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Hip examination

Patient must be suitably undressed (down to underwear)

First examine patient standing and then lying down.

Look, feel, move and special tests.

1. PATIENT STANDING

Look

  • Front and back of pelvis/hips and legs: any ischaemic or trophic changes
  • Swelling (e.g. lipoma) Scars (previous surgery)
  • Sinuses (infection/neuropathic ulcers)
  • Wasting (old polio, Carcot-Marie-Tooth) or hypertrophy (e.g. calf pseudo-hypertrophy in muscular dystrophy)
  • Deformity (leg length inequality, pes cavus, scoliosis)

Feel (Not a lot!)

  • Assess any swellings
  • Assess pelvic tilt by palpating iliac crests

Move

  • Gait:    
    • Trendelenburg (pelvic sway/tilt, aka waddling gait if bilateral)
    • Broad-based (ataxia)
    • High-stepping (loss of proprioception/drop foot)
    • Antalgic (mention "with reduced stance phase on left/right side")
    • Smooth progression of phases of gait cycle: stance, toe-off, swing and heel-strike
    • In-toeing (persistent femoral anteversion: most PFA is not clinically significant as both Monica Selles and Andre Agassi manage quite well with theirs!)
    • Appropriate stride length
    • Sufficient flexion/extension at hip/knee ankle and foot: Any fixed contractures?
    • Observe arm-swing and balance on turning around


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