All important diseases of the hip can affect a person's gait. The hip exam therefore begins with an evaluation of the patient's gait as he or she is moving from the chair to the examining table. Normal gait is smooth and fluid with about a 2 - 4" distance between feet. Evaluate for a wide base or pelvic shift. Pay particular attention to the stance phase of walking. If you note gait problems, ask the patient to walk across the room for further evaluation. Next, with the patient standing, inspect the lumbar spine and the anterior, posterior, and lateral hip noting any muscle atrophy.
To palpate the hip appropriately, the patient should be supine with his or her leg bent and internally rotated, so that the heel is on the opposite leg's knee. After reviewing the surface landmarks of the hip, palpate along the inguinal ligament from the anterior superior iliac spine to the pubic tubercle. Then, palpate laterally over the greater trochanteric bursa.
The hip moves in flexion, extension, abduction, adduction and [rotation]. Testing should evaluate all these planes of motion.
Click on the video icon to view a demonstration of the hip exam. |