This document discusses the clinical examination of the hip joint, including inspection, palpation, range of motion testing, special tests, and gait analysis. Key examination findings are described for various hip pathologies like developmental dysplasia of the hip, arthritis, fractures, and dislocations. Landmark bony anatomy, compensations, and fallacies of certain examination maneuvers are also outlined.

1. Clinical examination

2.  Ball and socket, Synovial, Multiaxial joint
 Compensations for hip deficits
 Referred pain to knee joint
 Neck shaft angle
 Femoral anteversion
 Arterial supply
 Calcar femorale
 Capsular reflections
 Extension-first movement to be lost
 Joint space- most accomodative in Fl, Abd,ER

3.  Pubic tubercle
 Femoral head
 Femoral neck
 Mid inguinal point
 Mid point of inguinal ligament
 Line joining PSIS

4.  Pain – Night cries
 Limp
 Trauma
 Steroid intake
 Alcohol intake
 Tuberculosis
 Bronchial asthma
 Complaint during childhood

5.  Gait
 Trendelenberg’s gait-DDH
 Short limb gait
 Antalgic gait-OA hip
 Waddling gait-osteomalacia
 High stepping gait-foot drop
 Scissors gait-cerebral diplegia

6.  DDH-wide perinium
 Synovitis-Flex.,Abd.,ER.,App. lenthening
 Arthritis-Flex., Add.,IR.,+/- True shortening
 Posterior dislocation-Flex.,Add.,IR.,True and
App. shortening
 Anterior dislocation-Flex.,Abd.,ER.,App.
lenthening
 Fracture trochanter-Marked ER
 Fracture neck of femur-ER-not so marked-
capsular catch

7.  Skin
 Exagerrated lumbar lordosis
 Level of ASIS
 Wasting
 Shortening/Lengthening
 Soft tissue
 Bony points
 Swelling

8.  To confirm the findings of inspection
 Temperature
 Tenderness-Ant/Post/Lat/Med/Iliac fossa
 Bony prominences/Greater trochanter
 Sites to be palpated for psoas abscess

9. NARATH’S SIGN
Femoral arterial pulsations
Positive in
Post. dislocation of hip
Excised or dissolved head and neck
Burger’s disease
Lymph nodes-Inguinal and External iliac

10. Flexion 0-110/130 Psoas major Rectus
femoris,Sartorius,Pecti
nius,TFL,Adductors
Ext 0-20 Gl.max.,Gl.med.,Semi
tendinosis,Semimembr
anous,Biceps femoris
Abd. 0-45/55 Gl.Med. Gl.min.,TFL,Gl.max.
Add. 0-35/45 Adductors,Pectinius
Grasilis
0-40/50 Obt.ext.,internus,Quad
.femoris,Piriformis, Sartorius,Long head of
Gamelli biceps
0-30/40 Gl.med,semitendinosu
Gl.min,TFL
s,Semimembranous

11.  Flexion

12.  Extension

13.  Rotation

14.  Abduction Adduction

15.  Line joining two ASIS cuts midline at right
angle
 Fallacies-Not possible in fixed scoliosis
due to fixed obliquity of pelvis
 Iatrogenic-ASIS removed for bone grafting
 Mal or ill development of hemipelvis e.g.
residual polio myelitis
 Unreduced dislocation of SI joint
 Malunited or unreduced verticle fracture
of ilium

16.  Position from where limb can’t be brought back
to neutral position but further movement in
same axis is possible
 Causes-Persistent muscular spasm
 Persistent posture to avoid pain or to conceal
deformity
 Disparity of limb lengths
 Destructive changes in joint
 Fibrotic contractures in periarticular soft tissues
 Surgical interventions

17.  To conceal deformity
 To maintain equilibrium by shifting centre of
gravity
 To apparently make up the disparity of limb
lengths
 To stabilise the unstable hip
 To assess fixed deformity it is essential to
neutralise compensatory mechanisms

18.  Exagerrated lumbar lordosis
 Thomas test-Hugh Owen Thomas 1876

19.  Critisism-Patient is hurt further in painful hip
 Obese or heavily built individuals
 Bilateral FFDs
 Ankylosed knee
 Inappropriate force for flexion
 Alternative method-Prone position-
Bilat.cases/FFD knee

20.  Fixed abduction-ASIS at
lower level
 Scoliosis with covexity on
affected side
 1cm of true shortening-10
degree of fixed abd.
 Fixed add.-ASIS at higher
level
 Scoliosis with convexity to
unaffected side

21.  Kothari’s angle
 Rotational deformities
are usually revealed due
to lack of compensation

22.  Shortening compensated by-Pelvic tilt,Ankle
equinus,Flexion of opposite hip and knee
 Apparent measurement-To assess extent of natural
compensation
 Pre requisites-Supine with affected limb in line with trunk
 Both lower limbs in parallel position
 Supratsernal notch /Xiphisternum to medial malleolus

23.  From ASIS to medial malleolus
 Pre requisites-Square the pelvis
 Both lower limbs in parallel positions
 True=App. No compensation
 True>App. Part of shortening
compensated(Abd. Defo.)
 True<App. Add. Defo.+ shortening
without compensation

24.  Leg-Central point on medial joint line to tip of med.
Malleolus
 Thigh-Supratrochanteric- neck and head -Bryant’s triangle
 Infratrochanteric-Tip of gr. Tr. to knee joint line

25.  Shortening of base-riding up of tr.,shortening in
head neck, dislocation
 Reversed Bryant’s triangle-Gross overriding of
trochanter
 Perpendicular line-Shortening-Post. and central
dislocation
Lengthening-FFD hip,Fracture
trochanter
 Hypotenuse-
Central dislocation of hip
Old fracture neck of femur with neck
absorption
Absence of head due to disease or
surgery

26.  Fallacies of Bryant’s triangle-Bilateral affection
Excision of ASIS e.g. for bone graft
Limb disarticulated at hip
 Lines-Nelaton’s line-Supra trochanteric shortening

27.  Schoemaker’s line-
 DDH, Bilat. Coxa vara
 Chine’s test-Lines
coverge on that side
 Morris’s bitroch. Test-
Tr. Ext. rotated or
displaced back or vice
versa
 Bilateral affe.-Seg.
Meas.
 Circum. Meas. At mid
thigh level

28.  Trendelenberg’s
sign
 Friedrich
Trendelenberg’s
1895
 Fulcrum-DDH
Leverarm- # N/F
Power-Polio
myelitis

29.  Fallacies-
 Intact Quadratus lumborum
 Incoordination of muscles-Cerebral palsy
 Affection of SI joint
 Medial shift of mechanical axis of leg below
hip-bow knee
 Obese and bulky persons

30.  Dislocatable hip
 Adduction and
posterior push
 Relaxed baby
preferably in
mother’s lap

31.  Marino Ortolani
1937
 Dislocated hip
 Abduction and
lifting the
trochanter
 Palpable clunk

32.  To calculate femoral anteversion

33.  Non union fracture
neck of femur
 Old unreduced
posterior dislocation
 Paralytic hip

34.  Hip-60 degree
 Knee-90 degree
 Foot planted over bed
 Tibial shortening Femoral shortening

35.  IT band contracture
 Hip abducted knee
flexed 90
 Polio myelitis
Meningomyelocele

36.  Flexion
 Abduction
 External rotation
 Extension

37.  Hart’s sign-Limitation of abduction
 Klisick’s sign
 Asymmetrical gluteal folds-Pelvic obliquity
-Limb length
discrepancy
- Muscular atrophy
 Ortolani’s and Barlow’s tests

38. 
THAN X