Hip examination

Patient must be suitably undressed (down to underwear)

First examine patient standing and then lying down.

Look, feel, move and special tests.

1. PATIENT STANDING

Look

• Front and back of pelvis/hips and legs: any ischaemic or trophic changes
• Swelling (e.g. lipoma) Scars (previous surgery)
• Sinuses (infection/neuropathic ulcers)
• Wasting (old polio, Carcot-Marie-Tooth) or hypertrophy (e.g. calf pseudo-hypertrophy in muscular dystrophy)
• Deformity (leg length inequality, pes cavus, scoliosis)

Feel (Not a lot!)

• Assess any swellings
• Assess pelvic tilt by palpating iliac crests

Move

• Gait:    
  • Trendelenburg (pelvic sway/tilt, aka waddling gait if bilateral)
  • Broad-based (ataxia)
  • High-stepping (loss of proprioception/drop foot)
  • Antalgic (mention "with reduced stance phase on left/right side")
  • Smooth progression of phases of gait cycle: stance, toe-off, swing and heel-strike
  • In-toeing (persistent femoral anteversion: most PFA is not clinically significant as both Monica Selles and Andre Agassi manage quite well with theirs!)
  • Appropriate stride length
  • Sufficient flexion/extension at hip/knee ankle and foot: Any fixed contractures?
  • Observe arm-swing and balance on turning around