Hip Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks if patient suffers from pain, stiffness or reduced range of movement in the hip	0	1
Washes hands	0	1
Exposes patient’s hips and the joints above and below (back, knees, ankles and feet) and asks them to stand	0	1
General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)	0	1
Asks patient to walk to the end of room and turn	0	1
Comments on patient’s speed, the phases of walking, stride length and arm swing	0	1	2
Inspects front for shoulder/hip alignment, limb-limb discrepancy, varus/valgus deformity, wasting of quadriceps, swellings at the knee	0	1
Inspects back for wasting of muscles (gluteal, calf), scoliosis, skin changes, scars, hindfoot deformities, wear of shoes	0	1
Inspects sides for fixed flexion deformities, swelling over the trochanters and increased kyphosis or lordosis	0	1
Performs Trendelenburg’s test whilst patient is still standing	0	1
Asks patient to lie down and measures true (ASIS to medial malleolus) and apparent leg limb length (umbilicus to medial malleolus)	0	1
Feels temperature of the hip joint	0	1
Palpates over greater trochanters for tenderness caused by trochanteric bursitis	0	1
Tests actively flexion of the hip and extends passively if necessary, comments on range of movement (120 degrees)	0	1
Assesses for fixed flexion deformity by performing Thomas’ test. Keep one hand under patient’s back to remove the normal lumbar lordosis then fully flex one hip and observe the opposite leg	0	1
Tests active internal and external rotation and extends passively if necessary. Comments on normal internal and external rotation range of movement (45 and 60 degrees respectively)	0	1	2
Tests active abduction and adduction and extends passively if necessary. Comments on normal abduction and adduction range of movement (40 and 25 degrees respectively)	0	1	2
Offers examination of back and knee exam, neurovascular exam and history	0	1
Thanks patient and offers help to redress	0	1
Washes hands	0	1
Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses	0	1

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