Hip Examination.

1. As always, wash your hands, explain the examination and gain informed consent.

2. The key to starting a hip examination is to ask the patient to walk for you. This allows you to assess muscle bulk around the hip joint, ensure that you check both from behind, the side and in front. Also compare both sides for any asymmetry. You can also check the gait. Check for an antalgic gait - limp or a Trendelenberg gait - waddling due to proximal muscle wasting.

3. Whilst the patient is still standing, perform the Trendelenberg test. This is done by asking the patient to alternately stand on one leg. Stand behind the patient and feel the pelvis. It should remain level or rise slightly. If the pelvis drops markedly on the side of the raised leg, then it suggests abductor muscle weakness on the leg the patient is standing on.

4. Next, you should ask the patient to lie on the bed. You should start with a general observation of the hip and legs. Check muscle bulk and symmetry as well as any obvious abnormalities such as scars. Finally, you should check leg length. This is both true and apparent length. True leg length discrepancy is found by measuring from the anterior superior iliac spine to the medial malleolus whereas apparent leg length discrepancy is measured from the xiphisternum to the medial malleolus.

5. There is little palpation to perform on the hip examination as the joint is deep. Therefore, you should just palpate the greater trochanter for any tenderness which might suggest trochanteric bursitis.

6. Movements to be assessed at the hip are flexion, extension, internal and external rotation. For flexion, flex the knee to 90 degrees and passively flex the hip by pushing the knee towards the chest. Extension is performed by placing your hand under the patient's ankle and asking them to push your hand into the bed. Internal and external rotation are also performed with the knee flexed and by everting the knee for internal rotation and inverting it for external rotation.

7. The last special test to be performed is Thomas' test. Place your hand under the patient's lumbar spine to stop any lumbar movements and fully flex one of the hips. Observe the other hip, if it lifts off the couch then it suggests a fixed flexion deformity of that hip.

8. Thank the patient and wash your hands again.