ASIS to medial malleolus
    • Apparent leg length = pubic symphysis to medial malleolus

Palpate

  • Feel for tenderness and swelling over
    • Hip Capsule anteriorly
    • ASIS
    • Greater Trochanter

Movement

All movements are passive movements, checking for crepitus, pain, and range of movements

  • Abduction and adduction
    • Place one hand across the patient’s pelvis to ensure that the pelvis remains still and that the movement is coming from the hip joint and not the pelvis
  • Flexion and extension
  • Medial and lateral rotation

Special Tests

  • Thomas’ Test, assessing for a fixed flexion deformity
    • Have patient lying in the supine position
    • Place one hand underneath the patients lumbar spine to ensure loss of the lumbar lordosis
    • Fully flex the contralateral hip to the side you are examining and observe the ipsilateral hip. Any flexion in the ipsilateral hip suggests a fixed flexion deformity of that side
    • Repeat this test on both sides
  • Trendelenburg test, assessing abductor muscle function. If there is abductor pathology (gluteus medius and minimus) on the side you are examining then the contralateral side (the normal side) will sag down (‘Sound Side Sags’)
    • Ask patient to place their hands on your outstretched hands (for stability)
    • Ask patient to stand on the side you are examining, lifting the contralateral leg off the ground (for 30 seconds)
    • Repeat this test on both sides

Complete the Examination

Thank the patient and allow them to redress. Remember, if you have forgotten something important, you can go back and complete this.

State to the examiner that to complete your examination you would also like to examine the joint above and below (lumbar spine and knees), the contralateral hip, and reviewing any relevant imaging available.

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