Hip History and Physical Exam

History

As the hip is a weight-bearing joint, inspection needs to happen while the patient is standing and walking.

Gait: Observe both stance and swing during gait. Assess width of base (normally 2-4 inches heel-to-heel), shift of pelvis, and bending of the knee.

Patients with hip problems often lurch over the affected hip (an antalgic gait).

Assess leg lengths. Shortening and external rotation suggests hip fracture.

Symmetry

Erythema, ecchmosis

Atrophy
Deformity
Swelling

bony landmarks

soft tissue

Flexion - with patient supine, bring knee to chest. The thigh should almost touch the chest wall, and the opposite thigh should move little.

Extension - done with patient lying prone

Internal/external rotation - done with knee flexed. Sensitive for hip diseases such as arthritis.

Abduction - with patient lying down, stabilize opposite pelvis with one hand and abduct or adduct the extended leg by holding the ankle.

Trendelenburg sign: standing on one leg, the contralateral leg should move higher or stay the same. A lowered contralateral leg suggests hip abductor weakness.
Thomas test: lying supine, ask the patient to flatten their back, then bring their contralateral knee to their chest. A flexion contracture will result in the ipsilateral knee popping up.