4. Traditional steps
History of symptoms.
General examination
Examination of Hip proper.
Inspection
Palpation
Movements
Measurements
Special tests
6. PAIN
Site :
Anterior hip pain : arthritis, hip flexor strain,
ilio-psoas bursitis, lebral tear.
Lateral hip pain : GT bursitis, GM tear,
iliotibial band syndrome(athletes),meralgia
paresthetica.
Posterior hip pain : hip extensor and external
rotators pathology, degenerative disc disease,
spinal stenosis.
7. Pain cont..
Onset :
Gradual : RA,OA, etc
Sudden onset : fractures ,muscle tear
,haematoma,
Any fall ? Fracture, haematoma, muscle tear
Playing sports? Muscle sprain, labral tear, etc
Character
Sharp: muscle strain/tear, fracture
Dull: OA, RA
Achy: OA, RA, AVN
8. Contd..
Radiation of pain : knee ,back of
thigh, leg
Aggravating or relieving factors :
OA gets worse as they day goes on and
is relieved by rest
Muscle tears/sprains may be
exacerbated by movement
RA is worse after prolonged periods of
rest
10. Swelling around hip
Gluteal region
1. Cold abscess
2. Femoral head
3. Soft tisue tumour
Femoral Triangle :
1. Cold abscess
2. Lymph nodes
3. Femoral head
Tochantric Region
1. Bursitis
2. Malunion
Medial aspect of thigh
1. Cold abscess
2. Ruptured Iliopsoas tendon
11. LIMP
any abnormality of normal
rhythmic biphasic walking.
Usually noted by kin
Onset
Duration
Association with pain
Progression
Ambulatory status
Stiffness
Deformity
Limb length disparity
Paralytic disability
16. Local examination of hip
Inspection
Palpation
Movements
Measurements
Special tests
17. Inspection
Should be done from
the front, side and
back
Gait of the patient.
Attitude of the lower
limb.
18. Gait :
Simplest of all definitions “mode of walking”
Normal gait is rhythmical bipedal biphasic
walking in which the lumbar spine, hip and
legs move in unison.
19. Types of gait :
Antalgic gait : In painful hip
conditions pt walks with reduced
stance phase on the affected side.
20. Waddling gait:
Body sways from side to side on a wide base seen in
b/l DDH,pregnancy.
23. Short limb gait-
When the affected
limb becomes short
Up and down
movement of half
of the body.
Pt lurches on the
affected side with a
pelvis drop on the
same side.
24. Attitude and Diagnosis
CDH – Broadening at trochantric level,
widening of the perineum, assymetry of
gluteal folds
Synovitis – mild flexion, abduction, Ext
Rotation ,with apparent lengthening
True arthritis – Flex Adduc Int Rota(FADIR)
with or without true shortening
Posterior dislocation – FADIR with apparent
and true shortening.
27. Inspection (side)
Iliac crest
/Trochanteric
region
Lumbar
lordosis/Gluteal
bulge /supra or
infratrochanteric
depression & thigh
ms mass
Level of tip of
trochanters.
30. Palpation:
Marking of bony
points.
Superficial:Temperatu
re ,Tenderness, area of
anesthesia etc.
Deep palpation:
Tenderness over bony
pt(ASIS,PSIS,GT,IT,Pub
is,iliac crest)
ASIS
PUBIS
GT
31. Deep palpation contd…
Anterior hip joint(direct)
Bitrochanteric
compression test.
Iliac crest
Femoral pulse(vascular
sign of Narah)
Iliac fossa
Lymb nodes
32. Trochanteric tenderness
Significance
Touch – fresh troch#, acute
inflamation
Deep pressure – healing troch#,
troch bursitis, troch. cyst, #NOF
Thrust – transmitted tenderness in
#nof, #acetabulum, T.B hip
33. MOVEMENTS:
Should be performed in
squaring pelvis.
Flexion : 0 to 110-130 deg.
Extension : o to 20 deg.
Abduction:o to 45-55 deg
Adduction:0 to 35-45 deg
Internal rotation : 30-40
deg.
External rotation: 40-50
deg.
34. Flexion :
Other muscle
contribution
Active SLRT against
resistance
For ilio-psoas
contribution.(sitting)
39. THOMAS TEST(IN FFD)
Deformity and
compensation:
Fixed flexion deformity –
Lordosis
Fixed abd. deformity –
lowering of pelvis and
scoliosis with convexity
towards the affected side
Fixed add. deformity –
raised pelvis and scoliosis
with convexity towards
unaffected side
Fixed rotational deformity
–no compensation
40. CRITICISM OF THOMAS TEST
Painful hip
Obese or heavily
built individuals
B/L fixed flexion
deformity of the
hip
In presence of
ankylosed knee.
43. Apparent measurement
Helps in assessing the extent
compensation developed for
concealing the actual deformity .
Prerequisites
Lying supine comfortably
Lower limbs parallel
Measurement taken from
central fixed point on the trunk
to tip of medial malleolus
No squaring of pelvis
44. True length
Prerequisites
Pt exposed adequately
Bony points marked
with pencil (metal end
of the tape)
Squaring of the pelvis
Limb in identical position
46. Total length
(quick assessment )
Allis or Galeazzi
sign
Hips flexed up to 600 ,
knees at 90 with feet
planted over the bed .
Both the knees should
be at the same level .
Any disparity in level
indicates limb length
disparity
47. Localization of limb length
disparity
Segmental
measurement
Leg length
Thigh length
Supra trochanteric infra tro-
(BRYANT’S TRIANGLE) -chanteric
48. Qualitative assessment of
shortening
Nelaton’s line – IT to
ASIS
Schoemaker’s line –
Troch tip to ASIS
Chiene’s line/test
Morris’s bitrochanteric
test
49. Measurement of muscle bulk
Circumferential
measurements
Any muscle
wasting indicates
chronic disease.
Should be in
same position.
50. Tests for stability of hip
Telescopy Test
Trendelenburg’s Test
Ortolani’s test
Barlow’s Test
51. Telescopy Test
Flex the hip to 90 deg
•one hand with the
thumb on ASIS and
the remaining
fingers over the soft
tissue proximal to
femur
•other hand at the
distal femur
•push and pull the
femur
52. Trendelenberg Test
assess the ability of the hip
abductors.
A positive test
demonstrates that the hip
abductors are not
functioning.
Causes:
• Power : Weakness of the
hip abductors e.g.
myopathy, neuropathy
• Lever : # NOF, Troch# etc
• Fulcrum:
Arthritis,RA,dislocation
53. ORTOLANI TEST
First flexion the hips and
knees of a supine infant to
90 degrees, then with the
examiner's index fingers
placing anterior pressure
on the greater trochanters
gently and smoothly
abducting the infant's legs
using the examiner's
thumbs.
A positive sign is a
distinctive 'clunk' which can
be heard and felt as the
femoral head relocates
anteriorly into the
acetabulum
54. BARLOW’S MANOUVRE
The maneuver is easily
performed by
adducting the hip
while applying light
pressure on the knee,
directing the force
Posteriorly.[2] If the hip
is dislocatable - that is,
if the hip can be
popped out of socket
with this maneuver -
the test is considered
positive.
55. Tests for hip pathology
PATRIC TESTS
Distinguish between SI
joint and hip joint
pathology.
Also known as
FABER TEST
JANSEN’S TEST
FIGURE OF FOUR
TEST
BUCKET HANDLE
TEST
56. Craig’s test
To measure femoral
anteversion
Also called Ryder
method for measuring
femoral anteversion
57. TESTS FOR JOINT CONTRACTURES
OBER’S TEST:
Test for ileo-tibial tract
contracture.
In lateral decubitus position
knee is flexed to 90 degree
hip is abducted to 40 degree
and pelvis is stabilised.
limb is gently adducted
towards the examining
table normally the hip
adducts and the limb
crosses the midline
58. ELY’S TEST
for the contracture of
the rectus femoris
prone position with the
knees extended
passively flex one knee
to be tested
normally knee can be
flexed fully
in contracted rectus full
flexion of the knee
forces the hip into
flexion causing the rise
of buttocks
59. PHELP’S TEST:
To detect the contracture
of gracilis muscle
Prone position with the
knee extended
Passive abduction to the
maximum with the
extended knee
Knees are then flexed to
relax gracilis
Attempt to further abduct
the hip with knee in
flexion
Further abduction is
possible in gracilis
contracture
60. PIRIFORMIS TEST(FADIR)
Lateral decubitus position
•hip is flexed to 45 degree
•knee is flexed to 90
degree
•one hand stabilises the
pelvis
•other hand pushes the
knee to the floor causing
the internal rotation
•pain locally-piriformis
tendinitis
•pain radiates down-
piriformis syndrome
