Clinical notes for step wise approach to hip examination in orthopaedic especially to TU/KU MBBS students of nepal.

1. Hip Examination
Prepared by:
Sunil Baniya
Student, NAIHS-COM
sanobharayang, ktm
Shoulder examination/ Sunil Baniya 1

2. Chief complaints:
1. Pain
2. Swelling
3. Deformity
4. Stiffness
5. Inability to squat
6. Limp
7. Inability to walk

3.  First exposed the part of body below midthorax except the private parts
 Patient is examined in 3 positions:
1. Standing
2. Sitting
3. Lying in couch
1. Examination of patient in standing position:
a) Look/ Inspection:

4. Front:
 Level of ASIS (for pelvic tilting)
 Muscle wasting (quadriceps femoris)
 Limb shortening
 Rotational deformity (Osteoarthritis)
Side:
 Increased lumbar lordosis (hyperlordosis)
 Kyphosis (thorax)

5. Behind:
 Gluteal muscle wasting
 Muscle prominence on either side of the vertebra
 Level of iliac crest
 Scoliosis
 Sinus, scars
 Tufts of hair on the lumbar regions
 Cafe au lait spots

6. b) Gait:
- May be
 Normal
 Antalgic gait
 Trendelenberg gait (waddling gait)
 Circumduction gait
 Schuffling gait
 Stomping gait etc
Note :
In OA hip, patient walk with his body lurches to affected hip so that center of gravity falls on affected limb. But abductor
being intact [Duchhene sign].
Should not be confused with Trendelenberg test +ve in which abductor mechanism is insufficient.

7. c) Trendelenberg’s test:
 Ask patient to stand on normal leg first + opposite leg to flex at knee around 90°
 Then ask to stand on affected limb as previously
 See the level of ASIS
 If the ASIS of normal side is lower than the affected side, this test is positive.
2. Examination with patient sitting:
 To test the iliopsoas function

8.  Place hand firmly on his thigh & ask him to flex/lift the thigh against resistance
 If pain or weakness occurs, tendinitis or psoas bursitis
3. Examination of patient lying on couch:
a) Look:
 Level of ASIS
 Attitude of leg
 Hip flexed or not
 Lumbar lordosis

9. b) Feel:
i) Temperature:
 At groin
 Greater trochanter
 Gluteal region
ii) Tenderness:
(vary for teachers)
For Dr. Bachhuram K.C.
 First normal then affected side

10.  Elicit tenderness over:
- Anterior [ Femoral head] : Just 2 cm below & medial to mid-inguinal point
- Lateral : above the GT (tip of GT)
- Posterior : at mid-point between ischial tuberosity and GT
For Dr. Bishnu Babu Thapa
 Try to elicit tenderness over bony landmarks
- Femoral head: just 2 cm below & medial to mid-inguinal point

11. - Over GT
- Over ischial tuberosity
- Over ASIS
- Over lesser trochanter (externally rotate the leg & feel over the LT)
iii) Femoral pulse:
 Palpate just below the mid-inguinal ligament
 Findings:
- Present = normal
- Absent = vascular sign of Narath (in posterior hip dislocation)

12. iv) Any swelling: examine it
 Dislocated femoral head either in
-Gluteal or
-Groin region
c) Move :
 First actively, if not possible (restricted) then only passively
 First normal then only affected
- Flexion = 120°
- Extension = 5-20°

13. - Adduction = 25°
- Abduction = 40°
- Internal rotation (at 90° flexion) = 45°
- External rotation (at 90° flexion) = 45°
Special tests:
1. Thomas test
2. Adduction and abduction deformity
3. Patrick test (Faber sign)
4. Galezzi test (Allis’ sign)

14. 1. Thomas test:
 To detect fixed flexion deformity
 Put one hand behind lumbar region on palm facing towards bed
 Flex hip of normal side (by examiner) until lumbar
 lordosis is obliterated i.e; patient’s back touches dorsum of
hand of examiner
 Then affected leg may be flexed at hip (or also in knee)
 Measure the angle at hip ( flexion with bed)
 Lets suppose it become 20° , then range of motion (ROM) is
20° to 120°.
Figs : A and B: Thomas test

15. 2. Adduction and abduction deformity:
 Ask patient to lie on bed as straight as he can with both legs
parallel to each other
 See ASIS on both side
 Findings:
- Pelvis square : no deformity
- ASIS on affected side lower than normal : abduction deformity, to
measure deformity, further abduct and then square the pelvis first
- ASIS on affected side higher than normal : adduction deformity,
to quantify deformity , further adduct and square pelvis first
- Degree of Abduction/ adduction deformity : angle between long
axis of body and that of leg

16. 3. Patrick test (Faber sign):
 Patient supine
 Leg flexed at hip and knee, abducted & externally rotated
Put on unaffected leg
Pressure over knee
Pain over hip joint means Faber sign +ve thus hip joint
pathology
Also a test for Sacroiliac joint
Fig: Faber test

17. 4. Galeazi test (Allis’s sign):
 Flex the knees at 90° and ankles at 45°
 Keep both heels at the same level
 Note
- Level of knees &
- Parallelism of thighs and legs :
# if legs are parallel: limb length discripancy is below knee joint
#if thighs are parallel: discrepancy is above knee joint. Again draw a
Bryants triangle from ASIS and GT => measure the distance from
GT to point of cross section (on both side)
Fig : Galleazi's sign
Fig : Bryant's triangle

18.  Findings: if both side equal, then infratrochanteric cause & if not equal,then
supretrochanteric cause like OA of hip
d) Measurement:
 Apparent length & true length
Apparent length:
- On both side
- Measure from xiphisternum to the lower border of medial malleoli (without
squaring the pelvis i.e; length with compensatory mechanism)
- Compare the apparent length of both legs

19. True length:
- Pelvic tilting is corrected by squaring
- Measure length from ASIS to lower border of medial malleoli
(length without compensatory mechanism)
- Compare the length of affected side with that of normal side
 Measure the girth of Quadriceps femoris
- At fixed distance from tibial tuberosity i.e; normally 15 – 20 cm
(to avoid error that may get obtained from joint effusion & swelling of
suprapatellar pouch)
 Compare both sides & find if any muscle wasting present

20. Thank You