mymrcgp

Physical Examination

Painful Hip

 

 

 

 

 

 

 

 

 

 

 

Common Examination Components:

(You are likely to be expected to examine the common components in each case)


Introduction: ‘What you have told me suggests I need to examine your right/left hip’

 

Inspection: Gait (for antalgic limp, Tendelenburg leg swinging*, drop shoulder of short leg gait). Compare range of movement on both hips.

 

*Trendelenburg leg swing is caused by pain or abductor weakness in the hip. 

 

Palpation: 
Limit palpation to the affected side only

  • Greater trochanter (for bursitis, groin tenderness of arthritis )
  • Hip joint (for tenderness)Range of movement

 

Range of Movement:

Compare range of movement on both hips.

  • Fixed flexion test (for deformity suggestive of hip arthritis)
  • Flexion (130 degrees is expected)
  • Internal & External rotation (with hip at 90 degrees, range of 45 degrees expected)
  • Abduction
  • Adduction

 

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Additional Examination Components:

(Examine an additional component If the specified indication is present)

 

Indication: Drop Shoulder Gait

 

Components: Leg length (square off pelvis and compare malleoli positioning)

 

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What CSA Examiners and Trainers Expect - A Typical Scenario

(Study by N.Boeckx: Data from 300 GP Trainers and 16 CSA examiners)


Case Details: A 70 year old man presents with a painful hip (groin pain). The cause is osteoarthritis. There are no alarming features in the history. The findings on examination are consistent with hip osteoarthritis. Choose the examinations you would expect from a safe GP in a 10 minute consultation.

Case Discussion: Another case that lends itself to examination in the CSA is the hip. This can be time consuming if the patient undresses (particularly if they are frail or disabled). Note that none of the components for hip examination expected by examiners in this case require the joint to be exposed. Whilst in some cases (i.e. groin pain with weakness or sensory changes) it may be necessary to expose the hip to look for abnormalities (i.e. muscle wasting, fasciculation) it is otherwise reasonable to examine the hip without exposing the joint.

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