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Hip Exam
 
 

Examining for Herniae

 
 
 
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Overview

Examine for herniae while sitting on a stool with the patient standing.
  • Look For

  • Bulge, above or below the inguinal crease. Examine with an light source shone at an oblique angle. Ask the patient to cough.
  • Feel For

  • Placing the fingers over the femoral region, external & internal inguinal rings, palpate for bulge or impulse on coughing.
In the male, invert the scrotum on each side and palpate along the course of the spermatic cord to the inguinal canal. Ask the patient to cough. Feel if it is possible to get above the hernia
If any hernia is palpated, gently attempt to reduce it with the patient supine. Do not attempt to reduce a tender hernia or a hernia associated with nausea or vomiting (as it may be strangulated).
  • Interpretation

  • Above the inguinal crease - indicative of a femoral hernia.
  • Below the inguinal crease - indicative of a direct or indirect inguinal hernia.
  • Can get above the mass - likely related to lesion within the scrotum such as a hydrocoele or varicocoele
  • Significance

    Herniae represent portions of bowel or ommentum that have passed outside of the abdominal cavity. Herniae may be reducible but may become trapped (encarcerated) or vascularly compromised (strangulated)
  • Femoral herniae - pass through a defect within the femoral canal medial to the femoral vein.
  • Indirect inguinal herniae - pass through the deep inguinal ring and through the inguinal canal into the scrotum
  • Direct inguinal herniae - pass through a weakness in the transversalis fascia, rarely into the scrotum.
The herniae mentioned above are those that are palpable within the groin. Other types of herniae to not forget include obturator, umbilical, epigastric, ncisional and Spigelian herniae.
Think about an obturator hernia in a patient with lower abdominal / groin pain with pain on hip movement.
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