Examination of the hip video
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With the patient lying as flat as possible look from the end of the bed comparing for symmetry. In a fractured neck of femur, for example, one leg may be shortened and externally rotated.
Any obvious leg length discrepancy may be seen and can be checked for using a tape measure. For this, a measurement can be taken from a fixed point such as the anterior superior iliac crest to the medial malleolus of the ankle. Both sides are compared. A difference suggests a real leg length discrepancy.
Obvious flexion deformity of the hip may be seen. Obvious scars should be checked for, and the greater trochanter should be palpated for tenderness.
Full flexion of the hip should be checked for, along with internal and external rotation with the hip and knee flexed to 90°. Both sides can be compared.
Thomas’ test: Thomas’ test assesses for a fixed flexion deformity of the contralateral hip. The examiner’s hand is placed under the patient’s back to check that lumbar lordosis is removed during full flexion of the hip. The contralateral hip should then be observed. If there is a fixed flexion deformity this leg will be forced off the couch.
Trendelenberg’s test: Trendelenberg’s test involves the patient standing alternately on each leg alone. It assesses the hip and gluteal muscle strength of the side they are standing on. In a negative test the pelvis remains level or even rises. In a positive test the pelvis will dip on the contralateral side.
Function is assessed by asking the patient to walk. A waddling gait may be a sign of hip pain or proximal muscle weakness.