Hip ExaminationBy Ed Graham

Orthopaedic Hip & Knee Surgeon

Examination

• To examine the hip I follow a systematic approach

• Apley described the orthopaedic examination as look, feel ,move

• Although this is probably too expansive for most surgeons

Hip Examination

Hip

• Look, feel, move

• Look for gluteal muscle wasting, scars from previous surgery

• Observe gait- speed, use of walking aid, limp, painful

Feel

• The hip joint has less bony prominence to feel than the knee joint

• Focus on Greater Trochanter and running laterally down thigh

• Feel for tenderness over inguinal ligament and anterior groin

Move

• Assess range of motion of internal and external rotation

• Internal rotation is usually reduced to a greater degree

• Quantify range of flexion and extension

• Check adduction and abduction

Internal Rotation

Abduction

Special Tests

• Measurement of leg length

• Trendelenberg’s test

• Thomas’ test

Leg Length

Leg lengths

• True length from fixed bone landmark to another

• Measured from anterior superior iliac spine to medial malleolus

Trendelenberg

• The patient stands on each leg in turn

• The examiner places hands on anterior superior iliac spines

• The pelvis drops on the unsupported side indicating weak or painful hip abductors

Thomas’ Test

• A fixed flexion deformity may be masked by tilting the pelvis forward and increasing the lumbar lordosis

• Both legs are fully flexed

• With one hand under the lumbar region the affected leg is extended

Thomas’ Test

Examination

• Look , feel, move

• Remember to examine the other side and the joint above and below

• Check pulse distally

• Assess gait

Osteoarthritis

• Reduced range on motion particularly internal rotation, abduction and extension