An evaluation of the hip includes a physical examination and sometimes arthrocentesis. (See also Evaluation of the Patient With Joint Symptoms.)
Physical Examination of the Hip
Examination begins with gait evaluation. A limp is common among patients with significant hip arthritis and may be caused by any of the following:
Pain
Leg shortening
Flexion contracture
Muscle weakness
Knee problems
Loss of internal rotation (an early change in hip osteoarthritis or any hip synovitis), flexion, extension, or abduction can usually be demonstrated. Placement of one hand on the patient’s iliac crest detects pelvic movement that might be mistaken for hip movement. Flexion contracture can be identified by attempting leg extension with the opposite hip maximally flexed to stabilize the pelvis. Tenderness over the femoral greater trochanter suggests bursitis and gluteal tendon pathology (which is extra-articular) rather than an intra-articular disorder, although the altered gait of hip arthritis may cause secondary trochanteric pain. Pain with passive range of motion (assessed by internal and external rotation with the patient supine and the hip and knee flexed to 90°) suggests intra-articular origin. However, patients may have simultaneous intra-articular and extra-articular disorders.
Arthrocentesis of the Hip
Arthrocentesis of the hip is usually done using ultrasound guidance by an orthopedic specialist or an interventional radiologist and is not discussed here.
