Hip & Pelvis:

N.B. a way to remember this examination is ‘I’ve Got To Prepare Student Teaching Monthly’: Inspection, Gait, Trendelenburg’s, Palpation, Shortening, Thomas’ test, Movements

Inspection

• scars, swellings, erythema, deformities
• N.B. a neck of femur fracture usually presents as a painful hip + a shortened externally rotated leg

Palpation

• palpate around trochanter (joint is too deep to easily palpate) + surrounding muscles for tenderness & assess temp

Shortening

• assess leg shortening by seeing if bottom of feet are at same level
• N.B. maybe due to pelvic tilting so check pelvis is also level

Thomas’ test

• looks for a fixed flexion deformity: put hand under patient’s back, flex the opposite hip to the one you are examining until their lumbar spine is flat on your hand, the test is +’ve if the leg you are examining has lifted off the bed

Movement (3 planes)

1. flexion = “keeping your leg straight lift it off the bed” (normal range = 0-135 degrees), someone with neck of femur fracture cannot usually straight leg raise
2. abduct leg away to the side then adduct past the other leg (normal abduction 0-45 degrees, normal adduction 0-30 degrees)
3. internal/external rotation: can either roll the hip with the leg flat on the bed or flex + support knee & move ankle left then right (normal = 0-40 degrees each way)

Trendelenburg test

• stand on the good leg, lift the other off the floor, put your hands on the patient’s pelvis to stabilise, test = +’ve if pelvis dips on the good side (suggesting weakness of abductors on the opposite side)
• N.B. remember ‘good side goes’

Gait/Function

• painful hip (patient limbs to avoid weight bearing), short leg, ‘swinging’ gait (due to weakness in hip muscles, see trendelenburg test)