Hip examination - OSCE Guide | Geeky Medics

3/4/15, 7:44 PMHip examination - OSCE Guide | Geeky Medics

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HIP EXAMINATION OSCE GUIDEHip examination frequently appears in OSCEs. Youll be expected to pick up therelevant clinical signs using your examination skills. This hip examination OSCE guideprovides a clear concise, step by step approach to examining the hip joint.

Introduction

Wash handsIntroduce yourself

Check patient details - name / DOBExplain examinationGain consentExpose patients legs and hips keeping underwear onPosition standingAsk if patient has any pain anywhere before you begin!

Look

Look around bed for any aids or adaptations walking stick / wheelchair / etc

Inspect patients footwear note any unequal wear on the soles suggestive of gaitabnormality

Inspect patient from all angles

Front scars /pelvic tilt /quadriceps wastingSides assess lumbar lordosis normal / hyperlordosisBack gluteal wasting / pelvic tiltGait note speed /smoothness /turning - antalgic gait / trendelenburg gait

Feel



Ask patient to lay on the bedPalpate hip joint for tenderness / warmth inflammation / infectionMeasure apparent leg length xiphisternum to tip of medial malleolusMeasure true leg length ASIS to tip of medial malleolus Palpate greater trochanter - tenderness (often indicative of bursitis)

Move

Use your left hand to stabilise the contralateral ASIS to prevent masking of hipproblemsFlexion (active & passive) - bring your knee towards your chest normal is 120 Abduction (active & passive) -keep leg straight & move away from the midline normal is 30-40Adduction (active & passive) keep leg straight & move it across themidline normal is 30Internal rotation (passive) - normal ROM 40External rotation (passive) - normal ROM 45

Position patient prone

Hip extension (passive) lift each leg in turn normal ROM is 10-20

Special Tests

Trendelenburgs Test

1. Place hands on the anterior superior iliac spines2. Ask patient to stand on one leg for 30 seconds3. Observe your hands4. Normally the iliac crest on the side with the foot off the ground shouldrise up



5. Repeat the test on the opposite side

The test is deemed positive (abnormal) if the pelvis falls on the side with thefoot off the ground

This abnormal result suggests weak hip abductors on the contralateral sideof the pelvis

Thomass Test

1. Place left hand under patients spine (palm upwards)2. Passively flex both legs (hips/knees) as far as you are able to3. Your hand should detect that the lumbar lordosis is now flattened4. Ask patient to extend the hip you are assessing:

Incomplete extension suggests a fixed flexion deformity at the hip

5. Repeat the test to assess the contralateral hip joint

DO NOT PERFORM ON PATIENTS WITH HIP REPLACEMENTS can causedislocation!

To complete the examination

Thank patientWash handsPresent findings

Say you wouldPerform a full neurovascular examination of both lower limbs Examine the joint above and below lumbar spine / kneeTake plain radiographs of the hip joints if indicated



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Hip examination - OSCE Guide | Geeky Medics