Learning outcome
- Coxa vara (bow legs)
- Coxa valga (knock-knees)
- Increased anteversion angle (pigeon-toed)
- Reduced anteversion angle (out-toeing)
- Hip osteoarthritis
- Impacted and dislocated fracture of the femoral neck
- Trochanteric tendinopathy/bursitis
Case 4
You are doing a rotation at a general practitioner's office. Your supervisor has scheduled a previously healthy 70-year-old man for you for a clinical examination of pain in the left hip joint with a view to referral for X-ray.
He reports that over the past year he has had pain at the start of movement and a slightly limping gait. The hip joint feels stiff, and he has gradually developed reduced walking distance.
Hip examination
- Perform a standard hip examination
- Inspection
- Active movement
- Passive movement
- Isometric movement
- Palpation
- You perform an inspection, what are you looking for?
- You ask the patient to perform active movements, what do you expect to find?
- You perform passive movements, indicate the range of motion in degrees?
- You perform isometric movements, which muscles flex the hip joint?
- You palpate the trochanter area, which two structures do you palpate?
Inspection of the hip
Passive movement of the hip
Isometric movement of the hip
Trendelenburg test
Clinical findings
During the examination, he has a slightly limping gait. During active movement in the hip joint, you note that there is reduced flexion movement, and the patient reports pain at the end range of motion. During examination of passive movement in the hip joint, you find reduced flexion and internal rotation. He reports pain at the end range of motion, and you get the sensation that there is a hard stop. Normal findings on palpation.
What is wrong with the patient?
Hip joint osteoarthritis.