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
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