Hip Exam
 

Examining for Herniae

 
 
Bookmark

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.
 
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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