Orthopaedics

Hip Examination

Shoulder Examination
Inspection
Palpation
Range of motion
Active and passive

Inspection
Anterior
Symmetry, pelvic tilt, joint level , short limb, limb rotation

Lateral
abnormal lumbar curve eg. excessive lordosis, hip flexion, knee flexion

Posterior
pelvic tilt, scoliosis, joint level, both heels touching floor .

Also look for scar, swelling, muscle wasting, wound,

discolouration ( erythema, pigmentation).
Gait
Look for short limb gait, antalgic gait, trendelenburg gait etc.

Trendelenburg Test
Ask patient to stand on the good leg first, then stand on the affected leg.
Look for sagging of the non weight bearing hip/ or excessive body tilt.

Palpation
Feel for tenderness, warmth, swelling, deformed
bone/ joints.
Hip joint - just distal to mid point of inguinal
ligament.
Also palpate ASIS, iliac crest, greater trochanter,
pubic symphysis.
Measurements
Apparent length Umbilicus to medial malleolus. Can be
caused by hip contracture, pelvic tilt, scoliosis
True length ASIS to medial malleolus. ( can be caused by
any pathology that cause shortening of the femur or tibia)

Range of Motion
Compare active and passive motion, both
sides
Active (Patient lying supine)
Flexion (0-120)*
Abduction ( 45 )*
Adduction (across the other leg 30)*
Internal rotation (30)
External rotation (45)

Passive(patient lying supine)

repeat the above movements.

Special Tests
Thomas Test
for fixed flexion deformity.
One hand under the lumbar spine, flex
the good hip with the other hand until
the lumbar curvature is fully obliterated.
If the affected hip rises from the couch,
this indicates loss of extension in that
hip.

Posterior ROM
Now, turn the patient prone. Palpate
the posterior structures eg. PSIS, SI
joints. Then perform the active and
passive hip extension.