HIP EXAMINATION

Basic Principles
( Prerequisites of Examination )

 Patient must be suitably undressed.

 Hard bed.
Pattern of Examination
 Inspection.
 Palpation.
 Movements.
 Measurements.
 Special tests.
Inspection
 Standing position.

 Lying down position.

Inspection (contd)
In standing position
 Patient able to stand – Yes / No.
 If yes, patient able to walk – Yes / No.
 If yes, check Gait.
 Gait :
– Trendelenburg.
– Antalgic
– Waddling
– Short legged
– High stepping
 Patient able to squat or not.
Inspection (contd)
In standing position

 Trendelenburg test
Inspection (contd)
In standing position
 Spine.
 Wasting eg Disuse atrophy, neurological
deficit.
 Swelling eg Cold abscess, dislocation, lipoma.
– Scarpas triangle.
– Greater trochanter.
– Gluteal region
 Scars / Sinus
 Level of natal fold eg CDH.
Inspection (contd)
In lying down position

Sequential -
Top to bottom
or
Bottom to top.
Inspection (contd)
In Lying down position
 Attitude.

 Lumbar lordosis.

 ASIS.

 Greater trochanter
– Position
– Prominence
Inspection (contd)
In Lying down position
 Scarpas triangle
– Fullness.
– Scars / sinus.
 Skin
– Colour, texture, prominent veins.
 Thigh
– Wasting.
 Patella
– Position
Inspection (contd)
In Lying down position
 Calf
– Wasting
 Malleoli
– Level
– Direction.
 Heel
– Level
 SLR
 Palpation
Confirmation of inspection findings in same
sequence plus few additions :
Temperature, Tenderness & Telescopy

 Lumbar lordosis
– Thomas’s test for FFD.
 Palpation (contd.)
 ASIS level
– How to feel ?
– Level.

 Greater trochanter
– Position, Promince (Bitrochanteric test).
– Tenderness – Antero posterior / Axial.
Palpation ( contd. )
 Temperature
 Scars
 Sinuses :
– Margins, Discharge, adherence to bone
 Tenderness
 Circumference of thigh / calf
 Medial malleolus
– How to feel?
– Level & direction
 Heel
– Level
Palpation ( contd. )
 Telescopy
Movements
Sagittal Flexion 0-90 ext knee
0 – 120 fl knee
Extension 0 -15
Coronal Adduction 0 – 30
Abduction 0 - 40
Vertical External 0 – 45
Internal 0 – 30
rotation.

Circumduction Incomplete

In fixed deformities, starting point will be the degree of deformity

 Measurements
Apparent : Lengthening / Shortening.

 Pre requisite
– Limbs parallel

 Measured between midline point -

xiphisternum, manubrium sterni or umbilicus
&
medial malleoli
Measurements
Real : Lengthening / Shortening

 Pre requisites
– Squaring of pelvis.
• ASIS at same level.
– Limbs in identical position.

 Measurement from ASIS to medial

malleolus.
Measurements ( contd )

 Find level of discrepancy

– Leg,

– Thigh or

– Supratrochanteric.
Measurements( contd )
(How to detect supratrochanteric
shortening)
 Bryants triangle.

 Nelaton’s line.

.
Measurements ( contd )
(How to detect supratrochanteric
shortening
 Schoemaker’s line.

 Chiene’s parallelogram
Special Tests
 Narath’s vascular sign.

 Ortolani’s test.
 Barlow’s test.

 Ely’s test.
Examination (contd)

 Examination of hip is incomplete without

examination of spine & knee.
Key to Examination findings
ASIS at same No adduction or Apparent
level abduction measurements =
deformity Real
measurements
ASIS raised Adduction Apparent
deformity shortening >
Real shortening
ASIS lower Abduction Apparent
deformity lengthening >
Real
lengthening