Hip examination
Encyclopedia
In medicine
, physiotherapy, and chiropractic, the hip examination, or hip exam, is undertaken when a patient has a complaint of hip pain and/or signs and/or symptom
s 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:
The middle three steps are often remembered with the saying look, feel, move.
and the bed or examination table should be flat. The patient's hands should remain at their sides with the 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 muscle
s and greater trochanter
can be assessed.
In hip fractures the affected leg is often shortened and externally rotated.
To assess for pelvic fracture one should palpate the:
Ober's test
for tight ITB
Thomas test
for tight hip flexors
should be undertaken in the ipsilateral knee to rule-out knee pathology.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, physiotherapy, and chiropractic, the hip examination, or hip exam, is undertaken when a patient has a complaint of hip pain and/or signs and/or symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s suggestive of hip joint pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
. It is a physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
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 supineSupine
In grammar a supine is a form of verbal noun used in some languages.-In Latin:In Latin there are two supines, I and II . They are originally the accusative and dative or ablative forms of a verbal noun in the fourth declension, respectively. The first supine ends in -um. It has two uses. The first...
and the bed or examination table should be flat. The patient's hands should remain at their sides with the head resting on a pillow. The knees and hips should be in the anatomical position (knee extended
Extension (kinesiology)
In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
, 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 muscle
Quadriceps muscle
The quadriceps femoris , also called simply the quadriceps, quadriceps extensor, quads, is a large muscle group that includes the four prevailing muscles on the front of the thigh...
s and greater trochanter
Greater trochanter
The greater trochanter of the femur is a large, irregular, quadrilateral eminence and a part of the skeletal system.It is directed a little lateralward and backward, and, in the adult, is about 1 cm lower than the head...
can be assessed.
Inspection done while the patient is standing
The hip should be examined for:- Abnormal gait - i.e. antalgic gaitAntalgic gaitAntalgic gait is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase. It can be a good indication of pain with weight-bearing.-Conditions associated with an antalgic gait:* Coxalgia...
Inspection done while supine
The hip should be examined for:- Masses
- Scars
- Lesions
- Signs of trauma/previous surgery
- Bony alignment (rotation, leg length)
- Muscle bulk and symmetry at the hip and knee
Measures
- True leg length - anterior superior iliac spineAnterior superior iliac spineThe anterior superior iliac spine is an important landmark of surface anatomy. It refers to the anterior extremity of the iliac crest of the pelvis, which provides attachment for the inguinal ligament, and the sartorius muscle...
(ASIS) to medial malleolus pelvis should be squared (i.e. both asis should be at same level - Apparent leg length - umbilicusNavelThe navel is a scar on the abdomen caused when the umbilical cord is removed from a newborn baby...
to medial malleolus
In hip fractures the affected leg is often shortened and externally rotated.
Palpation
The hip joint lies deep inside the body and cannot normally be directly palpated.To assess for pelvic fracture one should palpate the:
- Ischial spineIschial spineFrom the posterior border of the body of the Ischium there extends backward a thin and pointed triangular eminence, the ischial spine, more or less elongated in different subjects.It can serve as a landmark in pudendal anesthesia.-Surfaces:...
s - Pubic rami
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 ankle is adducted. (also done with the Patrick's testPatrick's testPatrick's test or Fabere test is performed by a health care provider to evaluate people who have pain for hip disease or sacroiliitis. The knee is flexed to ninety degrees on the affected side and the foot is rested on the unaffected knee...
/ FABER testFABER testThe FABER test is a test for evidence of pathology in the sacroiliac and/or hip joints. Pathologies like sacroiliitis an inflammation of the sacroiliac joint. This test is similar to and often done in conjunction with the Patrick's test.Method:1. Ask the patient to lie supine on the exam table.2...
) - Flexion (also known as the Gaenslen's testGaenslen's testGaenslen's test, also known as Gaenslen's maneuver, is a medical test used to detect musculoskeletal abnormalities and primary-chronic inflammation of the lumbar vertebrae and sacroiliac joint...
) - Extension - done with the patient on their side. Alignment should be assessed by palpation of the ASIS, PSISPosterior superior iliac spineThe posterior border of the ala, shorter than the anterior, also presents two projections separated by a notch, the posterior superior iliac spine and the posterior inferior iliac spine. The posterior superior iliac spine serves for the attachment of the oblique portion of the posterior sacroiliac...
and greater trochanterGreater trochanterThe greater trochanter of the femur is a large, irregular, quadrilateral eminence and a part of the skeletal system.It is directed a little lateralward and backward, and, in the adult, is about 1 cm lower than the head...
. - Abduction - assessed whilst palpating the contralateral ASISAnterior superior iliac spineThe anterior superior iliac spine is an important landmark of surface anatomy. It refers to the anterior extremity of the iliac crest of the pelvis, which provides attachment for the inguinal ligament, and the sartorius muscle...
. - 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:
- Placing a hand behind the lumbar region of back
- Getting the patient to fully flex the contralateral hip.
- 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 be evident, as the hip will appear flexed.
Normal range of motion
- Internal rotation - 35°
- External rotation - 45°
- Flexion - 135°
- Extension - 15°
- Abduction - 45°
- Adduction - 25°
Special maneuvers
- Trendelenburg's testTrendelenburg's signTrendelenburg's sign is found in people with weak or paralyzed abductor muscles of the hip, namely gluteus medius and minimus. It is named after the German surgeon Friedrich Trendelenburg....
: This test is performed with the patient standing. The patient is asked to raise one leg; the test is positive if the hip on the raised side drops. A positive test suggests weakness of the abductors of the other hip.
Ober's test
Ober's test
Obert's test is a test used in physical examination in order to identify contracture of the iliotibial band. During the test the patient lies on his/her side with the unaffected leg on bottom and bent and the affected leg on top and straight...
for tight ITB
Thomas test
Thomas test
The Thomas test is a physical examination test, named after Dr. Hugh Owen Thomas , a British orthopaedic surgeon, used to rule out hip flexion contracture. The patient lies supine on the examination table and brings one knee in direction to the chest, while the other leg remains extended...
for tight hip flexors
Other tests
A knee examinationKnee examination
The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.The exam includes several parts:*position/lighting/draping...
should be undertaken in the ipsilateral knee to rule-out knee pathology.
External links
- Trendelenburg test - gpnotebook.co.uk.
- Clinical Hip Examination - Orthopaedic Research Institute Australia.