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EXAMINATION OF THE
HIP JOINT
CURRENT TREND
Clinical examination
Early imaging
IN ORTHOPAEDIC TRAINING
• The skill in
eliciting/demonstrating
abnormalities of the hip
remains as the mainstay
in assessment of
orthopaedic trainee
CLINICAL EXAMINATION OF HIP
USEFUL IN
• DDH
• NEONATAL SEPTIC
ARTHRITIS
• TRANSIENT
SYNOVITIS
• PERTHES DISEASE
• SUFE
• TUBERCULOSIS
• OSTEOAARTHROSIS
• TRAUMATIC
CONDITIONS
EXAMINATION OF HIP
Traditional steps
• History of
symptoms
• Relevant general
examination
• Gait
• Inspection
• Palpation
• Looking for Fixed
deformities
• Movements
• Measurements
• Special tests
• Tests for instability
HISTORY
• Pain
• Felt in
groin, thigh
or knee
• Limping
• Also an early
symptom
RELEVANT GENERAL
EXAMINATION
• For the diagnosis
&
• Its management
RELEVANT GENERAL
EXAMINATION
For the diagnosis
RELEVANT GENERAL
EXAMINATION
Not relevant for diagnosis
RELEVANT GENERAL
EXAMINATION
For his management
GAIT
• Simplest of all definitions “mode of
walking”
GAIT
• Normal gait is rhythmical bipedal
biphasic walking in which the lumbar
spine, hip and legs move in unison
GAIT
LIMPING
• Limping is the most common
abnormality
• Can be defined as any abnormality of
normal rhythmic biphasic walking
GAIT
• Types
– Painless limping
– Painful limping
– Stiff hip
– High stepping
– Crutch gait
STIFF HIP GAIT
CRUTCH WALKING
– Two point
– Three point
– Swing to
– Swing through
CRUTCH GAIT
Three point gait Swing through gait Swing to gait
INSPECTION
• Attitude
Lumbar lordosis
ASIS
Lower limbs
INSPECTION
Muscle wasting
INSPECTION
• Swelling
• Scars
• Sinuses
PALPATION
• TENDERNESS
– ANTERIOR
– Posterior & lateral
– Bitrochanteric compression
PALPATION
• Swelling
PALPATION
• Femoral artery
pulsation
Weak or absent
FIXED DEFORMITIES
• Fixed flexion deformity
Concealed during walking by increase in lumbar
lordosis
FFD DEMONSTRATION
HUGH OWEN THOMAS’S TEST
FFD DEMONSTRATION
FIXED ABDUCTION &
ADDUCTION DEFORMITY
• Pelvic tilt indicated by ASIS at
different level
FIXED ABDUCTION &
ADDUCTION DEFORMITY
DN
FIXED ABDUCTION &
ADDUCTION DEFORMITY
N
D
FIXED ABDUCTION &
ADDUCTION DEFORMITY
N D
FIXED ABDUCTION &
ADDUCTION DEFORMITY
N
D
MOVEMENT
Normal flexion
Normal range
MOVEMENT
Axis deviation
MOVEMENTS
Extension
MOVEMENTS
ADDUCTION
Normal range
MOVEMENTS
Abduction
In flexion
Normal range
MOVEMENTS
Internal rotation
In flexion
Normal range
MOVEMENTS
External rotation
In flexion
Normal range
MEASUREMENTS
• Shortening
–Apparent
–True
MEASUREMENTS
• Apparent
shortening
• Due to pelvic tilt or
FFD
• Measured from
xiphisternum to
medial malleolus
MEASUREMENTS
True shortening
Square the pelvis
ASIS  MEDIAL JOINT LINE KNEE  MEDIAL MALLEOLUS
MEASUREMENTS
True shortening- Supra Trochanteric
Bryants
triangle
Nelatons
line
MEASUREMENTS
Supra trochanteric
• Coxa Vara
• Perthes
• SCFE
• Malunited basal # NOF
• Congenital Coxa Vara
• Arthritis
• Dislocation
Infra trochanteric
– Malunion
– Fracture femur & tibia
– Growth arrest from
polio
– Trauma and infective
sequale
True shortening
MEASUREMENT
• Muscle wasting
SPECIAL TESTS
• Trendeleberg Test
• Fulcrum  socket
• Lever  length of head
and neck
• Force  Gluteus Medius
HIP ABDUCTION MECHANISM
12
3
SPECIAL TESTS
Trendelenberg test
Normal hip Positive test
SPECIAL TESTS
Telescoping test
SPECIAL TESTS
• Ortolani test
• Barlow’s test
• Patrick test
• Febere sign
• Duchnne sign
Thank you

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