hip examination - lakeview private hospital...hip •look, feel, move •look for gluteal muscle...
TRANSCRIPT
Hip ExaminationBy Ed Graham
Orthopaedic Hip & Knee Surgeon
Examination
• To examine the hip I follow a systematic approach
• Apley described the orthopaedic examination as look, feel ,move
• Although this is probably too expansive for most surgeons
Hip Examination
Hip
• Look, feel, move
• Look for gluteal muscle wasting, scars from previous surgery
• Observe gait- speed, use of walking aid, limp, painful
Feel
• The hip joint has less bony prominence to feel than the knee joint
• Focus on Greater Trochanter and running laterally down thigh
• Feel for tenderness over inguinal ligament and anterior groin
Move
• Assess range of motion of internal and external rotation
• Internal rotation is usually reduced to a greater degree
• Quantify range of flexion and extension
• Check adduction and abduction
Internal Rotation
Abduction
Special Tests
• Measurement of leg length
• Trendelenberg’s test
• Thomas’ test
Leg Length
Leg lengths
• True length from fixed bone landmark to another
• Measured from anterior superior iliac spine to medial malleolus
Trendelenberg
• The patient stands on each leg in turn
• The examiner places hands on anterior superior iliac spines
• The pelvis drops on the unsupported side indicating weak or painful hip abductors
Thomas’ Test
• A fixed flexion deformity may be masked by tilting the pelvis forward and increasing the lumbar lordosis
• Both legs are fully flexed
• With one hand under the lumbar region the affected leg is extended
Thomas’ Test
Examination
• Look , feel, move
• Remember to examine the other side and the joint above and below
• Check pulse distally
• Assess gait
Osteoarthritis
• Reduced range on motion particularly internal rotation, abduction and extension