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  • Print publication year: 2015
  • Online publication date: July 2015

21 - Examination of the hip

from Section 5 - Orthopaedic surgery

Summary

Checklist

WIPER

• Patient standing in shorts or underwear, back and knees exposed.

• Access is required to the groin, thighs and gluteal region.

Physiological parameters

Gait

• Asymmetry of spine

• Gait: antalgic, short leg, Trendelenburg gait

• Walking aids

Test

• Trendelenburg's test

Tape: leg length

• Apparent leg length (xiphisternum to medial malleolus)

• True leg length (ASIS to medial malleolus)

Look

• Skin:

• scars, erythema, ecchymosis

• sinuses and alignment of skin creases

• psoas abscess draining in sub gluteal fold

Soft tissues: swelling or wasting of glutei and quadriceps.

Bone:

• deformity or asymmetry: shortening of leg; external or internal rotation of hip

• pelvic tilt

• valgus or varus knee, lordosis, kyphosis, scoliosis

Feel

Skin: temperature, tenderness, sensation.

Soft tissues:

• adductor tenderness, bursitis

• pulses, capillary refill time

• sensation and movement

Bone:

• greater trochanter

• midpoint of inguinal ligament (hip joint)

• pubic bone and symphysis

• femoral shaft

• tenderness or mobility

Move

Active and passive:

• flexion/fixed flexion

• internal rotation (foot moves outwards)

• external rotation (foot moves inwards)

• extension (press thigh onto bed)

• abduction/adduction whilst stabilising pelvis (palpating contralateral ASIS)

Resisted:

• flexion

• adduction

Special tests (* = essential tests)

• Thomas's test*

• Impingement sign*

• Straight leg raise*

• FABER test

• Sciatic nerve stretch test

• Ober's test

To complete the examination

• Examine the joint above (back and sacroiliac joint) and the joint below (knee).

• Check full neurovascular status of the lower limb.

• Order appropriate radiographs and further imaging.

Examination notes

What do you look for during gait and initial observations?

• Look for an antalgic gait or the use of any walking aids.

• Inspect the soles of the shoes for the pattern of wear.

• In the setting of possible neck of femur fracture, gait and weight-bearing activities should not be examined.