EXAMINATION OF HIP

Prerequisites
• Patient must be suitably undressed
• Examination of hip should be performed on a
hard bed
 Inspection
• Examine the standing patient from front
– Any pelvic tilting
• Add/Abd deformity of hip
• Leg shortening
• Scoliosis
– Muscle wasting
• Secondary to infection
• Disuse
• Polio
– Rotational deformities
• Usually seen in osteoarthritis
• Examine from side
– Lumbar lordosis
• FFD of hip
• Examine the patient from behind
– Scoliosis
• Secondary to pelvis tilting
• Add deformity of hip
– Gluteal muscle wasting
• Disuse, Infection
– Gluteal folds
• DDH
• Gait
– From front, sides and behind
• Assess the stride, dwell time
– Trendelenburg
– Antalgic
– Waddling
– Short legged 
– High stepping
• Shortening
– Apparent
• As pelvic tilting
• limb not altered in length- adduction contracture of hip
– May be compensated by
• Foot plantarflexion
• Flexion of knee contralaterally
– May be compensatory for lumbar lordosis
 Palpation
• Palpate femoral head in scarpa’s triangle
– Tenderness
– Rotate the limb- crepitus
• Origin of Adductor Longus
– Strain
– Adductor contractures of hip in OA
• Lesser trochanter
– Extrenally rotate the limb
– Tenderness
• Iliosposas strain
• Ischial tuberosity
– Hasmtring injuries
• Greater trochanter
– Bursitis
 Movements
• Extension
– Thomas test
• Check for lumbar lordosis
• If it has been obliterated during the course of exam or
not
• flex the good hip fully- till lumbar lordosis is obliterated
• Affected hip rises from couch- FFD hip
– In prone position
• Lift each leg
• Normal- 5-20°
• Flexion
– Flex the good hip first
– Obliterate the lumbar lordosis- steady the pelvis
– Ask the patient to hold the leg
– Flex the hip to be examined
– Use hand to check any pelvic movement
– Normal 0-120°
• Abduction
– Fix the pelvis
• Hold the opposite ASIS with one hand
• Fix the other spine with forearm of same hand
• Flex the other leg over the edge of the couch
– Move the leg laterally
– Normal- 40°
– Patrick’s/FABER test
• Flex, Abduct, Externally Rotate
• Flex both hips and knees
• Place one foot on contralateral knee
• Gently press down on ipsilateral knee
• Pain- first sign of OA
• Abduction
– Ideally an assistant should lift the good leg up
– If not available
• Cross the leg being examined over the other leg
• Leg being examined is in slight flexion
– May also be tested from a starting position of 90°
of hip flexion
• Internal rotation at 90° flexion
– Steady the flexed hip by holding the knee
– Move foot laterally- internal rotation
– Comparison- Ask the patient to hold knees together
while moving legs laterally
– Normal- 45°
– Loss of IR is common in most hip pathologies
• External rotation at 90°
– Same postion as IR
– Leg is moved medially
• External rotation at 90°
– Same postion as IR
– Leg is moved medially
– Normal- 45°
– Comparison- crossing over of both legs over each
other
• Anteversion of femoral neck
– Prone position
– Flex the knees
– Hold the leg in one hand and rock it from side to
side
– Feel the GT simultaneously
– GT facing true lateral- measure the angle with the
midline
• Testing for hip fusion
– Flex the good hip
– Sudden abduction- involuntary adductor
contraction
 Measurements
• True shortening
– Patient should lie squarely
• The plane of ASIS should be parallel to the edge of table
• Medial malleolus will not be on the same level
– Above trochanter
• Feel the ASIS and GT
• Measure the distance between ASIS and ipsilateral GT
• Seen in
– Coxa vara- SCFE, LCPD, congenital
– Loss of articular cartilage
– Hip dislocation
– Femoral length
• From GT to superior pole of patella
– Tibial length
• From tibial tuberosity to medial malleolus
– Total limb length
• From ASIS to medial malleolus
• For comparison- Xiphisternum to medial malleolus
– In adduction deformity
• Measurements should be taken with both limbs in
same attitude
 Trendelenberg test
• Ask the patient to stand on the affected side
• Support/stick should be in same hand, if any
• Ask the patient to raise the non stance leg
• Prevent excessive trunk movements
• Test positive if
– Pelvis on the normal side drops below
– Or the patient can’t hold the position for 30 sec
• Not valid for age < 4 yrs
• False positive- pain/poor compliance/ bad balance
 Duchenne sign
• Observe the patient when walking
• Lurching to one side +/-
• Patient tries to shift body weight on the
affected side
• Lesser reaction force at hip joint
• Lessens hip pain
 Ortolani’s test
• Carried out on a relaxed child- well fed baby
• Flex the knees and encircle them with hands
• Thumb on medial aspect of thighs
• Flex the hips to right angle
• Abduct the hip gently and smoothly
• At full abduction- femoral head slips into the
acetabulum
• Indicative of DDH
 Barlow’s test
• Fix the pelvis between symphysis pubis and
sacrum with one hand
• Gentle but firm pressure backward with the
thumb of the other hand
• Check if hip dislocatable
• If femoral head is dislocated/ subluxated-
forward pressure by fingers or wider
abduction reduces it