2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd s1

19 Hip

Checklist / P / MP / F /
HELP
H: ‘Hello’ (introduction and gains consent)
E: Exposure (nipples to knees/down to groins)
L: Lighting
P: Positions correctly (supine), asks if the patient is in any pain
Washes hands
Inspects from the end of the bed for relevant paraphernalia:
• Walking stick
• Zimmer frame
Assesses gait:
• Symmetry (symmetrical – normal, parkinsonian, marche à petits pas, wide-based; asymmetrical – hemiplegic gait, antalgic, orthopaedic)
• Size of paces (normal – waddling, small – parkinsonian, marche à petits pas)
• Distance between feet (normal, scissoring, cerebellar, broad-based)
• Knees (normal, high-stepping)
• Painful gait (arthritis, trauma)
• Phases of walking (heel strike, stance, push-off, swing)
• Arm swing (present or absent)
Inspection (patient standing, inspect all around patient, 360 degrees):
• Skin – trophic, sinuses, scars (e.g. total hip replacement)
• Muscle (gluteal muscle bulk)
• Leg length (disparity)
• Bony deformity (scoliosis)
• Posture (lumbar lordosis for fixed flexion deformity)
• Erythema/swelling (rheumatoid arthritis, osteoarthritis, trauma, tumour, septic arthritis)
• Position (degree of rotation of leg, fixed flexion deformity)
Trendelenburg test (see below)
Measure (patient lying):
• Leg length
Palpate (patient lying):
• Skin – temperature (infection, inflammation)
• Bone – tenderness (fracture, trochanteric bursitis, labral tears)
Move (patient lying):
• Flexion (normal: flexion arc 0–120 degrees)
• Extension (patient prone, normal: 0–10 degrees)
• Abduction (normal: 0–40 degrees)
• Adduction (normal: 0–25 degrees)
• Rotation (normal: internal 0–45, external 0–60)
• Assess pain and any reduction in range of movement (ROM)
Special tests (patient lying):
To assess the joint:
• FABER test
• FAIR test
To assess the muscles and tendons:
• Thomas test
Thanks patient
Offers to help patient get dressed
Washes hands
Offers to examine sacroiliac (joint above) and knee (joint below)
Offers to examine neurovascular function of lower limbs
Presents findings
Offers appropriate differential diagnosis
Offers appropriate investigations and management plan
OVERALL IMPRESSION:

OSCEs for Medical Finals, First Edition. Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and Sathiji Nageshwaran.

© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.