From the Guidelines
The standard hip examination template includes inspection, palpation, range of motion assessment, special tests, and neurovascular evaluation. Begin by observing the patient standing and walking to assess gait, posture, and obvious deformities. Then examine the patient in supine position, palpating key landmarks including the greater trochanter, anterior superior iliac spine, and inguinal region to identify areas of tenderness. Assess active and passive range of motion including flexion (normal 110-120°), extension (10-30°), abduction (30-50°), adduction (20-30°), and internal/external rotation (40-60°) 1.
Special Tests
Perform special tests such as:
- The FABER/Patrick test (for labral tears or arthritis)
- FADIR test (for impingement), as recommended by the international hip-related pain research network, zurich 2018 1
- Trendelenburg test (for gluteal weakness)
- Straight leg raise (for nerve involvement)
Neurovascular Assessment
Complete the exam with neurovascular assessment including:
- Muscle strength testing of hip flexors, extensors, abductors, and adductors
- Sensation testing
- Distal pulses
This systematic approach ensures comprehensive evaluation of hip pathology while the specific tests help differentiate between various conditions including osteoarthritis, labral tears, impingement syndromes, and referred pain from the spine or surrounding structures. According to the American College of Radiology, radiographs of the pelvis and hip should be the first test ordered for the evaluation of patients with chronic hip pain 1.
From the Research
Standard Exam Template for Hip Exam
The standard exam template for a hip exam includes a comprehensive evaluation of the hip joint, surrounding soft tissues, and associated structures of the spine, pelvis, and lower extremities 2. The exam typically involves:
- A thorough medical and surgical history focused on the hip joint, surrounding soft tissues, and associated structures of the spine, pelvis, and lower extremities 2
- Physical examination in various positions, including upright, supine, prone, and lateral positions, as well as an evaluation of gait 2, 3
- A systematic approach to differentially diagnose hip problems with overlapping pain referral patterns 3
- Evaluation of the 4 main pain generators of the hip from deep to superficial: the osteochondral, capsulolabral, musculotendinous, and neurovascular elements of the hip 3
Key Components of the Hip Exam
The hip exam contains 21 steps, which compares well with the shoulder 20 step exam and the knee 33 step exam 4. The exam should consider the hip as comprised of 4 layers: the osseous, capsulolabral, musculotendinous, and neurovascular, as well as the kinematic chain 4. The exam should also include:
- Standing examination and gait analysis
- Seated, supine, lateral, and prone examination
- Targeted physical examination to guide diagnostic testing and distinguish hip-specific diagnoses from similar presenting pathologies 3
Importance of Sacroiliac Joint Evaluation
The sacroiliac joint (SIJ) should be evaluated as part of the hip exam, as SIJ dysfunction can be an important pain generator 5, 6. The evaluation should include: