Exam - Hip

From CambridgeNotes

General

  • Look at gait: Trendelenberg or antalgic?
  • Trendelenberg’s test: patient stands on one leg; positive if "sound side sags" below horizontal (causes: gluteal paralysis or inhibition (hip pain), or fractured neck of femur)
  • Look when standing from front (pelvic tilt?), side (fixed flexion deformity?), and behind (scoliosis?)

Look (reposition patient to lie on bed)

  • Scar, skin, swelling, muscle (polio causes asymmetry)
  • Shortening – true (fractured neck of femur, cartilage loss, shaft fracture etc) vs. apparent (pelvic tilt compensates adduction deformity)

Feel

  • Measure shortening: true length from anterior superior iliac spine to medial malleolus (MM), apparent from xiphisternum to MM
  • Feel femoral head below inguinal ligament, lateral to femoral artery: tenderness? crepitus on rotation?

Move: must isolate from pelvic movement!

  • Thomas’s test: hand under lumbar spine; flex good hip until lumbar lordosis obliterated then any flexion in other hip is a fixed flexion deformity; repeat on other side
  • Flexion (passive): place fingers on greater trochanter and thumb on iliac spine while leg flexed (N = 120o)
  • Abduction (N = 40o) and adduction (N = 25o): little finger and thumb on each iliac spine to steady
  • Flex hip to 90o, foot out = internal rotation (N =45o), foot in = external rotation (N =45o)
  • Turn patient over and test extension (5-20o) and rotation

Neurovascular

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