Hip examination

Jump to navigation Jump to search
Hip examination

WikiDoc Resources for Hip examination

Articles

Most recent articles on Hip examination

Most cited articles on Hip examination

Review articles on Hip examination

Articles on Hip examination in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Hip examination

Images of Hip examination

Photos of Hip examination

Podcasts & MP3s on Hip examination

Videos on Hip examination

Evidence Based Medicine

Cochrane Collaboration on Hip examination

Bandolier on Hip examination

TRIP on Hip examination

Clinical Trials

Ongoing Trials on Hip examination at Clinical Trials.gov

Trial results on Hip examination

Clinical Trials on Hip examination at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Hip examination

NICE Guidance on Hip examination

NHS PRODIGY Guidance

FDA on Hip examination

CDC on Hip examination

Books

Books on Hip examination

News

Hip examination in the news

Be alerted to news on Hip examination

News trends on Hip examination

Commentary

Blogs on Hip examination

Definitions

Definitions of Hip examination

Patient Resources / Community

Patient resources on Hip examination

Discussion groups on Hip examination

Patient Handouts on Hip examination

Directions to Hospitals Treating Hip examination

Risk calculators and risk factors for Hip examination

Healthcare Provider Resources

Symptoms of Hip examination

Causes & Risk Factors for Hip examination

Diagnostic studies for Hip examination

Treatment of Hip examination

Continuing Medical Education (CME)

CME Programs on Hip examination

International

Hip examination en Espanol

Hip examination en Francais

Business

Hip examination in the Marketplace

Patents on Hip examination

Experimental / Informatics

List of terms related to Hip examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


In medicine, the hip examination, or hip exam, is undertaken when a patient has a complaint of hip pain and/or signs and/or symptoms suggestive of hip joint pathology. It is a physical examination maneuver.

The hip examination, like all examinations of the joints, is typically divided into the following sections:

  • Position/lighting/draping
  • Inspection
  • Palpation
  • Motion
  • Special maneuvers

The middle three steps are often remembered with the saying look, feel, move.

Position/Lighting/Draping

Position - for most of the exam the patient should be supine and the bed or examination table should be flat. The patient's hands should remain at her sides with her head resting on a pillow. The knees and hips should be in the anatomical position (knee extended, hip neither flexed nor extended).

Lighting - adjusted so that it is ideal.

Draping - both of the patient's hips should be exposed so that the quadriceps muscles and greater trochanter can be assessed.

Inspection

Inspection done while the patient is standing

The hip should be examined for:

  • Abnormal gait - i.e. antalgic gait

Inspection done while supine

The hip should be examined for:

  • Masses
  • Scars
  • Lesions
  • Signs of trauma/previous surgery
  • Bony Alignment (rotation, leg length)
  • Muscle bunk and symmetry at the hip and knee

Measures

In hip fractures the affected leg is often shortened and externally rotated.

Palpation

The hip joint lies is deep and cannot normally be directly palpated.

To assess for pelvic fracture one should palpate the:

Movement

  • Internal rotation - with knee and hip both flexed at 90 degrees the ankle is abducted.
  • External rotation - with knee and hip both flexed at 90 degrees the ankel is adducted.
  • Flexion
  • Extension - done with the patient on their side. Alignment should be assessed by palpation of the ASIS, PSIS and greater trochanter.
  • Abduction - assessed whilst palplating the contralateral ASIS.
  • Adduction - assessed whilst palpating the ipsilateral ASIS.
  • Assessment for a hidden flexion contracture of the hip - hip flexion contractures may be occult, due to compensation by the back. They are assessed by:
    1. Placing a hand behind the lumbar region of back
    2. Getting the patient to fully flex the contralateral hip.
    3. The hand in the lumbar region is used to confirm the back is straightened (flexed relative to the anatomic position). If there is a flexion contracture in the ipsilateral hip it should evident, as the hip will appear flexed.

Normal range of motion

  • Internal rotation - 35°
  • External rotation - 45°
  • Flexion - 135° (L 2, 3, 4)

With the patient seated, place your hand on top of one thigh and instruct the patient to lift the leg up from the table. The main hip flexor is the Iliopsoas muscle, innervated by the femoral nerve.

(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

  • Extension - 25° (L5, S1):

With the patient lying prone, direct the patient to lift their leg off the table against resistance. Test each leg separately. The main hip extensor is the gluteus maximus, innervated by inferior gluteal nerve.

(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

  • Abduction - 45° (L 4, 5, S1):

Place your hands on the outside of either thigh and direct the patient to separate their legs against resistance. This movement is mediated by a number of muscles.

(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)


  • Adduction - 25° (L 2, 3, 4):

Place your hands on the inner aspects of the thighs and repeat the maneuver. A number of muscles are responsible for adduction. They are innervated by the obturator nerve.

(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

Video: Hip Examination

{{#ev:youtube|5LNYdJIrWYo}}

Special maneuvers

  • Trendelenburg's test: Telescoping axial movement is tested with knee bent 90 degrees and lying on couch. Tests for dislocation

Other tests

A knee examination should be undertaken in the ipsilateral knee to rule-out knee pathology.

See also

External links

Template:WH Template:WikiDoc Sources