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During hip flexion and extension, especially if the hip is held in medial rotation. This condition is exacerbated by trochanteric bursitis. c. Acetabular labral tears or loose bodies cause intra-articular snapping. In this case, the patient complains of a sharp pain into the groin and anterior thigh, especially during pivoting movements. Passively, clicking may be felt and heard when the extended hip is adducted and laterally rotated. Mechanism. Did the patient fall on the outside lateral aspect of his her hip? A fall on the lateral aspect of the hip could indicate a fracture or something more benign, such as trochanteric bursitis. Did they land on their knees? Landing on the knee and jarring the hip may result in a subluxation and or labral tear. Were they involved in a repetitious type of work? Repetitive loading activities can result in a femoral stress fracture. Progression. To gauge the progression of the pain, the level of functional impairment should be noted. How many blocks could the patient walk prior to the onset of their hip pain? How many blocks can they now walk? Also, ask if the patient is taking any medication s ; for the pain. The type of medication, dosage and frequency will suggest the severity of the pain. Exacerbation. What type of activity exacerbates the pain? For example, trochanteric bursitis often results from abnormal running mechanics with the feet crossing midline increased adduction ; , wide pelvis and genu valgum, or running on bankless tracks. Physical Examination When examining the hip, the following sequence is useful: inspection, palpation, range of motion, muscle strength and special tests. Inspection. Much of the patient's hip problem can be assessed from observing gait, curvature of the back, pelvic symmetry and leg length. The following areas should be noted on inspection: Deformity. With the patient standing, inspect from the front and from behind for any pelvic tilting or rotational deformity. While observing the patient from behind, look for presence of scoliosis; from the side, note if lumbar lordosis is increased, which may indicate a fixed flexion deformity. Gait. Common abnormal gait patterns associated with hip disease are antalgic and Trendelenburg. To apply the Trendelenburg test, ask the patient to stand on one leg. The hemi-pelvis on the opposite side should remain elevated, indicating funcCanes, crutches tioning adductors on the weight bear- and walkers are a ing leg. If the common part of hemi-pelvis falls, the nonsurgical this is a positive treatment for test, which can be caused by gluteal arthritis of muscle weakness, the hip. inhibition from pain or a hip deformity. Leg length. Measure each leg from the anterior superior iliac spine to the medial malleolus. Leg-length discrepancies indicate hip pathology on the shortened side. Palpation. Because the hip joint is a deep interior structure, careful palpation is necessary to localize the pain and to determine whether the pain radiates elsewhere.
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