HOWTRAININGMATERIAL2010/11 SESSION4

THEHIP

History

Paininhipjoint:Groin,frontofthigh,knee(sometimes;orevenonlysymptom!)
Stiffness:withproblemwithputtingsocksorsittinginalowchair.
Limpwithsometimeslegisgettingshorter
Walkingdistance:shortenedorusingwalkingstick

Signs

a) Upright
Gait:Antalgic(duetopain),Shortleglimp,Trendelenburglurch(abductorweakness)
Trendelenburgtest(stability):patientisaskedtostand,unassisted,oneachleginturn;onelegisliftedand
bendingthekneeoftheothersideofleg(notthehip).Positivetest:
Dislocationorsubluxationofhip
Weaknessofabductors
Shorteningoffemoralneck
Anypainfuldisorderofhip

b) Lyingsupine
Look:Besurepatientiscomfortable,pelvisatsamelevelandlegsareplacedsymmetrically.Check
levelofbothmedialmalleoliorshorteningofoneleg,
scarorsinuses,
swellingorwasting,
deformityormalposition
Asymmetryofskincreases(inbabies).

a) Limblength
Placingof2lowerlimbsincomparablepositionsinrelationtopelvisandthenmeasuringdistance
fromanteriorsuperioriliacspinetomedialmalleolusoneachside.
Shortening?Flexbothkneesandplaceheeltogetherdiscrepancyisbeloworaboveknee?If
above:isabnormalityliesabovegreatertrochanter?

Thumbsarepressedfirmlyagainsttheanteriorsuperioriliacspineandmifflefingersfeelforthe
topsofgreatertrochanterstocheckforanyelevationof1side.

b) ApparentShorteningorlengthening(nottrueshorteningorlengthening)
Happenswhenpelvisistiltedandonelimbishitchedupwards.Reasons:Uncorrecteddeformityin
thehip
withfixedadductiononeoneside,thelimbswouldtendtobecrossed;whenthelegsare
placedsidebyside,thepelvishastotiltupwardsontheaffectedside,givingtheimpressionof
ashortenedlimb.
Ortheoppositewithfixedabduction,andthelimbseemstobelongerontheaffectedside.


HOWTRAININGMATERIAL2010/11 SESSION4
Feel
Bonecontourarefeltwhenlevelingthepelvisandjudgingtheheightofgreatertrochanters.
Tendernesselicitedinandaroundthejoint.
Surfacemarkingofthejointofthefemoralhead:halfwaybetweenanteriorsuperioriliacspineand
pubictubercle.

Move
Thomasstest(fixedflexiondeformitytest):bothhipsareflexedsimultaneouslytotheirlimit
(lumbarlordosisobliterated);holdingthesoundhipfirmlyinthisposition(andthuskeepingthe
pelvisstill),theotherlimbisloweredgently.Measurethefullrangeofflexion(Normal:130degrees).
PostiveThomasstest:withanyflexiondeformity,thekneewillnotrestonthecouch.

Abductiontest:Placethesoundhipinfullabductionandkeepingitthere,thusfixingthepelvisin
thecoronalplane.Ahandisplacedononeiliaccresttodetecttheslightestmovementofthepelvis.
Then,aftercheckingthattheanterioriliacspinesarelevel,theaffectedjointismovedgentlyinto
abduction.(Nrange:45degrees)

Adductiontest:Crossingonelimbovertheother;thepelvismustbewatchedandfelttodetermine
thepointatwhichitstartstotilt.(Nrange:30degrees)

Rotationtest:bothlegsareliftedbyankles,arerotatedfirstinternallythenexternally;thepatellae
arewatchedtoestimatetheamountofrotation.Rotationinflexionistestedwithhioandkneeeach
flexed90degrees.

Abnormalmovement(movementgreatlyexcessthenorm,orabilitytoelicittelescopingby
alternativekypullingandpushingthelimbinitslongaxis)suggestseitherinstabilityoran
pseudoarthrosisofhip).

c) Lyingprone
Scars,sinusesorwasting.
Extensionof2hips(moreaccuratethanpatientinlyingsupine)
Rotationwithflexionofbothkneesandmovingthelegs:firstawayfromeachotherandthencrossingeach
other.