Hip Exam

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The hip is a ball-and-socket joint that consists of the femoral head articulating with the acetabulum. When combined with the hip ligaments, the hip makes for a very strong and stable joint. But, despite this stability, the hip has considerable motion and is prone to degeneration with wear and tear over time and after injury. Hip pain can affect patients of all ages and can be associated with various intra- and extra-articular pathologies. Anatomic location of pain in the hip region can often provide initial diagnostic clues. Essential aspects of the hip exam include an inspection for asymmetry, swelling, and gait abnormalities; palpation for areas of tenderness; range of motion and strength testing; a neurological (sensory) exam; and additional special diagnostic maneuvers to narrow down the differential diagnosis.

1. Inspection

When examining the hip, make sure the patient has removed enough clothing to expose and compare both hips.

Inspect both hips from the front, back, and sides. Note any asymmetry due to muscle wasting or swelling.
Instruct the patient to walk back and forth, and observe the gait, checking for a limp.

2. Palpation

The hip joint is relatively inaccessible by palpation; however, palpation allows access

Examination of the hip is best done in the sitting and standing positions, following a stepwise approach. The exam should begin with inspection, looking for asymmetry between the involved and uninvolved hip. It is important to have the patient remove enough clothing, so the surface anatomy can be seen and compared to the uninvolved side. The patient should be observed for limp or pain while walking. Patients with intra-articular pathology can present with so-called antalgic gait, characterized by shortened standing time

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