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Hip examination - OSCE Guide | Geeky Medics

3/4/15, 7:44 PM

HIP EXAMINATION OSCE GUIDE


Hip examination frequently appears in OSCEs. Youll be expected to pick up the
relevant clinical signs using your examination skills. This hip examination OSCE guide
provides a clear concise, step by step approach to examining the hip joint.
Introduction
Wash hands
Introduce yourself
Check patient details - name / DOB
Explain examination
Gain consent
Expose patients legs and hips keeping underwear on
Position standing
Ask if patient has any pain anywhere before you begin!
Look
Look around bed for any aids or adaptations walking stick / wheelchair / etc
Inspect patients footwear note any unequal wear on the soles suggestive of gait
abnormality
Inspect patient from all angles
Front scars /pelvic tilt /quadriceps wasting
Sides assess lumbar lordosis normal / hyperlordosis
Back gluteal wasting / pelvic tilt
Gait note speed /smoothness /turning - antalgic gait / trendelenburg gait
Feel
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Hip examination - OSCE Guide | Geeky Medics

3/4/15, 7:44 PM

Ask patient to lay on the bed


Palpate hip joint for tenderness / warmth inflammation / infection
Measure apparent leg length xiphisternum to tip of medial malleolus
Measure true leg length ASIS to tip of medial malleolus
Palpate greater trochanter - tenderness (often indicative of bursitis)
Move
Use your left hand to stabilise the contralateral ASIS to prevent masking of hip
problems
Flexion (active & passive) - bring your knee towards your chest normal is 120
Abduction (active & passive) -keep leg straight & move away from the midline
normal is 30-40
Adduction (active & passive) keep leg straight & move it across the
midline normal is 30
Internal rotation (passive) - normal ROM 40
External rotation (passive) - normal ROM 45

Position patient prone


Hip extension (passive) lift each leg in turn normal ROM is 10-20
Special Tests
Trendelenburgs Test
1. Place hands on the anterior superior iliac spines
2. Ask patient to stand on one leg for 30 seconds
3. Observe your hands
4. Normally the iliac crest on the side with the foot off the ground should
rise up

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Hip examination - OSCE Guide | Geeky Medics

3/4/15, 7:44 PM

5. Repeat the test on the opposite side


The test is deemed positive (abnormal) if the pelvis falls on the side with the
foot off the ground
This abnormal result suggests weak hip abductors on the contralateral side
of the pelvis
Thomass Test
1. Place left hand under patients spine (palm upwards)
2. Passively flex both legs (hips/knees) as far as you are able to
3. Your hand should detect that the lumbar lordosis is now flattened
4. Ask patient to extend the hip you are assessing:
Incomplete extension suggests a fixed flexion deformity at the hip
5. Repeat the test to assess the contralateral hip joint
DO NOT PERFORM ON PATIENTS WITH HIP REPLACEMENTS can cause
dislocation!
To complete the examination
Thank patient
Wash hands
Present findings

Say you would


Perform a full neurovascular examination of both lower limbs
Examine the joint above and below lumbar spine / knee
Take plain radiographs of the hip joints if indicated
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Hip examination - OSCE Guide | Geeky Medics

3/4/15, 7:44 PM

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