Hip Examination
Hip Examination
Hip Examination
Objective:
● To be able to perform a proper hip examination and identify any
abnormality that aids in diagnosis
While Standing
★ Look
○ Shoulder level.
○ Pelvis level.
○ Lumbar lordosis.
○ Spinal deformities (Kyphosis, Scoliosis,Hyperlordosis...).
● Next you ask the patient to walk in a straight line, comment on the Gait if it’s:
● There are many ways for doing the test. The preferred way to do the test by the
doctors who taught us is the following:
○ You sit on a chair in front of the patient and you ask him/her to stand
unassisted on each leg in turn, while placing his/her hands on your
shoulders for support.
○ Place your hands on the anterior superior iliac spines of the patient (one on
each side).
○ Ask the patient to rise the foot on the contralateral side from the floor by
flexing the knee. “If we want to examine the right side, ask patient to flex
his/her left leg”
○ Normally, the hip is held stable by Gluteus Medius acting as an abductor in
the supporting leg.
○ If the pelvis drops on the unsupported side/flexed knee = positive
Trendelenburg sign.
While Lying
★ Look
● Skin Changes.
● Scars.
● Discolorations/erythema.
● Swellings.
● Muscle Wasting: Glutei.
OSCE Tip: If you were asked to do a Focused exam on one side, this means that you
have to do all the exam only to that side (not only the special tests). Mention that you’ll
examine the other side to compare at the end for the sake of time.
★ Feel
● Don’t forget to Ask the patient before you start: Do you have any pain?
● Skin Temperature (by the dorsum of your hands).
● Tenderness over the Bony Landmarks:
○ Anterior Superior Iliac Spine.
○ Iliac crest.
○ Greater Trochanter.
○ Pubic Tubercle.
★ Move
● While flexing the hip you can examine the Internal Rotation and the External
Rotation of hip at 90 degrees hip and knee flexion passively. Comment on the
degree.
● Passive Abduction and Adduction and stabilize the pelvis. Comment on the
degree.
★ Special Tests
● Thomas test:Video
○ With the help of a measuring tape, measure both legs from the Anterior Superior Iliac spine to
the medial malleolus of each side. (“True” leg length discrepancy measurement)
○ Compare both legs’ length to look for any discrepancy.
○ If there is a difference, look for the Galeazzi sign to Identify level of leg length discrepancy.
(The “apparent” leg length is measured from the umbilicus to the medial malleolus.)
● Galeazzi sign:Video
○ I’ll finish my examination by examining one joint above (Lumbar spine) and
one joint below (knees).
○ I’ll also do a full neurovascular exam.
○ I’ll order imaging if it’s indicated.
○ Don’t forget to thank and to cover the patient.
OSCE Tip: At the end of your exam explain to the patient his/her most likely condition. We
were told it was marked in the checklist.