Hip Exam
 

Assessing Movement

 
 
Bookmark

Active Movement

    • How to Assess

    • Ask the patient to move the joint themselves. Assess the neutral position and the range of motion, and ask whether range of motion is limited by pain, weakness or stiffness.
    • Significance

    • Active movement is an indicator of the patient's ability to move the joint. It may be limited due to weakness, pain, mechanical stiffness or poor compliance.
    • Causes of Limited Active Movement

    • Joint pain / stiffness - see below
    • Upper motor neuron lesion - stroke, tumour, trauma, hypoxia, demyelination, deposition, inflammation
    • Lower motor neuron lesion - trauma, compression, demyelination, neuromuscular disorders, diabetes
    • Poor compliance

Passive Movement

    • How to Assess

    • Move the patient's joint. Note the range of motion and whether it is limited by pain, swelling or stiffness. Note any crepitus.
    • Significance

    • Passive movement is a measure of the objective range of motion of the joint. It may be limited by stiffness of the joint, or active resistance on the patient's part.
    • Causes of Limited Range of Motion

    • Trauma - dislocation, fracture
    • Arthritis - osteoarthritis, rheumatoid arthritis, septic arthritis, gout, pseudogout, reactive arthritis, psoriatic arthritis, Reiter’s syndrome
    • Intra-articular haemorrhage
    • Tendinitis
    • Bursitis
    • Intra-articular bleed
    • Tear - meniscus, ligament
    • Loose intra-articular body
    • Fibrous adhesions - surgery, trauma, overuse, inflammation
    • Muscle tightness
    • Prolonged joint immobilisation
    • Compartment syndrome

Extra Credit

    • Causes of Limited Hip Range of Motion

    • Fracture - pelvis, femur
    • Dislocation
    • Trochanteric bursitis
    • Avascular necrosis (Perthe’s disease)
    • Slipped capital femoral epiphysis
    • Arthritis - gout, septic arthritis, osteoarthritis, rheumatoid arthritis
    • Loose intra-articular body
    • Causes of Clicking / Snapping Hip

    • Fascial band over greater trochanter
    • Loose intra-articular body
    • Extra-articular tenodesis
    • Dislocation (newborn)
 
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Want more info like this?
  • Your electronic clinical medicine handbook
  • Guides to help pass your exams
  • Tools every medical student needs
  • Quick diagrams to have the answers, fast
  • Quizzes to test your knowledge
Explore
   
 
 

Read More...

 Amerson JR. Inguinal Canal and Hernia Examination. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 96. Available from: http://www.ncbi.nlm.nih.gov/books/NBK423 Bailey R. The Role of the Trendelenburg Test in the Examination of Gait. Physical Therapy Reviews. 2009 Jun; 14(3): 190-197. Byrd JW. Evaluation of the hip: history and physical examination. N Am J Sports Phys Ther. Nov 2007; 2(4): 231–240.
Dixon JK, Keating JL. Variability in Straight Leg Raise Measurements. Physiotherapy. 2000;86:361-370.
 Dutro JA. Obturator hernia. Am Surg. 2012;78:E217. Hallaceli H, Uruc V, Uysal HH, Ozden R, Hallaceli C, Soyuer F, Ince Parpucu T, Yengil E, Cavlak U. Normal Hip, Knee and Ankle Range of Motion in the Turkish Population. Acta Orthop Traumatol Turc. 2014; 48(1): 37-42. Hardcastle P, Nade S. The Significance of the Trendelenburg Test. J Bone Joint Surg Br. 1985 Nov; 67(5): 741-746. Harvey D. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998; 32: 68-70. Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. The Lancet. 2003 Nov; 362(9395): 1561-1571. Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon MJ. Acetabular Labral Tears of the Hip: Examination and Diagnostic challenges. Journal of Orthopaedic and Sports Physical Therapy. 2006: 36(7): 503-515. Martin RL, Sekiya JK. The Interrater Reliability of 4 Clinical Tests Used to Assess Individuals with Musculoskeletal Hip Pain. Journal of Orthopaedic and Sports Physical Therapy. 2008 Feb; 38(2): 71-77. Rahman LA, Adie S, Naylor JM, Mittal R, So S, Harris IA. A Systematic Review of the Diagnostic Performance of Orthopedic Physical Examination Tests of the Hip. BM Musculoskeletal Disorders. 2013; 14: 257. Roach KE, Miles TP. Normal Hip and Knee Active Range of Motion: The Relationship to Age. Physical Therapy. 1991; 656-665. Sabharwal S, Kumar A. Methods for Assessing Leg Length Discrepancy. Clin Orthop Relat Res. 2008; 466: 2910-2922. Shailam R, Jaramillo D, Kan JH. Growth Arrest and Leg-Length Discrepancy. Pediatric Radiology. 2013. 43(S1): S155-S165.
Smith NP, Kenny SE. Inguinal hernia and hydrocele. Surgery (Oxford). 2008;26:307-309.
 Whalen HR, Kidd GA, O'Dwyer PJ. Femoral hernias. BMJ: British Medical Journal. 2011;343:1271-1273.
Feedback