Orthopedics Book

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Hip Exam

Aka: Hip Exam, Hip Joint Examination
  1. See Also
    1. Hip Range of Motion
    2. Rheumatologic Conditions affecting the Hip
    3. Hip Rotation Evaluation in Children
    4. Hip Pain
    5. Abnormal Gait
  2. Anatomy
    1. See Hip Anatomy
    2. Images
      1. orthoLegHipJointRtCapsuleGrayBB343.gifLewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
  3. Precautions: Findings most suggestive of hip intra-articular cause
    1. Pain on external and internal hip rotation
    2. Pain on hip axial loading (force applied at foot or knee towards hip)
  4. Exam: External to hip
    1. Critical to evaluate for referred pain
      1. Low Back Exam (e.g. radicular pain)
      2. Lower extremity Neurologic Exam
      3. Exam of Abdomen and Pelvis
        1. Appendicitis or Diverticulitis may present with Hip Pain
    2. Other common causes of pain referred to the hip
      1. Knee Exam
      2. Greater trochanter tenderness to palpation
        1. Trochanteric Bursitis
  5. Exam: Observation
    1. Resting position of the hip
    2. Hip deformity or swelling
    3. Overlying skin changes
    4. Hip Asymmetry
      1. Leg Length Discrepancy
      2. SI Joint Dysfunction
  6. Exam: Hip Range of Motion
    1. See Hip Range of Motion for normal findings
    2. Pain on even slight range of motion should suggest intrinsic hip pathology
      1. Septic Arthritis of the hip should be on the differential
      2. See causes of inability to bear weight below
  7. Exam: Mobility and gait
    1. See Abnormal Gait
    2. Observe sitting, standing and Transferring
    3. Observe while standing
      1. Look for C Sign (Cupping the painful, anterolateral hip)
        1. OrthoHipCSign.jpg
      2. Modified Trandelenburg Test (Single leg stance phase)
        1. GaitLeftLegUpTrand.jpg
    4. Observe for limp or altered gait
      1. See Gait
      2. Trandelenburg Gait (hip adductor weakness)
      3. Waddling Gait
      4. Antalgic Gait
      5. Pelvic Rotational Wink
    5. Observe for inability to bear weight
      1. Hip Stress Fracture
      2. Hip Septic Arthritis
      3. Avascular Necrosis of the Hip
      4. Femoral lesion (e.g. malignancy)
    6. Observe for inability to climb onto exam table
      1. Decreased Hip Joint flexibility
      2. Iliopsoas muscle or quadriceps Muscle Weakness
  8. Exam: Specific Tests
    1. FABER Test
      1. Flexion ABduction External Rotation
      2. Also known as Patrick's Test or Figure of Four Test
    2. FADIR Test
      1. Flexion ADduction Internal Rotation
    3. Ober Test
      1. Passive Hip Adduction
    4. Log Roll Test (Freiberg Test)
      1. Passive Supine Hip Rotation (with hip and knee extended)
    5. Stinchfield Test
      1. Straight Leg Raise Against Resistance
  9. References
    1. Braly (2006) Clin Sports Med 199-210 [PubMed]
    2. Wilson (2014) Am Fam Physician 90(1): 27-34 [PubMed]

Examination of hip joint (C0562270)

Concepts Diagnostic Procedure (T060)
SnomedCT 284400003
English Examination of hip joint, Examination of hip joint (procedure)
Spanish examen de articulación de la cadera (procedimiento), examen de articulación de la cadera
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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