Hip and Knee Examinations

Fahad M. Al-Suwayeh
Orthopedic Resident
KKUH
 Objectives
• Hip examination
• Knee examination
• Distal neurovascular examination
 General examination
• General look
• Vitals
 Hip
• Inspection
• Swelling, erythema, ecchymosis, atrophy, deformity,
scars
– GAIT (for any lower limb examination)
– Standing:
• Anterior,
• Posterior, pelvic obliquity
• LLD (Iliac crest)
• Palpation
– Supine (Anterior, Lateral)
• Bony and soft tissue tenderness
• ROM
– Passive and active flexion (+ Thomas) 0-130
– Abduction (35-50) and Adduction (25-35)
– IR, ER
– Hamstring flexibilty
 Special tests
• Trendelenburg test
• FABER test
– SI joint
• Logrolling test
• Piriformis test (FADIR In lateral position)
 Knee Examination
• Inspection (Anterior, Lateral, Posterior)
– SEADS
– Malalignment
– GAIT
• Palpation
– In a systematic way for bony and soft tissue (in full
extension and 30 degree flexion for JL)
– Looking for tenderness, effusion, PT defect
• ROM
– Active then passive (0-140)
• Special tests (6)
– Collaterals,
– Cruciate,
– patella,
– Menisci,
– ITB
– PLC,
• Collaterals
– Varus, Valgus stress test
• ACL
– Anterior drawer,
– Pivot shift test
– Lachman
• PCL
– Posterior drawer
• Patella
– Apprehension test
• Menisci
– Mcmurry (w/pain free flexion)
• ER: Medial meniscus
• IR: Lateral meniscus
• ITB
– Ober test
• PLC (Dial test)
– Prone v.s. supine
– w/ 30 flexion externally rotate the foot
– w/ 90 flexion externally rotate the foot
• If +ve only in 30: PLC
• If +ve with both: PLC + PCL
 Neurovascular examination of the lower
limbs
• Neurological
– Dermatomal
– Nerve distribution
• Vascular
– Pulses
– ABI
Neuro exam
 Vascular
• Dorsalis pedis / Posterior tibial

– If palpable
– If not, use doppler
• ABI
– Ankle P/Brachial P
– Instruments?
– How to do?
– Interpretation?
• 0.9-1.2 Acceptable
• >1.3 Calcified
• <0.8 arterial disease or injury to LL arteries
Thank you