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Hip examination

Follow the scheme below:

  • Inspection
  • Palpation
  • Measurment
  • Movement

Before starting

  • Introduce yourself
  • Explain what the examination entails
  • Ask permission to perform examination
  • Expose the patient appropriately - from waist down exposing both the lower limbs, but leaving the underwear on
  • Preserve dignity by using a blanket appropriately
  • Tell the patient to let you know if anything you do is uncomfortable
  • Remember - always watch the patients face 

Inspection

  • General observation
    • Does the patient look well?
    • Is there a walking stick? Frame?
    • Is there a shoe raise?
    • Hands (Rheuamtoid arthritis?) 

Patient Standing

  • Remember to inspect from all sides (front, laterally and from behind):
    • Skin
      • Scars (previous injuries or surgical scars)
      • Sinuses (secondary to TB or infected hip replacements)
      • Colour - discolouration?
    • Deformity
      • Abduction / adduction contracture
      • Fixed flexion deformity
      • Limb shortening
      • Limb rotation
      • Scoliosis
      • Lumbar lordosis 
    • Swelling (the hip joint is deep and thus swelling is not generally seen)
    • Muscle wasting - look at the gluteal folds
      • gluteals? quadraceps?
    • Pelvic obliquity (anterior superior iliac spines (ASIS) not horizantal)
      • Is there a leg length discrepancy?
      • Is there a fixed deformity?

Patient Walking

  • Observe the patient walking.
    • Gait pattern. There are different types of gait:
      • Stiff hip (pelvis swing)
      • Antalgic (short stance phase)
      • Short leg
      • Trendelenburg (Lurching gait, watch the shoulders)
      • Drop foot gait 
      • Broad based gait (ataxia)
    • Stride length
    • Use of a walking aid

Patient Lying down - supine with one pillow under the head

  • Observe the patient climb onto the examination couch
  • Deformity
    • Rotational deformity is common in osteoarthritis (observe the position of the patella and foot on either side)
    • Fixed flexion deformity (look at the angle between the thigh and the bed). Perform Thomas's test at this stage (see below) 
    • Abduction / Adduction deformity (adduction deformity - tilted pelvis and apparent shortening of that leg)
  • Detailed check:
    • Skin - scars

Palpation



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