import { HighYieldBox, ExamCheatSheet, Tabs, Tab, ComparisonTable, VivaScenario, ContentSection, SpecialTestCard , MedicalImage} from '@/components/content' # Hip Examination The hip examination is a core clinical station. Examiners expect you to begin with gait assessment, perform Thomas test for fixed flexion deformity, demonstrate Trendelenburg test, and systematically assess ROM and special tests. Common scenarios include osteoarthritis, FAI, and DDH. ## Quick Reference One-Pager ## Introduction and Setup **Start with Gait:** Always begin hip examination by observing the patient walking **Patient Positioning:** - Standing for Trendelenburg - Supine for ROM and most special tests - Prone for extension and posterior structures **Exposure:** Both legs exposed from waist to feet, patient in shorts or gown **Consent Script:** "I'd like to examine your hips. I'll start by watching you walk, then examine both sides lying down. Please let me know if anything is painful." ## Gait Assessment **Ask patient to walk normally across the room and back:** | Gait Pattern | Description | Indicates | |--------------|-------------|-----------| | Antalgic | Short stance phase on affected side | Hip pain (OA, AVN, fracture) | | Trendelenburg | Pelvis drops on swing side | Abductor weakness | | Compensated Trendelenburg | Trunk leans over affected hip | Abductor weakness (compensated) | | Short leg | Dipping on one side | Leg length discrepancy | | Stiff hip | Reduced hip motion, circumduction | Arthritis, fusion | **Additional Gait Tests:** - Heel walking: L5 (dorsiflexion) - Toe walking: S1 (plantarflexion) - Single leg stance: Assess balance and abductors ## Look (Inspection) - **Posture**: Pelvic obliquity, lumbar lordosis, scoliosis - **Muscle bulk**: Gluteal wasting (compare sides) - **Alignment**: Genu varum/valgum, foot progression angle - **Scars**: Anterior (direct anterior approach), lateral (lateral/posterolateral), posterior - **Skin changes**: Bruising, sinuses - **Leg position**: External rotation (fracture, OA), fixed flexion - **Leg length**: Gross difference visible - **Quadriceps**: Wasting (measure 15cm above patella) - **Knee position**: May compensate for hip - **Scars**: Check anterior approaches - **Hip flexion**: Fixed flexion deformity (exaggerated lumbar lordosis) - **Trochanteric region**: Swelling, scars - **Buttock**: Muscle wasting ## Leg Length Assessment **True (Anatomical) Leg Length:** - Measure from ASIS to medial malleolus - Legs in neutral position, equal abduction - Ensure pelvis is square **Apparent (Functional) Leg Length:** - Measure from xiphisternum or umbilicus to medial malleolus - Affected by pelvic obliquity, adduction contracture **Galeazzi Test (Block Test):** - Patient supine, knees flexed to 90° - Compare knee heights (femoral shortening) and tibia (tibial shortening) | Type | True Length | Apparent Length | Cause | |------|-------------|-----------------|-------| | True shortening | Short | Short | Femoral/tibial fracture, AVN, DDH | | Apparent shortening | Equal | Short | Fixed adduction contracture | | Apparent lengthening | Equal | Long | Fixed abduction contracture | ## Feel (Palpation) **Anterior Structures:** 1. **ASIS**: Bony landmark, sartorius origin 2. **Inguinal ligament**: Deep palpation over hip joint 3. **Femoral triangle**: Pulse, lymph nodes 4. **Adductor longus origin**: Pubic tubercle **Lateral Structures:** 1. **Greater trochanter**: Tenderness (bursitis), prominence 2. **Gluteus medius insertion**: Superior trochanter 3. **IT band**: Snapping, tightness **Posterior Structures (Prone):** 1. **PSIS**: Pelvic landmarks 2. **Sacroiliac joint**: Tenderness 3. **Ischial tuberosity**: Hamstring origin 4. **Sciatic nerve**: Tenderness (piriformis syndrome) ## Move (Range of Motion) **Internal Rotation:** The first and most sensitive movement lost in hip pathology. In OA, there is a capsular pattern: internal rotation > abduction > flexion > extension. ## Special Tests ### Fixed Flexion Deformity ### Abductor Function ### Impingement Tests ### Other Tests ## Neurovascular Assessment **Motor:** | Muscle | Nerve | Root | Test | |--------|-------|------|------| | Hip flexion | Femoral | L1,2,3 | Resisted hip flexion | | Hip extension | Inferior gluteal | L5,S1 | Prone hip extension | | Hip abduction | Superior gluteal | L5,S1 | Side-lying abduction | | Knee extension | Femoral | L3,4 | Resisted knee extension | **Sensory:** - L1: Inguinal region - L2: Anterior thigh - L3: Medial thigh/knee - L4: Medial leg - L5: Lateral leg, dorsum foot - S1: Lateral foot, sole **Reflexes:** - Knee jerk: L3,4 - Ankle jerk: S1 - Femoral pulse: Below inguinal ligament, medial to nerve (NAVY) - Popliteal pulse: Posterior knee, deep - Dorsalis pedis: Lateral to EHL tendon - Posterior tibial: Behind medial malleolus ## Complete the Examination **Always state to the examiner:** "To complete my examination, I would like to: - Examine the **lumbar spine** for referred pain - Examine the **knee** as the joint below - Perform **neurovascular assessment** of the lower limb - Assess **gait** with and without walking aids - Obtain **X-rays** (AP pelvis, lateral hip)" ## Summary Presentation ## Common Conditions Table ## Examiner Tips