EXAMINATION OF THE HIP

© Krisna. 2009
• Hip joint is inherently stable, ruquiring
significant force to dislocate
• Hip joint  ball-and-socket
• Acetabulum = socket, head femur = ball
• The stability is maintained by bone & strong
ligaments
– From the front : pelvic tilting, muscle wasting, rotation
– From the side : lumbar lordosis
– From behind : Scoliosis, gluteal muscle wasting, sinus scars

McRae. Clinical Orthopaedic Examination

– From the front
– From the side
– From behind

McRae. Clinical Orthopaedic Examination

• Notice any area of tenderness
• Bone & soft tissue
– Anteriorly
– Laterally
– Posteriorly
• Supine position
• Prone position : hip extension
• Symmetry/asymmetry
Compare with the other side
Clinical Tests for the Musculoskeletal System. Klaus Buckup (2004)
Clinical Tests for the Musculoskeletal System. Klaus Buckup (2004)
Clinical Tests for the Musculoskeletal System. Klaus Buckup (2004)
 Muscle Grading Chart
Muscle Gradation Description
5 – normal Complete ROM againts gravity with full resistance
4 – good Complete ROM againts gravity with some resistance
3 – fair Complete ROM againts gravity
2 – poor Complete ROM with gravity eliminated
1 – trace Evidence of slight contractility, no joint motion
0 – zero No evidence of contractility

Hoppenfeld, Stanley. Physical Examination of

The Spine and Extremities
 Flexors
Musle Origin Insertion Nerve Other
function
Iliopsoas Psoas : T12-L5 Lesser Femoral nerve -
(primary) Iliacus : Iliac fossa trochanter
Rectus Femoris AIIS Patella Femoral nerve Knee extension
Superior rim of
acetabulum

Thompson, J. Netter’s Concise Atlas of Orthopaedic Anatomy

 Extensor
Musle Origin Insertion Nerve Other
function
Gluteus Ilium, dorsal Gluteal tuberosisty Inferior External
Maximus sacrum gluteal nerve Rotation
(primary)

Hamstrings Ischial tuberosity Semimembranous : Sciatic nerve Knee flexion

Proximal medial tibia
Short head biceps: Semitendinous :
Linea aspera, Posteromedial tibial condyle
supracondylar line Biceps :
Head of fibula, lateral tibia

Thompson, J. Netter’s Concise Atlas of Orthopaedic Anatomy

 Abductors
Musle Origin Insertion Nerve Other
function
Gluteus Ilium Greater trochanter Superior -
medius gluteal
(primary) nerve
Gluteus Ilium Greater trochanter Superior -
minimus gluteal
nerve

Thompson, J. Netter’s Concise Atlas of Orthopaedic Anatomy

 Adductors
Musle Origin Insertion Nerve Other
function
Adductor Body of pubis Linea aspera (mid 1/3) Obturator -
longus nerve
(primary)
Adductor brevis Body, inferior Pectineal line, upper linea Obturator -
pubic ramus aspera nerve
Adductor Ischiopubic ramus Linea aspera Obturator Hip flexion
magnus ischial tuberosity nerve
Pectineus Pectineal line of Pectineal line of femur Femoral Hip flexion
pubis nerve
Gracilis Body, inferior Proximal medial tibia Obturator Flexion, Internal
pubic ramus nerve rotation

Thompson, J. Netter’s Concise Atlas of Orthopaedic Anatomy

 Thomas Test
• Hugh Owens Thomas (1876)
• Assesses extension in the hip
 detect flexion contracture
• Contractures of the hip occur in osteoarthritis,
inflammation, and articular deformities of the
hips. They can also cause by spinal disorders.

Hoppenfeld, Stanley. Physical Examination of The Spine and Extremities

 Thomas Test
• Supine position
• Stabilize the pelvic by placing hand under the
patient’s lumbar spine dan flexing the hip
• Flex the hip as far as possible
• (+) if : inability to extend the leg straight without
arching the spine or the hip doesn’t extend fully

Hoppenfeld, Stanley. Physical Examination of The Spine and Extremities

 Trendelenburg Sign & Test
• To evaluate the strenght of the gluteus medius
muslce
• Observe form behind

Abnormal
With incuficiency of
The gluteal muscle

normal

Hoppenfeld, Stanley. Physical Examination of The Spine and Extremities

 Ober Test
• To test for contracture of the iliotibial track

Hoppenfeld, Stanley. Physical Examination of The Spine and Extremities

 True Length Measurement
• Measure the distance from ASIS to medial
malleoli of the ankle
• Compare with the other side

Hoppenfeld, Stanley. Physical Examination of The Spine and Extremities

 Apparent Length Measurement
• Measure from umbilicus to the medial
malleoli of the ankle
• Compare with the other side

Hoppenfeld, Stanley. Physical Examination of The Spine and Extremities

Thank you