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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 The Pelvic Examination The Oral Presentation
The Rest of the History Male Genital/Rectal Exam Outpatient Clinics
Review of Systems The Upper Extremities Inpatient Medicine
Vital Signs The Lower Extremities Clinical Decision Making
The Eye Exam Musculo-Skeletal Exam Physical Exam Lecture Series
Head and Neck Exam The Mental Status Exam A Few Thoughts
The Lung Exam The Neurological Exam Commonly Used Abbreviations
Cardiovascular Exam Physical Exam Check Lists References
Exam of the Abdomen Medical Links  

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:

  1. 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:

  1. Trochanteric Bursitis:

    Anatomy and function: The troachanteric bursa overlies the greater trochanter of the femur. When it becomes inflamed, patient's report vague hip pain, focused on the lateral area of the joint. Symptoms tend to get worse with walking.

    Examination:


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