Hip Examination

Prepared by:
Sunil Baniya (Roll No. 3083)
4th Year, 3rd Batch
NAIHS-COM, sanobharayang, ktm

Shoulder examination/ Sunil Baniya 1

Chief complaints:

1. Pain

2. Swelling

3. Deformity

4. Stiffness

5. Inability to squat

6. Limp

7. Inability to walk
 First exposed the part of body below midthorax except the private parts

 Patient is examined in 3 positions:

1. Standing

2. Sitting

3. Lying in couch

1. Examination of patient in standing position:

a) Look/ Inspection:
Front:
 Level of ASIS (for pelvic tilting)

 Muscle wasting (quadriceps femoris)

 Limb shortening

 Rotational deformity (Osteoarthritis)

Side:
 Increased lumbar lordosis (hyperlordosis)

 Kyphosis (thorax)
Behind:
 Gluteal muscle wasting

 Muscle prominence on either side of the vertebra

 Level of iliac crest

 Scoliosis

 Sinus, scars

 Tufts of hair on the lumbar regions

 Cafe au lait spots

b) Gait:
- May be

 Normal

 Antalgic gait

 Trendelenberg gait (waddling gait)

 Circumduction gait

 Schuffling gait

 Stomping gait etc

Note :
In OA hip, patient walk with his body lurches to affected hip so that center of gravity falls on affected limb. But abductor
being intact [Duchhene sign].
Should not be confused with Trendelenberg test +ve in which abductor mechanism is insufficient.
c) Trendelenberg’s test:

 Ask patient to stand on normal leg first + opposite leg to flex at knee around 90°

 Then ask to stand on affected limb as previously

 See the level of ASIS

 If the ASIS of normal side is lower than the affected side, this test is positive.

2. Examination with patient sitting:

 To test the iliopsoas function

 Place hand firmly on his thigh & ask him to flex/lift the thigh against resistance

 If pain or weakness occurs, tendinitis or psoas bursitis

3. Examination of patient lying on couch:

a) Look:
 Level of ASIS

 Attitude of leg

 Hip flexed or not

 Lumbar lordosis
b) Feel:
i) Temperature:

 At groin

 Greater trochanter

 Gluteal region

ii) Tenderness:

(vary for teachers)

For Dr. Bachhuram K.C.

 First normal then affected side

 Elicit tenderness over:

- Anterior [ Femoral head] : Just 2 cm below & medial to mid-inguinal point

- Lateral : above the GT (tip of GT)

- Posterior : at mid-point between ischial tuberosity and GT

For Dr. Bishnu Babu Thapa

 Try to elicit tenderness over bony landmarks

- Femoral head: just 2 cm below & medial to mid-inguinal point

- Over GT

- Over ischial tuberosity

- Over ASIS

- Over lesser trochanter (externally rotate the leg & feel over the LT)

iii) Femoral pulse:

 Palpate just below the mid-inguinal ligament

 Findings:
- Present = normal
- Absent = vascular sign of Narad?? (in central hip dislocation)
iv) Any swelling: examine it

 Dislocated femoral head either in

-Gluteal or

-Groin region

c) Move :
 First actively, if not possible (restricted) then only passively

 First normal then only affected

- Flexion = 120°

- Extension = 5-20°
- Adduction = 25°

- Abduction = 40°

- Internal rotation (at 90° flexion) = 45°

- External rotation (at 90° flexion) = 45°

Special tests:
1. Thomas test
2. Adduction and abduction deformity
3. Patrick test (Faber sign)
4. Galezzi test (Allis’ sign)
1. Thomas test:
 To detect fixed flexion deformity

 Put one hand behind lumbar region on palm facing towards bed

 Flex hip of normal side (by examiner) until lumbar

 lordosis is obliterated i.e; patient’s back touches dorsum of

hand of examiner

 Then affected leg may be flexed at hip (or also in knee)

 Measure the angle at hip ( flexion with bed) Figs : A and B: Thomas test

 Lets suppose it become 20° , then range of motion (ROM) is

20° to 120°.
2. Adduction and abduction deformity:

 Ask patient to lie on bed as straight as he can with both legs

parallel to each other

 See ASIS on both side

 Findings:
- Pelvis square : no deformity

- ASIS on affected side lower than normal : abduction deformity, to

measure deformity, further abduct and then square the pelvis first

- ASIS on affected side higher than normal : adduction deformity,

to quantify deformity , further adduct and square pelvis first

- Degree of Abduction/ adduction deformity : angle between long

axis of body and that of leg
3. Patrick test (Faber sign):

 Patient supine

 Leg flexed at hip and knee, abducted & externally rotated

Put on unaffected leg

Pressure over knee

Pain over hip joint means Faber sign +ve thus hip joint
pathology
Fig: Faber test
Also a test for Sacroiliac joint
4. Galeazi test (Allis’s sign):
 Flex the knees at 90° and ankles at 45°

 Keep both heels at the same level

 Note

- Level of knees &

Fig : Galleazi's sign
- Parallelism of thighs and legs :

# if legs are parallel: limb length discripancy is below knee joint

#if thighs are parallel: discrepancy is above knee joint. Again draw a
Bryants triangle from ASIS and GT => measure the distance from
GT to point of cross section (on both side) Fig : Bryant's triangle
 Findings: if both side equal, then infratrochanteric cause & if not equal,then
supretrochanteric cause like OA of hip

d) Measurement:

 Apparent length & true length

Apparent length:

- On both side

- Measure from xiphisternum to the lower border of medial malleoli (without

squaring the pelvis i.e; length with compensatory mechanism)

- Compare the apparent length of both legs

True length:

- Pelvic tilting is corrected by squaring

- Measure length from ASIS to lower border of medial malleoli

(length without compensatory mechanism)

- Compare the length of affected side with that of normal side

 Measure the girth of Quadriceps femoris

- At fixed distance from tibial tuberosity i.e; normally 15 – 20 cm

(to avoid error that may get obtained from joint effusion & swelling of
suprapatellar pouch)

 Compare both sides & find if any muscle wasting present

Thank You