Hip Examination – OSCE Guide

Dr Lewis Potter

Hip examination frequently appears in OSCEs. You’ll be expected

to pick up the relevant clinical signs using your examination
skills. This hip examination OSCE guide provides a step by step
approach to examining the hip joint.

Check out the hip examination mark scheme here.

Introduction
Wash hands

Introduce yourself

Confirm patient details – name / DOB

Explain examination:
“Today I need to examine your hip joints, this will involve looking,
feeling and moving the joints.”

Check understanding and gain consent:

“Does everything I’ve said make sense? Are you happy for me to
examine your hips?”

Ask if the patient has had a hip replacement (if so internal

rotation, adduction and flexion greater than 90° should be avoided
due to risk of dislocation)

Expose patient appropriately

Position patient standing

Ask if the patient currently has any pain

Look
Look around bed for any aids or adaptations – walking stick /
wheelchair

Inspect patient from all angles

Front – scars / pelvic tilt /quadriceps wasting / foot deformity

Side – assess lumbar lordosis – normal / hyperlordosis

Behind – scoliosis / gluteal wasting / pelvic tilt

Gait

Observe the patient’s gait from multiple angles

Assess speed /smoothness /turning

Note any evidence of antalgic gait or Trendelenburg gait

Assess the patient’s footwear – unequal sole wearing – abnormal

gait

Feel
Ask patient to lay down on the examination couch

Palpate the tissues overlying the hip joint for

tenderness/warmth – inflammation/infection
Palpate the greater trochanter – tenderness (often indicative of
greater trochanteric bursitis)

Assess leg length

Measure apparent leg length – umbilicus to the tip of the medial

malleolus

Measure true leg length – anterior superior iliac spine to the tip of
the medial malleolus

Move
Active movements

Place your hand under the lumbar spine to detect masking of hip
movement by the pelvis / lumbar spine.

Flexion – “bring your knee towards your chest” – normal ROM is

120°

Passive movements

Flexion – assess the degree of flexion in each hip individually –

normal ROM is 120°

Internal rotation:

This can be assessed with the hip and knee joint flexed at 90°

Rotate the foot laterally

Normal ROM 40°

External rotation:
This can be assessed with the hip and knee joint flexed at 90°

Rotate the foot medially

Normal ROM 45°

ABduction – whilst stabilising the contralateral iliac crest, use your

other hand to abduct the hip until you feel the pelvis begin to tilt –
normal ROM is 45°

ADduction – whilst stabilising the contralateral iliac crest, use

your other hand to adduct the patient’s leg across the midline
as far as possible – normal ROM is 30°

Position patient prone

Hip extension (passive):

Place a hand on the pelvis to assess for movement

Lift one leg at a time to assess range of extension
Normal ROM is 10-20°

Special tests
Thomas’s test

1. Place a hand under the patient’s spine.

2. Passively flex the unaffected leg (hips/knees) as far as you

are able to.

3. Your hand should detect that the lumbar lordosis is now

flattened.

4. With the unaffected leg flexed, the contralateral leg should

be flat on the bed

5. Repeat the test to assess the contralateral hip joint.

The test is positive (abnormal) if the affected thigh raises off

the bed, indicating a loss of extension in the hip. This would
suggest a fixed flexion deformity in the affected hip.

DO NOT PERFORM ON PATIENTS WITH HIP REPLACEMENTS –

can cause dislocation!

Trendelenburg’s sign

1. Place hands on the iliac crests on either side of the pelvis.

2. Ask the patient to stand on one leg for 30 seconds.

3. Observe your hands to see which moves up or down.

4. Normally the iliac crest on the side with the foot off the
ground should rise up.

5. Repeat the test on the opposite side.

The test is deemed positive (abnormal) if the pelvis falls on the

side with the foot off the ground.

This abnormal result suggests weak hip abductors on the

contralateral side of the pelvis.

This video demonstrates a positive Trendelenburg’s sign [LINK]

To complete the examination

Thank patient
Wash hands

Summarise findings

Suggest further assessments and investigations

Full neurovascular examination of both lower limbs

Examine the joint above and below – lumbar spine/knee
Consider further imaging if indicated – e.g. X-ray / CT / MRI

Further reading
Arthritis research UK provides some excellent free guides to
musculoskeletal examination and history taking [LINK]

REVIEWED BY

Mr Tejas Yarashi

Trauma & Orthopaedic Surgeon (ST7)