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8 - Examination of the hip

Ian Stockley
Affiliation:
Sheffield Teaching Hospitals NHS Foundation Trust
Richard Villar
Affiliation:
Spire Cambridge Lea Hospital
Alexandra Dimitrakopoulou
Affiliation:
Spire Cambridge Lea Hospital
Nick Harris
Affiliation:
Department of Orthopaedic Surgery, Leeds General Infirmary
Fazal Ali
Affiliation:
Department of Orthopaedic Surgery, Chesterfield Royal Hospital
Mark D. Miller
Affiliation:
James Madison University, Virginia
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Summary

History

A detailed clinical history and complete physical examination are mandatory in the assessment of the patient with a painful hip. Often a tentative diagnosis can be made on the history alone. The onset (acute or insidious), duration and severity of symptoms, as well as any earlier injury, are significant in any history taken. Examination and subsequent investigations allow for confirmation or modification of the presumptive diagnosis.

Presenting complaints in hip pathology may include pain, limp and stiffness. Patients may not complain of stiffness per se but of the disability produced by it (e.g. the inability to put socks on). In trying to evaluate a patient’s symptomatology it is important to know what effect, if any, the symptoms have on the patient’s ability to undertake activities of everyday living. Mechanical symptoms such as locking, clicking, catching or popping can also be presenting symptoms in their own right.

It is important to ask patients whether they have had any previous problems with their hips. Childhood conditions affecting the hip may cause symptoms in early adult life because of the development of secondary degenerative changes. In addition, a history of previous surgery is very important when contemplating further surgical procedures as consideration needs to be given to previous scars, the surgical approach, skeletal deformity and, in addition, the increased risk of infection with arthroplasty surgery.

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Publisher: Cambridge University Press
Print publication year: 2014

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References

Byrd, JW. Physical examination. In: Byrd, JW. Ed. Operative Hip Arthroscopy. New York: Springer, 2005, pp.36–50.CrossRefGoogle Scholar
Beals, RK. Painful snapping hip in young adults. West J Med 1993;159:481–482.Google ScholarPubMed
Thurston, A. Assessment of fixed flexion deformity of the hip. Clin Orthop 1982;169:186–189.Google Scholar
Broadhurst, N, Bond, M. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spin Disorders 1998;11:341–345.Google ScholarPubMed

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