Physical Examination of The Hip
Examination of a painful hip is fairly succinct. One study demonstrated that the clinical assessment can be 98% reliable at detecting the presence of a hip joint problem; although the exam may be poor at defining the exact nature of the intra-articular disorder.1 However, examination of the hip region can be quite complex due to co-existent pathology, secondary dysfunction, or coincidental findings.
For example, hip joint disease may co-exist with lumbar spine disease. Considerable attention may be necessary in order to distinguish which is the major factor. Among athletes, a significant incidence of hip pathology and concomitant athletic pubalgia can occur. The symptoms can be difficult to distinguish, especially when they co-exist.
Hip joint disorders often remain undetected for protracted periods of time. In the course of compensating for their symptoms, patients often develop secondary dysfunction. This dysfunction may lead to symptoms of trochanteric bursitis or chronic gluteal discomfort. The examination findings for the secondary disorders may be more evident and mask the underlying problem with the hip.
Coincidental findings unrelated to disorders of the hip may exist. Snapping of the iliopsoas tendon and iliotibial band are usually incidental findings without clinical significance. However, this snapping can become a source of symptoms or may exist coincidentally with hip joint pathology. Once again the clinical assessment can become challenging to distinguish the features of each.
A myriad of structures may create similar or overlapping symptoms. In addition to the joint, the clinician must be cognizant of bone problems, surrounding musculotendinous and bursal structures, neurological disorders including numerous small sensory nerves, and even visceral disorders that can refer symptoms to the hip area.