Palpation

Review the surface landmarks of the hip. On the anterior surface locate the iliac crest, the iliac tubercle, and the anterior superior iliac spine. On the posterior surface identify the posterior superior iliac spine, the greater trochanter, the ischial tuberosity, and the sciatic nerve.

With the patient supine, ask the patient to place the heel of the leg being examined on the opposite knee. Then palpate along the inguinal ligament, which extends from the anterior superior iliac spine to the pubic tubercle. The femoral nerve, artery, and vein bisect the overlying inguinal ligament; lymph nodes lie medially. The mnemonic NAVEL may help you remember the lateral-to-medial sequence of Nerve—Artery—Vein— Empty space—Lymph node.

Bulges along the ligament may suggest an inguinal hernia or, on occasion, an aneurysm.

Enlarged lymph nodes suggest infection in the lower extremity or pelvis.

Tenderness may be due to synovitis of the hip joint, bursitis, or possibly psoas abscess.

If the hip is painful, palpate the iliopectineal (iliopsoas) bursa, below the inguinal ligament but on a deeper plane.

With the patient resting on one side and the hip flexed and internally rotated, palpate the trochanteric bursa lying over the greater trochanter. Normally, the ischiogluteal bursa, over the ischial tuberosity, is not palpable unless inflamed.

Trochanteric bursa

Trochanteric bursa

Ischiogluteal bursa
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