Hip examination

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Hip examination Classification and external resources

WikiDoc Resources for Hip examination
Articles
Most recent articles on Hip examination Most cited articles on Hip examination Review articles on Hip examination Articles on Hip examination in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Hip examination Images of Hip examination Photos of Hip examination Podcasts & MP3s on Hip examination Videos on Hip examination
Evidence Based Medicine
Cochrane Collaboration on Hip examination Bandolier on Hip examination TRIP on Hip examination
Clinical Trials
Ongoing Trials on Hip examination at Clinical Trials.gov Trial results on Hip examination Clinical Trials on Hip examination at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Hip examination NICE Guidance on Hip examination NHS PRODIGY Guidance FDA on Hip examination CDC on Hip examination
Books
Books on Hip examination
News
Hip examination in the news Be alerted to news on Hip examination News trends on Hip examination
Commentary
Blogs on Hip examination
Definitions
Definitions of Hip examination
Patient Resources / Community
Patient resources on Hip examination Discussion groups on Hip examination Patient Handouts on Hip examination Directions to Hospitals Treating Hip examination Risk calculators and risk factors for Hip examination
Healthcare Provider Resources
Symptoms of Hip examination Causes & Risk Factors for Hip examination Diagnostic studies for Hip examination Treatment of Hip examination
Continuing Medical Education (CME)
CME Programs on Hip examination
International
Hip examination en Espanol Hip examination en Francais
Businness
Hip examination in the Marketplace Patents on Hip examination
Experimental / Informatics
List of terms related to Hip examination

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In medicine, the hip examination, or hip exam, is undertaken when a patient has a complaint of hip pain and/or signs and/or symptoms suggestive of hip joint pathology. It is a physical examination maneuver.

The hip examination, like all examinations of the joints, is typically divided into the following sections:

• Position/lighting/draping
• Inspection
• Palpation
• Motion
• Special maneuvers

The middle three steps are often remembered with the saying look, feel, move.

Position/Lighting/Draping

Position - for most of the exam the patient should be supine and the bed or examination table should be flat. The patient's hands should remain at her sides with her head resting on a pillow. The knees and hips should be in the anatomical position (knee extended, hip neither flexed nor extended).

Lighting - adjusted so that it is ideal.

Draping - both of the patient's hips should be exposed so that the quadriceps muscles and greater trochanter can be assessed.

Inspection

Inspection done while the patient is standing

The hip should be examined for:

• Abnormal gait - i.e. antalgic gait

Inspection done while supine

The hip should be examined for:

• Masses
• Scars
• Lesions
• Signs of trauma/previous surgery
• Bony Alignment (rotation, leg length)
• Muscle bunk and symmetry at the hip and knee

Measures

• True leg length - anterior superior iliac spine (ASIS) to medial malleolus
• Apparent leg length - umbilicus to medial malleolus

In hip fractures the affected leg is often shortened and externally rotated.

Palpation

The hip joint lies is deep and cannot normally be directly palpated.

To assess for pelvic fracture one should palpate the:

• Ischial spines
• Pubic rami

Movement

• Internal rotation - with knee and hip both flexed at 90 degrees the ankle is abducted.
• External rotation - with knee and hip both flexed at 90 degrees the ankel is adducted.
• Flexion
• Extension - done with the patient on their side. Alignment should be assessed by palpation of the ASIS, PSIS and greater trochanter.
• Abduction - assessed whilst palplating the contralateral ASIS.
• Adduction - assessed whilst palpating the ipsilateral ASIS.

• Assessment for a hidden flexion contracture of the hip - hip flexion contractures may be occult, due to compensation by the back. They are assessed by:
  1. Placing a hand behind the lumbar region of back
  2. Getting the patient to fully flex the contralateral hip.
  3. The hand in the lumbar region is used to confirm the back is straightened (flexed relative to the anatomic position). If there is a flexion contracture in the ipsilateral hip it should evident, as the hip will appear flexed.

Normal range of motion

• Internal rotation - 35°
• External rotation - 45°
• Flexion - 135° (L 2, 3, 4)

With the patient seated, place your hand on top of one thigh and instruct the patient to lift the leg up from the table. The main hip flexor is the Iliopsoas muscle, innervated by the femoral nerve.

(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

Hip flexion

• Extension - 25° (L5, S1):

With the patient lying prone, direct the patient to lift their leg off the table against resistance. Test each leg separately. The main hip extensor is the gluteus maximus, innervated by inferior gluteal nerve.

(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

Hip extension

• Abduction - 45° (L 4, 5, S1):

Place your hands on the outside of either thigh and direct the patient to separate their legs against resistance. This movement is mediated by a number of muscles.

(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

Hip abduction

• Adduction - 25° (L 2, 3, 4):

Place your hands on the inner aspects of the thighs and repeat the maneuver. A number of muscles are responsible for adduction. They are innervated by the obturator nerve.

(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

Hip adduction

Video: Hip Examination

Special maneuvers

• Trendelenburg's test: Telescoping axial movement is tested with knee bent 90 degrees and lying on couch. Tests for dislocation

Other tests

A knee examination should be undertaken in the ipsilateral knee to rule-out knee pathology.

See also

• Anatomical terms of location
• Anatomical terms of motion

External links

• Clinical Hip Examination - Orthopaedic Research Institute Australia.

v • d • e Physical examination
Neurology | Mental state | Eyes | Jugular venous pressure | Respiratory system | Precordium | Abdomen | Peripheral vascular | Hip | Knee | Intimate

v • d • e WikiDoc Research Resources for Hip examination
Articles on Hip examination	Most recent articles on Hip examination • Most cited articles on Hip examination • Review articles on Hip examination • Articles on Hip examination in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Hip examination	Powerpoint slides on Hip examination • Images of Hip examination • Photos of Hip examination • Podcasts & MP3s on Hip examination • Videos on Hip examination
Evidence Based Medicine Regarding Hip examination	Cochrane Collaboration on Hip examination • Bandolier on Hip examination • TRIP on Hip examination
Cost Effectiveness of Hip examination	Cost Effectiveness of Hip examination
Clinical Trials Involving Hip examination	Ongoing Trials on Hip examination at Clinical Trials.gov • Trial results on Hip examination • Clinical Trials on Hip examination at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Hip examination	US National Guidelines Clearinghouse on Hip examination • NICE Guidance on Hip examination • NHS PRODIGY Guidance • FDA on Hip examination • CDC on Hip examination
Textbook Information on Hip examination	Books and Textbook Information on Hip examination
Pharmacology Resources on Hip examination	Dosing of Hip examination • Drug interactions with Hip examination • Side effects of Hip examination • Allergic reactions to Hip examination • Overdose information on Hip examination • Carcinogenicity information on Hip examination • Hip examination in pregnancy • Pharmacokinetics of Hip examination •
Genetics, Pharmacogenomics, and Proteinomics of Hip examination	Genetics of Hip examination • Pharmacogenomics of Hip examination • Proteomics of Hip examination
Newstories on Hip examination	Hip examination in the news • Be alerted to news on Hip examination • News trends on Hip examination
Commentary on Hip examination	Blogs on Hip examination
Patient Resources on Hip examination	Patient resources on Hip examination • Discussion groups on Hip examination • Patient Handouts on Hip examination • Directions to Hospitals Treating Hip examination • Risk calculators and risk factors for Hip examination
Healthcare Provider Resources on Hip examination	Symptoms of Hip examination • Causes & Risk Factors for Hip examination • Diagnostic studies for Hip examination • Treatment of Hip examination
Continuing Medical Education (CME) Programs on Hip examination	CME Programs on Hip examination
International Resources on Hip examination	Hip examination en Espanol • Hip examination en Francais
Business Resources on Hip examination	Hip examination in the Marketplace • Patents on Hip examination
Informatics Resources on Hip examination	List of terms related to Hip examination

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