The Hip Joint
Clinical Hip Examination
Steps in the orthopaedic examination for hip problems
The examination of the hip proceeds in an orderly manner as for any other joint examination. It involves the sequence of Look, Feel, Move.
If you come to the clinic for a hip examination, you will be examined from all directions while standing, sitting, and lying down. Firstly, you will be examined while standing (Fig. 5a).
The standing posture may reveal a difference in leg length or deformity. If hip disease is present, wasting of the muscles may be noted. You will be asked to stand on each leg in turn. If you stand on your right leg and the left part of your pelvis tilts downwards you are exhibiting a Trendelenberg sign which indicates muscle weakness and/or hip joint instability.
Next, you will be viewed while walking. An asymmetric walking pattern results if one leg is shorter or if hip muscle weakness is present. You will then be asked to lie on your back on an examination table. A tape measure will be used to measure your leg lengths, from a bony landmark on each side of the pelvis to the bottom of each foot.
Your hip will be further inspected by feeling the pelvic region for tissue masses or irregularities.
Next you will be tested to determine how far the leg can be moved in various directions. The following leg movements are used.
Forward Flexion Lying on the back, the straight leg is raised in front of the body, as far as possible.
Abduction Lying on the side, the straight leg is raised to the side as far as possible.
External Rotation Lying on the back, with the knee bent, the thigh is rotated outward as far as possible (Fig. 5b).
Internal Rotation Lying on the back, with the knee bent, the thigh is rotated inwardly as far as possible.
Finally, depending on your symptoms, the spine, knee, and foot may also be examined. Spinal disease can produce similar symptoms to hip disease and pain from knee problems often shows up in the hip region. Or, knee pain may result from your hip disorder.