Академический Документы
Профессиональный Документы
Культура Документы
Hip examination
HISTORY
It is important to bear in mind the following points when performing a hip examination:
Inspection
Palpation
Measurment
Movement
Before starting
Introduce yourself
Explain what the examination entails
Ask permission to perform examination
Expose the patient appropriately - from waist down exposing both the lower limbs, but leaving the
underwear on
Preserve dignity by using a blanket appropriately
Tell the patient to let you know if anything you do is uncomfortable
Remember - always watch the patients face
Inspection
General observation
o Does the patient look well?
o Is there a walking stick? Frame?
o Is there a shoe raise?
o Hands (Rheuamtoid arthritis?)
Patient Standing
Remember to inspect from all sides (front, laterally and from behind):
o Skin
Scars (previous injuries or surgical scars)
Sinuses (secondary to TB or infected hip replacements)
Colour - discolouration?
o Deformity
Abduction / adduction contracture
o
o
o
Patient Walking
Patient Lying down - supine with one pillow under the head
Palpation
Ask the patient.."Does it hurt anywhere?"
Skin temperature (use dorsal surface of your hand to compare temperatures over both hips)
Is there tenderness over the bony landmarks?
o Anterior and posterior superior iliac spines
o Ischial Spine
o Greater Trochanters (trochanteric bursitis)
o Iliac crests
o Ischial tuberosity (hamstring tear)
o Pubic Tubercle
Is there tenderness of the soft tissues?
o Muscles
o Femoral triangle
Measurement
Before measuring, if a fixed deformity of one leg has been observed, the unaffeted leg should be placed in
the same position as the one affected to make them identical.
The different types of measurements to be taken are:
Apparent length - the distance between the xiphi-sternum (a fixed point) and the medial mallelous.
True length - the distance between the ASIS and the medial malleolus
Circumference of the quadriceps at a fixed point (from the tibial tuberosity).
If a difference has been observed in true leg length measurements, it is important to determine whether the
shortening is above (femoral) or below (tibial) the knee:
Having asked the patient to bend their knees, keeping their ankles together, compare the position
of both knees.
Movement
These should be performed both actively and passively for both legs. When assessing hip movements, it is
important to fix the pelvis and prevent any movement taking place at this anatomical structure. This is done
either by dropping one leg over the edge of the couch and assessing movements of the other leg, or by
placing one forearm between the ASIS's.
Active movement
Passive movements
Repeat the above movements but additionally testing for hip rotation.
Rotation - With each leg in turn, flex both hip and knee to 90o , and having stabilised it with one
hand, move the heel first outwards (internal rotation - 0-45o) and inwards (external rotation - 0-45o)
with the other hand.
Special Tests
There are two special tests:
Trendelenburg test - test of abductor function (gluteus medius weakness)
Watch for the patients' response in terms of balance (truncal position) and pelvic tilt
Negative test (normal)
o If pelvis stays level or rises slightly, with the trunk staying over the pelvis (i.e. staying over
the centre of gravity), AND can be maintained for 30 seconds.
Positive test (abnormal)
o The patient is unable to hold pelvis level and maintain this for 30 seconds.
o The patient leans over to the affected side, in order to keep their centre of gravity over
their foot
For further information about performing a Trendelenburg test, please Click Here.
Thomas' test - test for fixed flexion deformity
With the palm up, place your hand beneath the lumbar spine
Passively flex the unaffected hip until the hollow of the lumbar spine is eliminated
The affected leg rises up from the bed, if there is a fixed flexion deformity present.
Repeat for the other side
Finally