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Inspection of the hips and gait has already been described. The Trendelenburg test is used to detect a disorder between the pelvis and the femur. The patient is asked to stand on the ''good'' leg, as illustrated in Figure 20-42A. The examiner should note that the pelvis on the opposite side elevates, demonstrating that the gluteus medius is working efficiently. When the patient is asked to stand on the ''bad'' leg, as shown in Figure 20-42B, the pelvis on the opposite side falls. This is a positive Trendelenburg test result.

Figure 20-42 Trendelenburg test. A, Position of the hips when standing on the normal left leg. Note that the hip elevates as a result of contraction of the left hip musculature. B, Position of the hips when standing on the abnormal right leg. Note that the left hip falls as a result of lack of adequate contraction of the right hip muscles.

Figure 20-42 Trendelenburg test. A, Position of the hips when standing on the normal left leg. Note that the hip elevates as a result of contraction of the left hip musculature. B, Position of the hips when standing on the abnormal right leg. Note that the left hip falls as a result of lack of adequate contraction of the right hip muscles.

Figure 20-43 Evaluation for flexion deformity of the hip.

Ask the patient to lie on his or her back. The hip is acutely flexed on the abdomen to flatten the lumbar spine. Flexion of the opposite thigh is suggestive of a flexion deformity of that hip. Figure 20-43 illustrates the technique.

Leg length measurements are useful in evaluating hip disorders. The distance between the anterosuperior iliac spine and the tip of the medial malleolus is measured on each side, and the two measurements are compared. A difference in leg length may be caused by hip joint disorders.

As indicated, loss of rotation of the hip is an early finding in hip disease. To test this movement, ask the patient to lie on his or her back. Flex the patient's hip and knee to 90°, and rotate the ankle inward for external rotation, as illustrated in Figure 20-44A, and outward for internal rotation, as shown in Figure 20-44B. Restriction of this motion is a sensitive sign of degenerative hip disease.

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