The document outlines the examination and assessment of hip joint conditions, detailing inspection methods, functional tests, palpation techniques, and radiological considerations. It emphasizes tools like the Trendelenburg test and specific deformity evaluations to diagnose issues such as congenital dislocation, arthritis, and fractures. Additionally, it highlights the importance of measuring limb girth and assessing related joint involvement for comprehensive evaluation.

1. HIP JOINT EXAMINATION
&
HIP RADIOLOGY
SUSAN KURIEN
2020 BATCH

2. LOCAL EXAMINATION
INSPECTION
 GAIT- bipedal
aided or unaided
stable or unstable
coordinated or not
antalgic
 ATTITUDE- It is the position of ease- the patient is examined in the supine position
look for exaggerated lumbar lordosis
asis (same or different level)
comment on the position of the limb starting from hip, knee, ankle, foot

3. Trendelenberg test
Normally when the weight of the body is taken on one
leg the pelvis rises on the other side. This is due to the
pull exerted by the abductors of the hip.
The patient is asked to stand on the unaffected limb
first, the buttock on the affected side automatically
rises.
The patient is the asked to stand on affected limb- the
pelvis on the opposite side sinks- trendelenberg positive
SOUND SIDE SINKS (SSS)
Trendelenberg’s positive sign is commonly seen
1.when abductors are weak- poliomyelitis, muscle
dystrophies, motor neuron disease
2. Congenital or pathological hip dislocation
3.Fracture of neck of femur, perthes’, coxa vera etc;

4. FIXED FLEXION DEFORMITY
 THOMAS’ TEST (in unilateral cases)
In recumbent position the normal thigh
is bent with flexion of knee upto the
point to obliterate the lumbar lordosis.
This will flex the affected thigh to the
extend of fixed flexion deformity.
The angle between the affected thigh
and the horizontal line is the angle of
fixed flexion deformity.

5. ADDUCTION DEFORMITY
 Square the pelvis first‐means if ASIS is at higher level,
implies, adduction deformity. So further adduct the affected
limb so that the ASIS of the affected limb is brought to the
same level as the normal hips ASIS.
 Draw a vertical line from ASIS of affected hip downward ,
and angle subtended between the imaginary vertical line and
the line along the long axis of the thigh is the adduction
deformity .
In adduction deformity there will be
1. Apparent shortening
2. (TS<AS)(True shortening less than apparent shortening )
3. Scoliosis—convexity to the opposite side

6. ABDUCTION DEFORMITY
 Square the pelvis first, ‐means if ASIS is at Lower level,
implies abduction deformity. So further abduct the
affected limb so that the ASIS of the affected limb is
brought to the same level as the normal hips ASIS.
 Draw a vertical line from ASIS of affected hip downward ,
and angle subtended between the imaginary vertical line
and the line along the long axis of the thigh is the
abduction deformity.
In Abduction deformity there will be
 1.Apparent Lengthening
 2. TS>AS (true shortening more than apparent shortening ),
 3. Scoliosis—Convexity to the same side.

7. FIXED LATERAL OR MEDIAL ROTATION
DEFORMITY
 Determined by noting the direction of
anterior surface of the patella or of the
toes the foot is held at right angle to the
leg.
 Normally the lower limb remains in a
slight lateral rotation.
 In recumbent position if the patella or
toes point upto the ceiling it indicates
slight medial rotation.

8. TUBERCULOUS ARTHRITIS OF THE HIP
JOINT

9. Adolescent coxa vara-
marked external rotation with slight adduction due to eversion of
the femur resulting from upper epiphyseal separation
Congenital dislocation of hip
Attitude that of lordosis- b/l cases with undue protrusion of the
abdomen and buttock posteriorly
u/l cases- grooves between labia and the thigh are asymmetrical and
an additional skin crease on medial side of thigh
2. Muscular wasting
3. Swellings

10. PALPATION
 Superficial palpation‐ local raise in temperature(septic hip) and
increased superficial tenderness(seen in cellulitis)
 Deep palpation – Tenderness‐in scarpa triangle , Anterior hip joint
line, over the trochanter, posterior hip joint line ( obers point)

11. Palpation and Bony Examination
1 Trochanter Palpation
Palpate the level of the trochanter, looking for
tenderness, irregularity, thickening, or broadening, which
may indicate a malunited trochanteric fracture or fibrous
dysplasia.
2 Palpation of hip joint
Hip joint lies in its socket and is almost inaccessible,
only a small part of neck may be palpated. A finger is
placed just below the inguinal ligament and lateral to
femoral artery,the finger is pressed deep to detect
tenderness.
3
Assess the vascular sign of Narath by feeling for
femoral pulse, which not felt indicates a positive sign
seen in cdh
4 Swelling
Effusion of hip joint- suppurative arthritis-jst below the
midinguinal point.
Cold abcess can be palpated.
Vascular sign of NARTH

12. MOVEMENTS
 FL‐120, EX 15, ADD 30, ABD 40, IR 30, ER 45
 Check whether this rom is associated with pain(SYNOVITIS,
OA,TB,), spasm(TB), crepitus (OA), mechanical block(foreign body)

14. EXAMINATION OF STABILITY
 Mainly lost in congenital dislocation of hip. The
tests done include
1. Telescopic test- the pelvis is fixed with one
hand touching the greater trochanter. Hip
flexed to 90 and knee is grasped with one
hand of the clinician who pushes the thigh
downwards along the axis of the thigh with
this hand while other hand notes whether
the greater trochanter is moving downwards
Positive seen in congenital and pathological
dislocation of hip joint and charcot’s joint

15. ORTOLANIS’S TEST
Both hips and knees are flexed by
holding the limbs.
Thigh of the affected side is gradually
abducted.
A click of entrance is felt as the
femoral head slips into the
acetabulam and a click of exit as it
quits the acetabulam when the
pressure is released.

16. BARLOW’S TEST
The surgeon holds both the lower extremities in such a
way that the hips are flexed at 90° and the knees are
fully flexed.
The lower limbs are now complete and pressure is
exerted downwards along the bony axis of the femur
while the little fingers of both the hands are placed on
the greater trochanters.
If the hip is dislocatable, the femoral head will be
heard to roll over the posterior rim of the acetabulum
as a distinct 'cluck! The hip is dislocated.
The second phase of the test is started. The hip is now
gradually abducted from the position of full adduction.
The little fingers on the greater trochanter are now
pushed inwards simultaneously.
The head can now be felt to reduce with a soft cluck
into the acetabulum.

17. MEASUREMENTS

18.  Girth of the limb- measures to find out
wasting
A mark is made on the affected limb at a
convenient distance from asis. This mark
is made on both limbs and circumference
of the limbs is compared.
 Shortening above the greater trochanter.
1.Bryant’s triangle-line drawn vertically
down from asis and another from tip of
the same spine to tip of greater trochanter
and a horizontal line from the tip of the
trochanter to the first line.
Deminution in the length of the horizontal
line is compared with the other side.
2.Nelaton’s line

19.  Lymph nodes- important in inflammatory conditions
 Other joints- other major joints like lumbosacral spine, sacroiliac joints and knee
joint should be examined
 Rectal examination- if intrapelvic abcess is suspected in tuberculous arthritis.

20. RADIOLOGY

21. CONGENITAL HIP DISLOCATION

23. LESSER TROCHANTER AVULSION
FRACTURE
FRACTURE OF NECK OF
FEMUR
INTERTROCHANTERIC
FRACTURE

24. POSTERIOR HIP DISLOCATION

25. SLIPPED CAPITAL FEMORAL EPIPHYSIS

26. PERTHES DISEASE
TUBERCULOUS SEPTIC ARTHRITIS

27. REFERENCES
 S DAS- A MANUAL OF CLINICAL SURGERY
 APLEY AND SOLOMON’S –SYSTEM OF ORTHOPEDICS AND TRAUMA

28. THANK YOU