HIP EXAMINATION

Basic Principles( Prerequisites of Examination )

Patient must be suitably undressed.

Hard bed.

Pattern of Examination

Inspection. Palpation. Movements. Measurements. Special tests.

Inspection

Standing position.

Lying down position.

Inspection (contd)In standing position Patient able to stand – Yes / No. If yes, patient able to walk – Yes / No. If yes, check Gait. Gait :

– Trendelenburg.– Antalgic– Waddling– Short legged – High stepping

Patient able to squat or not.

Inspection (contd)In standing position

Trendelenburg test

Inspection (contd)In standing position Spine. Wasting eg Disuse atrophy, neurological

deficit. Swelling eg Cold abscess, dislocation, lipoma.

– Scarpas triangle.– Greater trochanter.– Gluteal region

Scars / Sinus Level of natal fold eg CDH.

Inspection (contd)In lying down position

Sequential -

Top to bottom

or

Bottom to top.

Inspection (contd)In Lying down position Attitude.

Lumbar lordosis.

ASIS.

Greater trochanter– Position

– Prominence

Inspection (contd)In Lying down position Scarpas triangle

– Fullness.– Scars / sinus.

Skin– Colour, texture, prominent veins.

Thigh– Wasting.

Patella– Position

Inspection (contd)In Lying down position Calf

– Wasting

Malleoli– Level– Direction.

Heel– Level

SLR

Palpation

Confirmation of inspection findings in same sequence plus few additions :Temperature, Tenderness & Telescopy

Lumbar lordosis– Thomas’s test for FFD.

Palpation (contd.) ASIS level

– How to feel ?

– Level.

Greater trochanter– Position, Promince (Bitrochanteric test).

– Tenderness – Antero posterior / Axial.

Palpation ( contd. ) Temperature Scars Sinuses :

– Margins, Discharge, adherence to bone Tenderness Circumference of thigh / calf Medial malleolus

– How to feel?– Level & direction

Heel– Level

Palpation ( contd. ) Telescopy

MovementsSagittal Flexion

Extension

0-90 ext knee

0 – 120 fl knee

0 -15

Coronal Adduction Abduction

0 – 30

0 - 40

Vertical External Internal rotation.

0 – 45

0 – 30

Circumduction Incomplete

In fixed deformities, starting point will be the degree of deformity

MeasurementsApparent : Lengthening / Shortening.

Pre requisite– Limbs parallel

Measured between midline point - xiphisternum, manubrium sterni or umbilicus

&

medial malleoli

Measurements Real : Lengthening / Shortening

Pre requisites– Squaring of pelvis.

• ASIS at same level.

– Limbs in identical position.

Measurement from ASIS to medial malleolus.

Measurements ( contd )

Find level of discrepancy– Leg,

– Thigh or

– Supratrochanteric.

Measurements( contd ) (How to detect supratrochanteric shortening) Bryants triangle.

Nelaton’s line.

.

Measurements ( contd ) (How to detect supratrochanteric shortening Schoemaker’s line.

Chiene’s parallelogram

Special Tests

Narath’s vascular sign.

Ortolani’s test. Barlow’s test.

Ely’s test.

Examination (contd)

Examination of hip is incomplete without examination of spine & knee.

Key to Examination findings

ASIS at same level

No adduction or abduction deformity

Apparent measurements = Real measurements

ASIS raised Adduction deformity

Apparent shortening > Real shortening

ASIS lower Abduction deformity

Apparent lengthening > Real lengthening