Hip Examination

General: permission, privacy, exposure (from waist down the knee), assisted canes or
crutches

Look
From front:

- Posture - Alignment
- Shoulder level - Pelvic obliquity
- Muscle wasting - Deformities
- Skin - Scars
- Swelling - Sinuses

From lateral:

- Thoracic Kyphosis - Lumber lordosis

- Muscle wasting - Scars
- Swelling - Sinuses

From behind:

- Spinal curvature - Gluteal folds

- Skin - Scars
- Hamstring and calf wasting - Heel and foot

Ask the patient to walk (GAIT):

- Antalgic gait - Short-leg gait

- Trendelenburg gait - Ataxic gait
- Hemiparetic gait - Shuffling gait
- High stepping gait

Trendelenburg test:

- -/+ Trendelenburg sign - Trendelenburg lurch

- Sound side sag sign
Feel
Ask the patient to lay down in supine position

 Palpate for temperature, tenderness, swelling, LNs, joint line, ASIS, GT and
symphysis pubis for tenderness.
 Square the pelvis.
 Measure the length:
 Apparent length (Umbilicus or xiphisternum to medial malleoli
bilaterally)
 True length (ASIS to medial malleoli bilaterally) , If there is a fixed
deformity, the good leg must be placed in a comparably deformed
position relative to the pelvis before measurements are taken( mirroring)
 Galeazzi's test. In case of shortening to determine whether is it tibial or
femoral shortening. For femoral shortening check for :
 Bryant’s triangle.
 Nelaton’s line.
 Schoemaker’ s line.
 Thomas test for fixed flexion deformity.

Move
For Range of Motion:
 Flexion (with flexed Knee, from 0° to between 100° and 135°).
 Extension (not routinely tested, from 0° to between 15° and 30°).
 Abduction ( pelvis stabilized with the examiner hand on the opposite
anterior superior iliac spine, normal ranges are from 0° to between 40°
and 45°).
 Adduction (Normal ranges are from 0° to between 20° and 30°).
 Internal rotation in extension from 0° to between 30° and 40°and in
flexion also from 0° to between 30° and 40°.
 External rotation in extension from 0° to between 40° and 60°and in
flexion also from 0° to between 40° and 50°.

NB: in range of motion examination don’t miss to cub the heel.

Special Tests:

 Impingement tests:
 Anterior Impingement test: With the patient supine, the hip is
flexed to 90°, then adducted and internally rotated.
 Posterior Impingement test: For this test, the patient lies supine at
the edge of the examination couch with the affected leg dangling. The
contra lateral leg is held in flexion while the examiner fully extends the
affected hip while abducting and externally rotating the leg.
 Patrick or FABER (Flexion, ABduction, External Rotation) test:
for sacroiliac joint.
 Tests of hip contractures:
 Ely’s test is used to evaluate a tight rectus femoris. The patient lies
prone and the knee is passively flexed. If the rectus femoris is contracted,
then the patient’s hip, on the same side as the flexed knee, will
spontaneously rise.
 Ober’s test evaluates contracture of the fascia lata or iliotibial band.
The patient lies on the unaffected side. The unaffected hip is maximally
flexed to flatten the lumbar spine. The affected hip is flexed and
abducted 45°. This hip is then slowly extended. Normally, in bringing the
hip into extension it will be possible to adduct the hip to the midline. If
the leg remains abducted this is indicative of a contracture of the iliotibial
band.
 Phelps’ test evaluates tightness in the gracilis muscle. The patient lies
supine and the affected hip is abducted as far as possible. The knee is
then flexed over the side of the couch. If more abduction is possible by
flexing the knee (and relaxing the gracilis), then this signifies that the
gracilis is tight.