Examination: Hip

There are 6 main concepts that need to be remembered for ALL of the regional examination of the musculoskeletal system:

  1. Position – always position your patient as you would like to examine them before you begin
  2. Look – inspect and observe the patient and around the patient's bedside
  3. Feel – for example, feeling a joint to see if it is hot or swollen
  4. Move – actively (the patient moves the joint) then passively (you do the movements for them)
  5. Function – can the patient move their joints in order to complete day to day tasks?
  6. Special tests – if applicable

  • Wash hands
  • Introduce yourself
  • Ask permission to examine the relevant part of the body
  • Expose the patient – ideally in underwear only, at least exposing the joint of interest and the joints above and below this
  • Reposition the patient – standing up at first

Position:
  • Lying on bed

Look:
  • Look from the foot of the bed
  • For wasting, asymmetry, redness, rashes
  • Measure leg length - compare the 'apparent' and 'true' leg lengths between sides
    • Apparent leg length - from midline point (e.g. umbilicus) to the medial malleolus - this can be shortened when there is either actual shortening of one leg, or when there is a fixed flexion deformity that causes an apparent discrepancy in leg length
    • True leg length - from anterior superior iliac spine to ipsilateral medial malleolus - this is only asymmetrical when there is a true difference between leg lengths

Feel:
  • Temperature of the hip
  • The greater trochanter for pain (trochanteric bursitis)

Move:
  • Actively and passively
  • Flexion
  • Internal and external rotation
  • Abduction and adduction

Function
  • Assess gait
Special testing:
  • Thomas' test:
    • With the patient lying down, put one hand under their lumbar spine to ensure that they maintain lumbar lordosis
    • Flex one of their legs at the hip as much as tolerated (with knees flexed). Ensure they relax the contralateral leg
    • Test is positive if the contralateral leg lifts upwards - indicates a fixed flexion deformity, e.g.: as seen in osteoarthritis
  • Trendelenberg's test:
    • Ask the patient to stand directly in front of you, facing you, with their hands placed on yours
    • Ask them to lift one leg off the ground
    • Positive test is when the pelvis tilts downwards on the side of the leg that is elevated. This is because the contralateral (ie straight) leg has weakness in the hip abductors and cannot support the weight of the ipsilateral leg. Abductor weakness is found in chronic degenerative conditions such as osteoarthritis
    • "The sound side sags"

To conclude the examination:
  • Thank the patient
  • Tell them they can get dressed now
  • Offer to examine the joint above and the joint below
  • Consider neurological examination of the limb examined



The complete examination of the musculoskeletal system includes:


written by: celine_lakra; joel_cunningham, first posted on: 21/01/12, 22:13

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Comments:

R3d says...
I think the Trendelenburg test is positive when there is weakness in the abductors, not adductors as stated in the guide.
POSTED ON: 29/07/16, 23:01
Joel_cunningham says...
Hi R3D,

Thanks very much for the comment. I've just corrected the OSCE guide, thanks for pointing out the error.

Best wishes,

Joel
POSTED ON: 28/12/16, 11:48

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