A Practical Guide to Clinical Medicine

A comprehensive physical examination and clinical education site for medical students and other health care professionals

Web Site Design by Jan Thompson, Program Representative, UCSD School of Medicine.
Content and Photographs by Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California 92093-0611.
Send Comments to: Charlie Goldberg, M.D.

Introduction Breast Exam Write Ups

History of Present Illness Male Genital/Rectal Exam The Oral Presentation

The Rest of the History The Upper Extremities Outpatient Clinics

Review of Systems The Lower Extremities Inpatient Medicine

Vital Signs Musculo-Skeletal Exam Clinical Decision Making

The Eye Exam The Mental Status Exam Physical Exam Lecture Series

Head and Neck Exam The Neurological Exam A Few Thoughts

The Lung Exam Putting It All Together Commonly Used Abbreviations

Exam of the Heart Medical Links References

Exam of the Abdomen

The "daVinci Anatomy Icon" denotes a link to related gross anatomy pictures. DaVinci's Anatomy Symbol

Musculo-Skeletal Examination

Hip

Function and Anatomy: The hip is a ball and socket type joint, formed by the articulation of the head of the femur with the pelvis. Normal range of motion includes: abduction 45 degrees, adduction 20-30 degrees, flexion 135 degrees, extension 30 degrees, internal and external rotation. Hip pathology can cause symptoms anywhere around the joint, though frequently pain is anterior and radiates to the groin region. Additionally, pathology outside of the hip can be referred to this region. History and exam obviously help in making these distinctions.

A few common problems are described below:

Degenerative Joint Disease and Osteoarthritis
Presentation and anatomy: Patients usually report pain with weight bearing and ambulation. Symptoms progress slowly over time (ie years) with pain precipitated by less activity (ie shorter distances walked) as the disease worsens. This tends to occur in patients > 50, as age increases the risk of wear and tear on the joint. Obesity, which chronically increases the load and stress that the joint must bear, is a major risk factor. There may also be a history of significant antecedent trauma that damaged the joint, "setting it up" for degenerative changes over time.
Examination:
- Pain with walking, perhaps even with limping. Patient's may develop an Antalgic gait, characterized by trying to minimize the amount of time spent with weight bearing on the affected joint.
- Range of motion reduced as degeneration progresses. Early on, internal rotation may elicit more pain then movement in other directions.