Examinations
CPSA · Clinical examination · Musculoskeletal
Hip examination
Look → feel → move → special tests (Trendelenburg, Thomas). Gait and leg-length assessment localise the problem.
Practise it out loudPosition: Observe standing & walking first, then supine on the couch.
The routine
Look
- 1Gait (antalgic, Trendelenburg); standing posture, pelvic tilt, muscle wasting
- 2Supine: scars, deformity, leg length (true vs apparent)
Feel
- 1Temperature; palpate the greater trochanter (bursitis) and the joint
Move
- 1Flexion, extension, abduction/adduction, internal/external rotation (active then passive); note range and pain
Special tests
- 1Trendelenburg (abductor weakness — pelvis drops on the *opposite* side)
- 2Thomas test (fixed flexion deformity)
Signs & what they mean
Antalgic gait, reduced internal rotation, groin pain, crepitusHip osteoarthritis
Positive Trendelenburg (contralateral pelvic drop)Weak hip abductors (superior gluteal nerve / arthritis)
Shortened, externally rotated leg after a fallFractured neck of femur
Lateral hip pain, tender greater trochanterTrochanteric bursitis
To complete, I would…
- Examine the joint above (spine) and below (knee)
- Assess neurovascular status
- Request pelvic/hip X-rays
OSCE tips
- In Trendelenburg the pelvis drops on the side opposite the weak abductors.
- A shortened, externally rotated leg = fractured NOF until proven otherwise.
- Reduced internal rotation is often the earliest sign of hip OA.