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Hip examinationfrequently appears in OSCEs. Youll be expected to
pick up the
relevant clinical signs using your examination skills. his hip
examination OSCE guide
provides a clear concise step by step approach to examining the
hip !oint.
Introduction
Wash hands
Introduce yourself
Confirm patient details name " #O$
Explain examination:
%oday & need to examine your hip !oint' this (ill involve
looking' feeling and moving the
!oint.)
Check understanding & gain consent:
%#oes everything &ve said make sense* +re you happy for me
to examine your
hip !oint*)
Ask if patient has had a hip replacement ,if so internal
rotation' adduction - flexion
greater than /0 should be avoided due to risk of
dislocation1
Expose patient appropriately
Position patient standing
Ask if the patient currently has any pain
Look
Look around ed for any aids or adaptations (alking stick "
(heelchair
Inspect patient from all angles
!ront scars / pelvic tilt /quadriceps wasting / foot
deformity
"ide assess lumbar lordosis normal " hyperlordosis
#ehind scoliosis$ gluteal wasting / pelvic tilt
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Inspect the lower hip joint, pelvis and lower limb.
Inspect the lower hip joint, pelvis and lower limb.
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Inspect the lower hip joint, pelvis and lower limb.
%ait
Observe patient from behind, the side and in front.
Assess speed $smoothness $turning
'ote any e(idence of antalgic gait or )rendelenurg gait
Assess the patient*s foot+ear unequal sole wearing2 abnormal
gait
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Observe the patient's !I".
Inspect the patient's footwear for signs of uneven sole
wear.
!eel
Ask patient to lay down on a bed.
Palpate the tissues o(erlying the hip ,oint for tenderness $
+armth inflammation "
infection
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Palpate greater trochanter tenderness,often indicative of
bursitis1
Assess leg length
-easure apparentleg length umbilicus to the tip of medial
malleolus
-easure trueleg length !#I# to the tip of medial malleolus
!ssess $ compare hip joint temperature.
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%alpate the greater trochanter for tenderness &bursitis.
(easure apparent leg length.
(easure true leg length.
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-o(e
Acti(e mo(ements
3lace your hand under the lumbar spine to detect masking of hip
movement by the
pelvis " lumbar spine.
!lexion %bring your knee to(ards your chest) 2 normal )O( is
*+-
Passi(e mo(ements
!lexion assess the degree of fleion in each hip individually
normal 4O5 is 67/0
Internal rotation:
his can be assessed (ith the hip - knee !oint flexed at /0
o )otate the foot laterally
o ormal )O( 0-
External rotation:
his can be assessed (ith the hip - knee !oint flexed at /0
o )otate the foot medially
o ormal )O( 01
A#duction whilst stabilising the contralateral iliac crest, use
your other hand abduct
the hip until you feel the pelvis begin to tilt normal 4O5 is
890
A.duction whilst stabilising the contralateral iliac crest, use
your other hand to adduct
the patient2s leg across the midline as far as possible normal
4O5 is :/0
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!ssess active 3I% 4567IO
!ssess passive 3I% 4567IO
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!ssess passive 3I% I"6)!5 )O"!"IO
!ssess passive 3I% 67"6)!5 )O"!"IO
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!ssess passive 3I% !889:"IO &stabilising contralateral iliac
crest
!ssess passive 3I% !;89:"IO &stabilising contralateral iliac
crest
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Position patient prone
/ip extension (passive):
o %lace a hand on the pelvis to assess for movement
o 5ift one leg at a time to assess range of etension
o ormal )O( is *
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78epeat the test to assess the contralateral hip ,oint
.9 '9) PE8!98- 9' PA)IE')" WI)/ /IP 8EPLACE-E')" can
causedislocation=
%assively fle both hips as far as possible &ensuring the
lumbar lordosis is eliminated.
!s> the patient to fully etend the hip being tested. !n
inability to fully etend the hip suggests a fied fleion d
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)rendelenurg*s test
0Place hands on the iliac crests on either side of the
pel(is
1Ask the patient to stand on one leg for 4 seconds
49ser(e your hands to see +hich mo(es up or do+n
6'ormally the iliac crest on the side +ith the foot off the
ground should rise up
78epeat the test on the opposite side
)he test is deemed positi(e,abnormal1if the pel(is falls on the
side +ith the foot
off the ground
)his anormal result suggests +eak hip aductors on the
contralateral side of the
pel(is
%erform "rendelenburg's test.
)o complete the examination
)hank patient
Wash hands
"ummarise findings
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"uggest further assessments & in(estigations
o !ull neuro(ascular examination of oth lo+er lims
o Examine the ,oint ao(e and elo+ lumbar spine " knee
o Consider further imaging if indicated e.g. ;
