RP's Ortho Notes

Examination of the Hip Joint

Written by

Dr Rajesh P

in

,

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.

To read the rest of the article please click the link below

http://learningorthopaedics.com/examination-of-the-hip-joint/

Comments

4 responses to “Examination of the Hip Joint”

  1. Manoj Avatar
    Manoj

    Excellent writing. Well done.
    Exhaustive and traditional teaching..

    Anyone who is thorough with the above method should be able to complete the whole process in 20 mts including the presentation and a 10 mts discussion afterwards.
    I wonder if you could try this method of 10 mts history, 10 mts exam and presentation( in front of the examiner) and 10 mts discussion including treatment plan.
    The point is you don’t necessarily have to go thru the whole exam ; but it has to be tailor made based on the history. If some one is not thorough he can’t do this important bit.
    And the management plan should be made in 10 mts , if not the 20 mts have wasted.
    Why don’t you try this on your trainees ; doing whole thing in front of the examiner.
    Well done, looking forward for more ..
    Best
    Manoj

    Reply
    1. Dr Rajesh Purushothaman Avatar
      Dr Rajesh Purushothaman

      Dear Manoj,
      I have made it clear in the first sentence under special tests that as per the clinical situation you can decide on the special tests needed.
      “Special tests are done as required depending on the clinical diagnosis. They can be divided into the following.”.
      I totally agree with your point
      Thanks for the nice comment and the interest you have shown.
      Rajesh

      Reply
  2. vik147 Avatar
    vik147

    Good evening Sir.
    Regarding trendelenburg gait of a unilateral involved hip . My question is when patient stand on normal limb

    The affected pelvis ( which is now in air ) moves up / down or remain normal ??

    Reply
    1. Dr Rajesh P Avatar
      Dr Rajesh P

      In unilateral hip disease, if the Trendelenburg test is positive on the affected side, when the patient stands on the diseased side the pelvis on the opposite side drops because of abductor insufficiency. When he stands on the normal side, the pelis on the opposite side will move up to shift the centre of gravity towards the weight bearing hip using the normally functioning abductor muscles.

      Reply

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