Examination of the Hip Joint

Introduction

• Introduce yourself
• Get consent of patient or the parent for examination.
• Note down the name, age, sex, race and occupation of the patient.
• Adequately expose the patient. Make sure that external genitalia is adequately covered and the patient is comfortable and relaxed. Explaining why you need to expose and the steps of examination will help in relaxing the patient and in establishing a good rapport.
• When examining a female patient make sure that you have a female nurse or assistant.
• Examine the child with the parents by the side. Very young children may be examined in the parent’s lap.
• First examine the normal or less symptomatic side to establish the normal range of movement for the particular patient and to make the patient understand what is going to be done on the painful side.
• Steps of all procedures should be explained to the patient to ensure patient comfort and cooperation.

Patients with hip joint disease may present with pain, alteration of gait, instability, functional limitation or limb length discrepancy as their presenting complaint. Hip symptoms may be due to intra-articular, extra-articular or referred causes. Intra-articular conditions usually will cause deformity, limitation of range of movement and worsening of symptoms on joint activity. Extra-articular conditions usually will not cause restriction of range of movement, pain will be present mainly in one particular movement or position of joint and tenderness will be localized to a specific area. Always rule out referred pain from spine, pelvis, and sacroiliac joint or vascular causes. Rarely hip disease may present as pain referred to the knee.

Examine the patient in standing, sitting, walking and lying down. When the patient is lying in the supine position, always examine the patient from the right side. Make sure that the patient lies on a hard surface to ensure that deformities are not concealed by a soft mattress.

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