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Examination of the Hip

Summary

Introduction

  • Aids, Exposure, Stigmata generalised disease

Look

  • Front:
    • Skin, scars, swelling, dystrophic changes,
    • Coronal plane Deformity – knees, feet, Wasting - quadriceps
  • Side:
    • turn affected side towards you,
    • Skin, scars,
    • Deformity
      • lumbar lordosis, flexion attitude of hip , flexion attitude of knee (may be 2° to hip)
    • lumbar spine - forward flexion -> “there is N unrolling of Lx spine”
  • Back
    • Skin, scars
    • lumbar spine
    • buttocks – wasting (look from above), popliteal creases, heels
    • Trendelenberg
      • 1. pain - painful disorder of hip
      • 2. pivot
        • dislocation or subluxation of hip
        • shortening of femoral neck
      • 3. power - weakness of abductors
  • Front
    • Pelvis
      • pelvis is level/not level
      • stance is symmetrical (knee flexed, ankle equinus)
      • blocks --> functional LLD

Gait

  • possibilities:
    • Short (shoulder drops & lurch on ipsilateral side)
    • Trendelenburg (gait or lurch)
    • Stiff knee
    • Antalgic
    • Weak
    • Supratentorial (CNS)

Supine on Couch

Feel

  • along line of inguinal ligament from medial to lateral
    • (dislocated f head, hernias, aneurysms, lymph nodes)
  • tenderness (LFCN)
  • greater trochanter (trochanteric bursitis)

Move

  • Lift both heels off bed & comment on knee FFD
  • Thomas' Test – hand under deep & leave there
    • [Special cases - FFD knee - place patient at edge of couch]
    • passively flex both knees to 45°
    • ask patient to actively flex unaffected hip & knee to chest
    • gently passively maximise flexion
    • ask patient to clutch knee to chest
    • comment
      • lumbar lordosis eliminated
      • contralateral flexion range of (x°)`
    • [do not remove hand throughout test]
    • gently extend affected hip passively
    • stop when painful comment FFD of (x°)
    • Other side

Rotation in flexion

    • hip flexed to 90°
    • hold leg with one hand
    • hand in popliteal fossa
    • leg resting on forearm
    • assess pelvis movement with other hand
    • palpate contralateral ASIS

Abduction / adduction in extension

  • hip & knee extended
  • fix pelvis - abduct unaffected hip over couch
  • examine unaffected side
  • Charnley test for Arthrodesis
  • - hand on abductors
  • - jerk of abduction -> feel add contraction
  • - if add contr then hip not fused

Leg Length

  • Must do once cor & sag plane deformity known
  • make pelvis square with bed
  • make legs square with pelvis & straight
  • Legs square & straight
    • Leg length (check heel height)
    • If not able to get symmetrical legs
    • Position legs symmetrical e.g. pillow for knee FFD
      • Hip add contracture – one at time over other
      • Valgus knee – measure cpts

Galeazzi’s Sign

  • flex knees to 90°
  • parallelism of femora & tibia

Bryant’s triangle – if Galleazzi’s test suggests above knee

  • identify ASIS with thumb & tip of gr troch with forefinger
  • diff between ASIS & GT suggests discrepancy proximal to GT
  • ‘when Bryant’s triangle constructed, ^ dis between points is diff by (x) fingerwidths’
  • if reduced, construct Roser-Nelaton’s line

Lateral On Couch

  • Abductor power, grade power

Prone On Couch

  • avoid with significant pain or FFD
  • Gluteal bulk
  • Rotation in extension
  • fix pelvis - place hand across SI joints
  • flex knee to 90°

Special

  • Circulation
    • distal pulses
  • Concealed
    • groin & perineum
  • Cephalad Joint

Notes

  • Apparent LL
    • leg length measured without correcting for sagittal or coronal plane deformity [ leg appears short]
  • Real LL
    • leg length measured once coronal & sagittal plane deformity corrected for [ leg is short]
    • sum of intercalated segments
  • Bryant’s Δ
    • vertical line from ASIS to couch & ^ to Gr T
  • Nelaton’s line
    • ASIS to Ischial T
    • hip flexed & add line N’ly crosses top Gr T

Faber Test

  • Flexion,abduction,IR
  • ie pos's when start test
  • foot to knee
  • abduct thigh
  • neg if at least parallel to opposite leg
  • +ve indicates pathology (Hip Jnt, Iliopsoas spasm, SI jnt)

Ober's Test

  • Tests TFL for contracture
    • patient on side with knee either flexed or extended
    • abduct & extend hip
    • lower limb to table (adduct)
    • if remains abducted then is +ve

Rectus Femoris Contracture

  • one leg over end of table
  • other is flexed to chest
  • postive if knee extends