Hip Examination

1. DR/ Mohga Ahmed EL-Badawy
Professor of Physical Medicine,
Rheumatology& Rehabilitation.
Ain Shams University

2. 1-Chief complaints in a patient
with a hip joint disease.
2-Items to be asked in the history
of a case with a hip joint disease.
3-How to perform a well
organized examination for a
patient with a hip joint disease

3.  CHIEF COMPLAINTS
 DURATTION
 ONSET
 PROGRESSION OF THE SYMPTOMS
 VARIOUS AETIOLOGIES
 CONSTITUTIONAL SYMPTOMS
 COMORBIDITIES
 HABITS
 TREATMENT TAKEN
 OCCUPATION AND RECREATIONAL DEMANDS
 EFFECT ON DAILY ACTIVITIES (ADL)

4.  PAIN
SWELLING
DEFORMITIES
LIMPING
STIFFNESS

5.  DURATION
 ONSET
 PROGRESSION
 GRADES OF PAIN
 SITE AND NATURE
 CONTINUITY
 REST PAIN
 NIGHT PAIN
( NOCTURNAL PAIN)

6. DURATION
ONSET
PROGRESSION
– STATIONARY
– INCREASING
– REGRESSING

7. DURATION
ONSET
PROGRESSION OF LIMP
LIMP WITHOUT AID
LIMP WITH AID
WHEEL CHAIR BOUND
BED RIDDEN

8. ACUTE / CHRONIC
PROGRESSIVE / NON PROGRESSIVE /
REGRESSIVE
MONOARTICULAR / POLYARTICULAR
POSSIBLE AETIOLOGY
(TRAUMATIC/INFECTIVE/INFLAMMATO
RY/NEOPLASTIC/DEGENERATIVE/
METABOLIC ETC)
PATIENT’S DEMAND / EXPECTATION

9. I- Look & walk.
II-Feel & measure.
III-Movement & power.
IV- Special tests.
V-Examine the (spine, SIJ,
Knees).
VI- Neurovascular
examination of both Lower
limbs.

10. 1-standing (front, sides, back).
-Skin(scars, sinuses).
-Soft tissue (swelling, Gluteal muscle wasting).
-Bone (spine alignment, tilting of the pelvis).
-2-Trendlenberg test.
-3-Walk Gait.

13.  THIS TEST EXAMINE THE STRENGTH OF THE GLUTEUS
MEDIUS. NORMALLY, IN A ONE LEGGED STANCE, THE
PELVIS IS RAISED UP ON THE UNSUPPORTED SIDE.
 IF THE WEIGHT BEARING HIP IS UNSTABLE, THE
PELVIS DROPS ON THE UNSUPPORTED SIDE, TO
AVOID FALLING THE PATIENT HAS TO THROW HIS OR
HER BODY TOWARDS THE LOADED SIDE.
 IN THE CLASSIC TEST, THE EXAMINER STANDS BEHIND
THE PATIENT. IF THE PATIENT STANDS ON A DISEASED
LEG THE GLUTEAL FOLD ON THE OPPOSITE SIDE
DROPS (THE SOUND SIDE SAGS (SSS).

14. 1- Inability to stand on diseased limb for
30 seconds.
2-Sagging of the other side of pelvis (SSS).
3-Lurch of the upper body towards
affected side.
Positive test indicates a defect in the
abductor apparatus(muscle,joint,bone).

15. The causes of positive
Trendelenburg test
are:-
1.. Weakness of the
hip abductors e.g.
poliomyelitis
2.. Shortening of
femoral neck e.g. coxa
vara.
3. Dislocation or
subluxation of the hip
FALSE POSITIVE: Pain
on weight bearing

16. Antalgic Gait
-Gait abnormality as a result of pain.
-Shortened stance phase on the affected
side.
-May be secondary to recent injury,
Subluxation, dislocation, advanced
stress fracture, significant degenerative
joint disease, acute muscle /
apophyseal injury,chronic pain.

17.  Trendelenberg Gait
-Secondary to abductor weakness
-Not usually secondary to pain as this increases
joint reactive force.
-Abductor tear, Neurologic disorder (superior
gluteal nerve), severe deconditioning.
-When placing weight on the affected leg the
contralateral hip drops.
-May also see an abductor lurch:Patient leans
towards the opposite side(affected side) to lift
the sound leg (normal side)clear off ground.

20. II-Feel (palpation) & measure
(true or apparent length).

21. ANTERIOR
Warmth
Joint LineTenderness
Swelling
LATERAL
TROCANTER WARMTH
TROCHANTERIC TENDERNES
POSTERIOR
HEAD OF FEMUR
POST JOINT TENDERNESS
MEDIAL
SWELLING
TENDERNESS PELVIC

22. LOWER LIMB LENGTH(TRUE
LENGTH).
•ANATOMICAL LENGTH.
•PATIENT IN STRAIGHAT LINE AND DEFORMITIES
CORRECTED AND THE LIMBS ARE KEPT IN
IDENTICAL POSITION.
•MEASURED FROM THE ASIS TO MEDIAL
MALLEOLUS.

26. • FUNCTIONAL LENGTH.
•PATIENT IN STRAIGHT LINE AND LIMBS PARELLEL,
DEFROMITIES NOT CORRECTED.
•FROM THE FIXED MIDPOINT TO THE MEDIAL
MALLEOLUS.

28. ADDUCTION APPARENT SHORTENING
ABDUCTION APPARENT LENGTHENING

29. Examine(ACTIVE AND PASSIVE) movements
PASSIVE :
RANGE
ASSOCIATED PAIN
MUSCLE SPASM
CREPITUS
INSTABILITY

30. Flexion: 110-120 degrees
Extension: 10-15 degrees
Abduction: 30-50 degrees
Adduction: 25-30 degrees
Internal Rotation: 30-40 degrees
External Rotation: 40-60 degrees

31. -Abductor strength testing :Resisted abduction in
the lateral position.
-Adductor strength testing:Tested in the supine
position.
-Gluteus Maximus testing: Tested in the prone
position.
-Hip flexor testing:Supine or seated position.

32. This test is used to diagnose fixed flexion
deformity of the hip.
The examiner blocks the pelvis by bringing
the contralateral sound hip into maximal
flexion.
This eliminates lumbar lordosis that can be
used to compensate for the hip flexion
contracture of the affected hip.

34. 1- FABER Test:
Mnemonic
Flexion
Abduction
External Rotation

35. Also known as Patrick's Test or Figure of
Four Test
Indications:
1-Hip pain.
2-Evaluation for Sacroiliac joint disease: sacroliliitis
in AS, Sacoiliac Joint Dysfunction.

36. External Hip Rotation
 Patient lies supine
 Knee on affected side flexed to 90 degrees
 Foot on affected side rests on opposite knee
 Examiner places one hand on opposite iliac
crest.
 Stabilizes pelvis against table
 Examiner places one hand on knee of
affected side.
 Examiner externally rotates hip on affected
side
 Knee pushed laterally and down

38.  SI joint pain on external hip rotation (Positive Patrick's
Sign)
 Sacroiliac Joint Dysfunction
 Sacroiliitis.
 Groin Pain on external hip rotation
 Iliopsoas Strain or Iliopsoas Bursitis
 Intraarticular Hip Disorder
 Hip Impingement (femoral acetabular impingement)
 Hip Labral Tear
 Hip loose bodies
 Hip chondral lesion
 Hip Osteoarthritis
 Posterior Hip Pain on external hip rotation
 Posterior Hip Impingement

39. Mnemonic
Flexion
Adduction
Internal Rotation

40. Indications
 Anterolateral Hip pain suggestive of Hip
impingement (Femoroacetabular
impingement).

41.  Flexion, Adduction and Internal Rotation (F-
Ad-Ir).
 Patient supine.
 Examiner raises one leg with hip flexed to 90
degrees and knee flexed to 90 degrees.
 Examiner adducts and internally rotates the
hip (foot and ankle rotated away from
midline).

43. Positive if maneuver induces pain
Causes of positive test
 Hip impingement (femoral acetabular
impingement)
 Hip labral tear
 Hip loose bodies

44. Technique
Patient lies at rest, supine with both hip
and knee extended.
Examiner places one hand at the mid-
thigh and the other at the calf.
Examiner passively rotates the entire
leg and hip both internally and
externally.

46. Positive if restricted movement or pain
on passive hip rotation.
Causes of positive test:
 Piriformis Syndrome.
 Slipped Capital Femoral Epiphysis.

47.  Cook,Orthopedic physical examination
tests.Pearson,2013
 Magee, Orthopedic physical Assessment,5th
edition Saunders. 2008
 Konin, Wiksten, Isear, Brader, special tests
for orthopedic examination, 3rd edition,
Slack.2006