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Hip examination frequently appears in OSCEs.

Youll be expected to pick up the


relevant clinical signs using your examination skills. This hip examination OSCE guide
provides a clear concise step by step approach to examining the hip joint.

Introduction
Wash hands
Introduce yourself
Confirm patient details name / DOB
Explain examination:
Today I need to examine your hip joint, this will involve looking, feeling and moving the
joint.
Check understanding & gain consent:
Does everything Ive said make sense? Are you happy for me to examine your
hip joint?
Ask if patient has had a hip replacement (if so internal rotation, adduction & flexion
greater than 90 should be avoided due to risk of dislocation)
Expose patient appropriately
Position patient standing
Ask if the patient currently has any pain

Look
Look around bed for any aids or adaptations walking stick / wheelchair

Inspect patient from all angles


Front scars / pelvic tilt /quadriceps wasting / foot deformity
Side assess lumbar lordosis normal / hyperlordosis
Behind scoliosis / gluteal wasting / pelvic tilt

Inspect the lower hip joint, pelvis and lower limb.

Inspect the lower hip joint, pelvis and lower limb.

Inspect the lower hip joint, pelvis and lower limb.

Gait
Observe patient from behind, the side and in front.
Assess speed /smoothness /turning.
Note any evidence of antalgic gait or Trendelenburg gait.
Assess the patients footwear unequal sole wearing abnormal gait

Observe the patient's GAIT.

Inspect the patient's footwear for signs of uneven sole wear.

Feel
Ask patient to lay down on a bed.
Palpate the tissues overlying the hip joint for tenderness / warmth inflammation /
infection

Palpate greater trochanter tenderness (often indicative of bursitis)

Assess leg length


Measure apparent leg length umbilicus to the tip of medial malleolus
Measure true leg length ASIS to the tip of medial malleolus

Assess & compare hip joint temperature.

Palpate the greater trochanter for tenderness (bursitis).

Measure apparent leg length.

Measure true leg length.

Move
Active movements
Place your hand under the lumbar spine to detect masking of hip movement by the
pelvis / lumbar spine.
Flexion bring your knee towards your chest normal ROM is 120

Passive movements
Flexion assess the degree of flexion in each hip individually normal ROM is 120
Internal rotation:
This can be assessed with the hip & knee joint flexed at 90
o

Rotate the foot laterally

Normal ROM 40

External rotation:
This can be assessed with the hip & knee joint flexed at 90
o

Rotate the foot medially

Normal ROM 45

ABduction whilst stabilising the contralateral iliac crest, use your other hand abduct
the hip until you feel the pelvis begin to tilt normal ROM is 45
ADduction whilst stabilising the contralateral iliac crest, use your other hand to adduct
the patients leg across the midline as far as possible normal ROM is 30

Assess active HIP FLEXION

Assess passive HIP FLEXION

Assess passive HIP INTERNAL ROTATION

Assess passive HIP EXTERNAL ROTATION

Assess passive HIP ADDUCTION (stabilising contralateral iliac crest)

Assess passive HIP ABDUCTION (stabilising contralateral iliac crest)

Position patient prone


Hip extension (passive):
o

Place a hand on the pelvis to assess for movement

Lift one leg at a time to assess range of extension

Normal ROM is 10-20

Assess HIP EXTENSION

Special tests
Thomass test
1. Place hand under patients spine.
2. Passively flex both legs (hips/knees) as far as you are able to.
3. Your hand should detect that the lumbar lordosis is now flattened.
4. Ask patient to fully extend the hip you are assessing:
o

Incomplete extension suggests a fixed flexion deformity at the hip joint.

5. Repeat the test to assess the contralateral hip joint.


DO NOT PERFORM ON PATIENTS WITH HIP REPLACEMENTS can cause
dislocation!

Passively flex both hips as far as possible (ensuring the lumbar lordosis is eliminated).

Ask the patient to fully extend the hip being tested. An inability to fully extend the hip suggests a fixed flexion deformity o

Trendelenburgs test
1. Place hands on the iliac crests on either side of the pelvis.
2. Ask the patient to stand on one leg for 30 seconds.
3. Observe your hands to see which moves up or down.
4. Normally the iliac crest on the side with the foot off the ground should rise up.
5. Repeat the test on the opposite side.
The test is deemed positive (abnormal) if the pelvis falls on the side with the foot
off the ground.
This abnormal result suggests weak hip abductors on the contralateral side of the
pelvis.

Perform Trendelenburg's test.

To complete the examination


Thank patient
Wash hands
Summarise findings

Suggest further assessments & investigations


o

Full neurovascular examination of both lower limbs

Examine the joint above and below lumbar spine / knee

Consider further imaging if indicated e.g. X-ray / CT / MRI