Say: "may I examine your legs, are you in any pain?"
Position the patient standing up in their underwear
Check the front and back: Leg shortened or externally rotated, scars (check
buttocks), swelling or wasting of the quads/glutei/hamstrings,
Greater Trochanter, ASIS, iliac crests, pubic rami. The hip is deep so tenderness is unlikely
Position the pelvis so ASIS at same level
True length: Distance from medial malleolus to ASIS each side
Apparent length: Distance from medial malleolus to bottom of sternum
Flexion (130 degrees), Extension (10 degrees)
Abduction (45 degrees), adduction (30 degrees). The hip must be stabilzed by putting your arm across their pelvis first.
External rotation (45 degrees), int rotation (20 degrees). Do this with the knee and hip flexed (note: in this position bringing the leg towards you is
rotation and vice versa)
Thomas' test for fixed flexion:
Fully flex both legs to
obliterate lumbar lordosis (can place 1 hand under back to
confirm). Hold one leg fully flexed and straighten the
other. The patient should be able to lie the other leg fully on to the bed, any angle left is the degree of fixed flexion. Repeat on other side.
Trendelenburg's test for stability:
Stand in front of the patient facing them and take their hands in yours. Ask the patient to stand on one leg. Normally the pelvis tilts up on unsupported side (abductors on weight
bearing side). A positive trendelenburg is when the unsupported side droops, indicating
pathology on the leg on which they are standing. A mnemonic is: "sound side sags", indicating the normal leg which is in the air sags. Causes:
weaknessof the abductors, dislocation/fractures, pain.
Walking stick (allow them to use). Antalgic (shorter step if painful, commonest = OA).
"I would like to"
Examine the pulses
Examine the neurological system
Common OSCE stations
The hip. Public domain Grays Anatomy (1918).