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Evaluation of the Hip

By Alexandra Villa-Forte, MD, MPH, Staff Physician, Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic

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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 (which is extra-articular) rather than an intra-articular disorder. 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.

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