Orthopaedic examination of any bone or joint follow the same basic structure:

LOOK - gait (if lower limb), erythema, swelling, scars, deformity, muscle wasting

FEEL - warmth, tenderness, swelling, crepitus

MOVE - range of motion, power

SPECIAL TESTS - joint stability, isolated muscle power, provocative tests

JOINT ABOVE & BELOW - ensure pain not radiating from elsewhere

NEUROVASCULAR - examine neurological and vascular supply to limb

This is followed by INVESTIGATIONS - blood tests, X-rays, further imaging

Each section describes a basic technique to examine the joints regularly seen in the exams and clinics. By following the routine described above, most joints can be examined thoroughly. The text does not provide an exhaustive description of every test available but outlines the commonly used basic examinations.

Hip examination

LOOK            

Gait - Trendelenburg (weak abductors allow pelvis to droop upon stance on the affected side, with reciprocal trunk lurch over weak hip to compensate and balance the pelvis; Antalgic (short stance phase due to pain)

Scars - Anterior (longitudinal inline with ASIS or parallel to groin crease - often from surgery as a child e.g. open reduction of DDH), lateral (longitudinal over greater trochanter - hip fracture or joint replacement), posterior (curved longitudinal behind greater trochanter - acetabular/hip fracture or joint replacement)

Muscle wasting - wasted gluteal muscles. 

Trendelenburg test - with a single leg stance, the opposite hip sags due to weak abductors on the side of stance

Lie patient supine on examination couch.

FEEL 

Tenderness - lateral tenderness indicates trochanteric bursitis

Leg length - Ensure the pelvis is level. Measure true length (ASIS to medial malleoli on both sides). Measure apparent length (xiphisternum to medial malleoli - difference indicates other cause e.g. scoliosis)

MOVE 

Thomas’ test - examiners hand under lumbar spine to ensure lordosis flattens. Flex one hip fully and assess other hip - if it has risen off bed, there is a fixed flexion deformity. Repeat with contralateral hip

Stabilise pelvis with free hand to ensure motion arises from hip and not pelvic movements

Range

1.             flexion 0-120°

2.             extension 0-15°

3.             abduction 0-45°

4.             adduction 0-30°

5.             flexion & internal rotation 0-35°

6.             flexion & external rotation 0-45°

SPECIAL 

Power - hip flexor and extensor power

Straight leg raise - ensure hip pain not originating from spinal pathology