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Hip pain.
Last reviewed: 04.07.2025
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Gait with hip pain
People with unstable or painful hip joints use a stick placed on the side opposite the affected leg (the opposite position occurs in case of knee joint pathology).
If you have pain in the hip joint, you should also inquire about the condition of other joints. Pain in the hip joint may be associated with pathology in the lumbar spine, in the sacroiliac joints, in the abdominal cavity or pelvic cavity.
Measuring the length of the lower limbs
Apparent leg length inequality (when the lower limbs are parallel and in line with the trunk), also called apparent shortening (e.g. due to pelvic tilt or fixed deformity with adduction, which gives an obvious shortening on the affected side), or apparent leg lengthening (e.g. due to fixed abduction of the hip), is said to exist when there is no true leg length inequality, which is determined by measuring the distance from the superior iliac spine to the medial malleolus on each side (the pelvis is held parallel to the lower limbs, which in turn are in equal abduction or adduction).
Fixed deformation
In this case, joint or muscle contracture prevents the legs from being in a neutral position. In a fixed adduction deformity, the angle between the limb and the transverse axis of the pelvis (the line between the two superior iliac spines) is usually less than 90°, and in a fixed abduction deformity, it is greater than 90°.
Fixed flexion deformity is established using the Thomas maneuver.
Thomas's Reception
On the side where you suspect the presence of a fixed flexion deformity, palpate the lumbar lordosis. If you succeed, bend the healthy side as much as possible. In this case, the lordosis disappears, and the fixed flexion deformity becomes quite obvious on the affected side. The angle to which you can raise the hip is the actual angle of fixed flexion.
Coxa vara (or inwardly curved hip)
This term refers to a hip joint in which the angle between the femoral neck and the shaft of the bone (hip) is less than the normal angle of 125°. Causes: congenital condition, slipped upper femoral epiphysis, fracture (trochanteric with malunion); softening of the bones (rickets, osteomalacia, Paget's disease). Consequences - true shortening of the limb. "Trendelenburg droop" causes the patient to limp while walking.
Examination of the hip joint
When examining the hip joint, it is necessary to check the following movements: flexion (the patient lies on his back; grasp the iliac crests to exclude pelvic rotation), normally it is 120 °; abduction - normally 30-40 ° (while keeping your hands on the upper iliac bones to exclude pelvic tilt); abduction with simultaneous flexion - normally 70 ° and adduction - normally 30 ° (examined by crossing the feet). Normally, lateral and medial rotation are equal to 30 °.
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Trendelenburg test
This test determines the stability of the hip joint and the ability to support the pelvis while standing on one leg. In this position, the pelvis normally rises on the side of the raised leg. This test is considered positive when the pelvis drops on the side of the raised leg. The reasons for this are as follows.
- Paralysis of the abductor muscle of the thigh (gluteus medius and minimus).
- Upward displacement of the greater trochanter (severe coxa vara or dislocation of the hip joint).
- Lack of a stable support point (for example, the fragments of a femoral neck fracture were not connected).