Updated: 6/17/2018

Hip Physical Exam - Adult

Topic
Review Topic
0
0
Questions
1
0
0
Evidence
2
0
0
Videos
4
https://upload.orthobullets.com/topic/5037/images/37264f9b81e151755f494569ed41291a_medium.jpg
https://upload.orthobullets.com/topic/5037/images/thomas_test.jpg
https://upload.orthobullets.com/topic/5037/images/ecd03f1c5c65e037d034002a15fc8420.jpg
https://upload.orthobullets.com/topic/5037/images/dsc_3377.jpg
https://upload.orthobullets.com/topic/5037/images/8-14.jpg
https://upload.orthobullets.com/topic/5037/images/20141026105426.jpg
Inspection
  • Skin
    • Discoloration, wounds, or gross deformity
  • Bony
    • Length - compare to contralateral side
    • Position - internally or externally rotated; flexion contractures
    • Gross deformity 
  • Gait 
    • Observe the stride length, foot rotation, pelvic rotation, stance phase
    • Antalgic (painful)
      • shortened stance phase on affected side
    • Trendelenberg 
      • secondary to abductor weakness 
      • weight bearing on the affected hip leads to a contralateral hip drop
Palpation
  •  Greater Trochanter / Bursea
    • Pain can be attributable to bursitis, tendonitis, infection, or fracture
    • Snapping Iliotibial band
      • ITB can snap over GT and cause pain
  • Anterior Superior Iliac Spine
    • pain with sartorius avulsions / injuries
  • Ischial tuberosity
    • pain with hamstring avulsions / tendinopathy
  • Iliac crest
    • pain with oblique avulsions / hip pointers
  • Iliotibial band / TFL
Neurovascular
  •  Motor
    • hip adduction - obturator nerve
    • thigh abduction - superior gluteal nerve
    • hip flexion - femoral nerve
    • hip extension - inferior gluteal nerve
  • Sensory
    • proximal anteromedial thigh - genitofemoral nerve
    • inferomedial thigh - obturator nerve
    • lateral thigh - lateral femoral cutaneous nerve
    • anteromedial thigh - femoral nerve
    • posterior thigh - posterior femoral cutaneous nerve
  • Pulses
    • femoral 
  • Reflexes
    • none
ROM
  • Flexion
    • 120-135 deg
    • Thomas test 
      • evaluates hip flexion contractures
  • Extension
    • 20-30 deg
  • Abduction
    • 40-50 deg
  • Adduction
    • 20-30 deg
  • Internal rotation
    • 30 deg
  • External rotation
    • 50 deg
Special Tests
  •  FADIR test  
    • hip Flexed to 90 deg, ADducted and Internally Rotated
    • positive test if patient has hip or groin pain
    • can suggest possible labral tear or FAI
  • FABER test (aka Patrick's test)  
    • hip Flexed to 90 deg, ABducted and Externally Rotated
    • positive test if patient has hip or back pain or ROM is limited
    • can suggest intra-articular hip lesions, iliopsoas pain, or sacroiliac disease (posteriorly located pain)
  • Log roll test
    • passive maximal internal and external rotation of lower extremity while supine
    • clicking or popping suggest acetabular labral tear
    • increased total ROM compared to contralateral side suggests ligament or capsular laxity
  • Thomas test  
    • with patient supine, fully flex one hip. 
    • if contralateral hip lifts off table, there is likely a fixed flexion deformity
  • Ober's test  
    • patient placed in lateral position with affected side up
    • with hip in slight extension, abduct the leg then allow it to drop into adduction
    • if unable to adduct leg, suspect tight ITB
  • Stinchfield resisted hip flexion test 
    • with patient supine and extended knee, examiner resists active hip flexion past 30-45 deg
    • a positive test ellicits pain which is likely to be associated with an intraarticular hip pathology
 
 

Please rate topic.

Average 4.2 of 29 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
ARTICLES (3)
VIDEOS & PODCASTS (4)
Topic COMMENTS (5)
Private Note