1. HIP EXAMINATION

2. Basic Principles ( Prerequisites of Examination )
Patient must be suitably undressed.
Hard bed.

3. Pattern of Examination
Inspection.
Palpation.
Movements.
Measurements.
Special tests.

4. Inspection
Standing position.
Lying down position.

5. Inspection (contd) In standing position
Patient able to stand – Yes / No.
If yes, patient able to walk – Yes / No.
If yes, check Gait.
Gait :
Trendelenburg.
Antalgic
Waddling
Short legged
High stepping
Patient able to squat or not.

6. Inspection (contd) In standing position
Trendelenburg test

7. Inspection (contd) In standing position
Spine.
Wasting eg Disuse atrophy, neurological deficit.
Swelling eg Cold abscess, dislocation, lipoma.
Scarpas triangle.
Greater trochanter.
Gluteal region
Scars / Sinus
Level of natal fold eg CDH.

8. Inspection (contd) In lying down position
Sequential -
Top to bottom or
Bottom to top.

9. Inspection (contd) In Lying down position
Attitude.
Lumbar lordosis.
ASIS.
Greater trochanter
Position
Prominence

10. Inspection (contd) In Lying down position
Scarpas triangle
Fullness.
Scars / sinus.
Skin
Colour, texture, prominent veins.
Thigh
Wasting.
Patella
Position

11. Inspection (contd) In Lying down position
Calf
Wasting
Malleoli
Level
Direction.
Heel
SLR

12. Palpation
Confirmation of inspection findings in same sequence plus few additions :
Temperature, Tenderness & Telescopy
Lumbar lordosis
Thomas’s test for FFD.

13. Palpation (contd.) ASIS level Greater trochanter How to feel ? Level.
Position, Promince (Bitrochanteric test).
Tenderness – Antero posterior / Axial.

14. Palpation ( contd. ) Temperature Scars Sinuses : Tenderness
Margins, Discharge, adherence to bone
Tenderness
Circumference of thigh / calf
Medial malleolus
How to feel?
Level & direction
Heel
Level

15. Palpation ( contd. )
Telescopy

16. Movements Sagittal Flexion Extension 0-90 ext knee 0 – 120 fl knee
0 -15
Coronal
Adduction Abduction
0 – 30
0 - 40
Vertical
External Internal rotation.
0 – 45
Circumduction
Incomplete
In fixed deformities, starting point will be the degree of deformity

17. Measurements Apparent : Lengthening / Shortening.
Pre requisite
Limbs parallel
Measured between midline point - xiphisternum, manubrium sterni or umbilicus &
medial malleoli

18. Measurements Real : Lengthening / Shortening
Pre requisites
Squaring of pelvis.
ASIS at same level.
Limbs in identical position.
Measurement from ASIS to medial malleolus.

19. Measurements ( contd ) Find level of discrepancy Leg, Thigh or
Supratrochanteric.

20. Measurements( contd ) (How to detect supratrochanteric shortening)
Bryants triangle.
Nelaton’s line. .

21. Measurements ( contd ) (How to detect supratrochanteric shortening
Schoemaker’s line.
Chiene’s parallelogram

22. Special Tests Narath’s vascular sign. Ortolani’s test. Barlow’s test.
Ely’s test.

23. Examination (contd)
Examination of hip is incomplete without examination of spine & knee.

24. Key to Examination findings
ASIS at same level
No adduction or abduction deformity
Apparent measurements = Real measurements
ASIS raised
Adduction deformity
Apparent shortening > Real shortening
ASIS lower
Abduction deformity
Apparent lengthening > Real lengthening

25. Thank you