How to perform hip joint examination at emergency department. general rules , look , feel , move , special tests

1. Hip Joint examination
Ahmed Ghoname

2. Objectives
• General rules
• Components of joint examination
• Closure of the station

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General rules
• Wash hands
• Introduce yourself
• Confirm patient details – name / DOB
• Explain examination
• Check understanding and gain consent
• Ask if the patient has had a hip
replacement (if so internal rotation,
adduction and flexion greater than 90°
should be avoided due to risk of dislocation)
• Expose patient appropriately
• Position patient standing
• Ask if the patient currently has any pain

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Components of joint examination
• Look (inspection)
• Feel (palpation)
• Move:
– Active movements
– Passive movements
– Grading muscular power
• Special tests
• Neurovascular assessment

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Look(inspection)
• Look around bed for any aids or
adaptations – walking stick / wheelchair
• Inspect patient from all angles
• Front – scars / pelvic tilt /quadriceps
wasting / foot deformity
• Side – assess lumbar lordosis – normal /
hyperlordosis
• Behind – scoliosis / gluteal wasting / pelvic
tilt

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Look(inspection)
• Gait
• Observe the patient’s gait from multiple
angles
• Assess speed /smoothness /turning
• Note any evidence of antalgic gait or
Trendelenburg gait
• Assess the patient’s footwear – unequal
sole wearing – abnormal gait

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Feel(palpation)
• Ask patient to lay down on
the examination couch
• Palpate the tissues overlying the hip joint
for tenderness / warmth – inflammation /
infection
• Palpate the greater trochanter –
tenderness (often indicative of greater
trochanteric bursitis)

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• Assess leg length
• Measure apparent leg length –
umbilicus to the tip of the medial
malleolus
• Measure true leg length – anterior
superior iliac spine to the tip of the medial
malleolus

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Movement
• Active movements
• Place your hand under the lumbar spine to
detect masking of hip movement by the
pelvis / lumbar spine.
• Flexion – “bring your knee towards your
chest” – normal ROM is 120°

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• Passive movements
• Flexion – – normal ROM is 120°
• Internal rotation:
• Rotate the foot laterally Normal ROM 40°
• External rotation:
• Rotate the foot mediallyNormal ROM 45°
• ABduction –– normal ROM is 45°
• ADduction –– normal ROM is 30°

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• Position patient prone
• Hip extension (passive):
• Place a hand on the pelvis to assess for
movement
• Lift one leg at a time to assess range of
extension
• Normal ROM is 10-20°

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Special test
• Thomas’s test
• The test is positive (abnormal) if the
affected thigh raises off the bed, indicating
a loss of extension in the hip. This would
suggest a fixed flexion deformity in the
affected hip
• DO NOT PERFORM ON PATIENTS WITH
HIP REPLACEMENTS – can cause
dislocation!

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• Trendelenburg’s test
• The test is deemed positive (abnormal) if
the pelvis falls on the side with the foot
off the ground.
• This abnormal result suggests weak hip
abductors on the contralateral side of the
pelvis.

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Neurovascular assessment
• Palpation of pulses
• Detailed examination of each nerve, and
its sensory and motor component
• A quick screening examination of the joint
above and below should also be
performed if time permits

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Closing the examination
• Make sure you leave the patient
comfortable
• Help them redress if necessary
• Thank them
• Wash hands

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Questions

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Summary
• General rules
• Inspection
• Palpation
• Movement
• Special tests
• Neurovascular assessment
• Closure