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Physical Exam Hip

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Introduction

  • Follows the IP-PASS examination methodology
    • Inspection
    • Palpation
    • Passive Range of Motion
    • Active Range of Motion
    • Strength & Neurovascular
    • Special Tests

Inspection

  • Skin
    • Color: erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
    • Swelling
    • Muscle tone: atrophy, hypertrophy
    • Deformity: asymmetry, rotation, amputation
  • Areas of emphasis for back exam
    • Resting position of hip/ leg (internal/ external rotation)
    • Leg length discrepency

Palpation

  • Palpate for
    • Effusion
    • Clicking
    • Snapping
    • Crepitus
    • Tenderness
    • Temperature
    • Masses
  • Areas of Emphasis
    • Greater Trochanter
    • Piriformis muscle
    • Ischial Tuberosity (if appropriate)
    • Pubic symphysis (if appropriate)
    • Iliopsoas bursa

Range of Motion

  • Hip
    • Flexion: 120
    • Extension: 45
    • Abduction: 40
    • Adduction: 25
    • Internal Rotation: 45
    • External Rotation: 45

Strength and Neurovascular

Motor Exam

Sensory Nerves /Dermatomes

  • L1: Iliac crest, groin
  • L2, L3: Anterior and inner thigh
  • L4: Lateral thigh, anterior knee, medial leg
  • L5: Lateral leg, dorsal foot
  • S1: Posterior Leg
  • S2: Plantar foot
  • S3, S4: Perianal

Reflexes

  • Commonly Used
    • Patellar (L3, L4)
    • Achilles (S1, S2)
  • Uncommonly Used
    • Medial Hamstring (L5, S1)
    • Lateral Hamstring (S1, S2)
    • Posterior Tibial (L4, L5)
    • Cremasteric (L1, L2)
    • Anal wink/ bulbocavernous (S2)

Myotomes

  • L2: Hip Adduction, Hip Flexion
  • L3: Knee Extension, Hip Adduction, Hip Flexion
  • L4: Knee Extension, Dorsiflexion
  • L5: Hip Abduction, Hip Extension, Toe Dorsiflexion, Foot Inversion, Dorsiflexion
  • S1 Foot Version, Plantarflexion
  • S2: Toe Plantar Flexion
  • S3: Bowel, bladder function
  • S4: Bowel, bladder function

Vascular


Special Tests


See Also


Created by:
John Kiel on 20 August 2020 16:06:06
Authors:
Last edited:
15 October 2020 14:20:47
Category: