Step-by-Step Guide to Hip Joint Examination

Introduction

• Introduce Yourself:
  • Greet the patient warmly.
  • Example: “Hello, my name is [Your Name], and I will be examining your hip today.”
• Hand Hygiene:
  • Wash your hands thoroughly to ensure hygiene and patient safety.
• Explain the Procedure:
  • Briefly describe what the examination will involve.
  • Example: “I will assess your hip by looking at how you walk, inspecting the hip area, and checking its movement.”
• Prepare the Patient:
  • Ask the patient to remove their lower clothing to expose the hip area.
  • Provide a gown or drape for privacy.
• Offer a Chaperone:
  • Offer to have a chaperone present if it makes the patient more comfortable.

Inspection

• Assess Gait (While Standing):
  • Observe how the patient walks.
    • Trendelenburg Gait: Look for the contralateral hip dropping and trunk leaning towards the affected hip.
    • Antalgic Gait: Notice any limp or shorter time spent on the painful leg.
• Check Quadriceps Muscle Bulk:
  • Look for muscle size and symmetry in the thighs.
• Inspect the Hip Area (While Lying Down):
  • Look for skin changes, scars from previous surgery, or swelling.
  • Measure leg length:
    • True Leg Length: From the anterior superior iliac spine (ASIS) to the medial malleolus.
    • Apparent Leg Length: From the pubic symphysis to the medial malleolus.

Palpation

• Check Temperature:
  • Feel for any unusual warmth around the hip.
• Check for Tenderness:
  • Gently press on the outer hip area (greater trochanter) to identify any tenderness.

Movement

• Passive Movements:
  • Move the patient’s hip gently to assess the range of motion.
  • Note any pain, limited movement, or a crackling sound (crepitus).
• Abduction and Adduction:
  • Move the leg away from (abduction) and toward (adduction) the body’s midline.
  • Stabilize the pelvis to ensure the movement comes from the hip joint.
• Flexion and Extension:
  • Bend (flex) and straighten (extend) the hip.
• Internal and External Rotation:
  • Rotate the hip inward and outward while it is bent.

Special Tests

• Thomas’ Test:
  • Check for fixed hip flexion:
    • With the patient lying flat, place your hand under their lower back.
    • Fully bend the opposite hip and see if the hip being examined lifts off the table.
• Trendelenburg Test:
  • Check hip abductor strength:
    • Have the patient place their hands on yours for stability.
    • Instruct them to stand on one leg and lift the other leg.
    • Observe if the hip on the side not being tested drops, indicating weakness.

Completing the Examination

• Thank the Patient:
  • Thank the patient for their cooperation.
• Allow the Patient to Redress:
  • Provide privacy for the patient to put their clothes back on.
• Report to the Examiner:
  • Mention that you would also check the lumbar spine, knees, the opposite hip, and review any relevant imaging to complete the examination.