examination of the hip
TRANSCRIPT
EXAMINATION OF THE HIP JOINT
CURRENT TREND
Clinical examinationEarly imaging
IN ORTHOPAEDIC TRAINING• The skill in
eliciting/demonstrating abnormalities of the hip remains as the mainstay in assessment of orthopaedic trainee
CLINICAL EXAMINATION OF HIP USEFUL IN
• DDH• NEONATAL SEPTIC
ARTHRITIS• TRANSIENT
SYNOVITIS• PERTHES DISEASE
• SUFE• TUBERCULOSIS• OSTEOAARTHROSIS• TRAUMATIC
CONDITIONS
EXAMINATION OF HIP Traditional steps
• History of symptoms
• Relevant general examination
• Gait• Inspection
• Palpation• Looking for Fixed
deformities• Movements• Measurements• Special tests• Tests for instability
HISTORY
• Pain
• Felt in groin, thigh or knee
• Limping
• Also an early symptom
RELEVANT GENERAL EXAMINATION
• For the diagnosis&
• Its management
RELEVANT GENERAL EXAMINATION
For the diagnosis
RELEVANT GENERAL EXAMINATION
Not relevant for diagnosis
RELEVANT GENERAL EXAMINATION
For his management
GAIT
• Simplest of all definitions “mode of walking”
GAIT
• Normal gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison
GAIT
LIMPING
• Limping is the most common abnormality
• Can be defined as any abnormality of normal rhythmic biphasic walking
GAIT
• Types– Painless limping– Painful limping– Stiff hip– High stepping – Crutch gait
STIFF HIP GAIT
CRUTCH WALKING
– Two point– Three point– Swing to– Swing through
CRUTCH GAIT
Three point gait Swing through gait Swing to gait
INSPECTION
• Attitude
Lumbar lordosis
ASISLower limbs
INSPECTION
Muscle wasting
INSPECTION
• Swelling
• Scars
• Sinuses
PALPATION• TENDERNESS
– ANTERIOR– Posterior & lateral– Bitrochanteric compression
PALPATION
• Swelling
PALPATION
• Femoral artery pulsation
Weak or absent
FIXED DEFORMITIES• Fixed flexion deformity
Concealed during walking by increase in lumbar lordosis
FFD DEMONSTRATION
HUGH OWEN THOMAS’S TEST
FFD DEMONSTRATION
FIXED ABDUCTION & ADDUCTION DEFORMITY
• Pelvic tilt indicated by ASIS at different level
FIXED ABDUCTION & ADDUCTION DEFORMITY
DN
FIXED ABDUCTION & ADDUCTION DEFORMITY
N
D
FIXED ABDUCTION & ADDUCTION DEFORMITY
N D
FIXED ABDUCTION & ADDUCTION DEFORMITY
ND
MOVEMENT
Normal flexion
Normal range
MOVEMENT
Axis deviation
MOVEMENTS
Extension
MOVEMENTS
ADDUCTION
Normal range
MOVEMENTS
Abduction
In flexion
Normal range
MOVEMENTS
Internal rotation
In flexion
Normal range
MOVEMENTS
External rotation
In flexion
Normal range
MEASUREMENTS
• Shortening–Apparent
–True
MEASUREMENTS
• Apparent shortening
• Due to pelvic tilt or FFD
• Measured from xiphisternum to medial malleolus
MEASUREMENTSTrue shortening
Square the pelvis
ASIS MEDIAL JOINT LINE KNEE MEDIAL MALLEOLUS
MEASUREMENTSTrue shortening- Supra Trochanteric
Bryants triangle
Nelatons line
MEASUREMENTS
Supra trochanteric• Coxa Vara • Perthes• SCFE• Malunited basal # NOF• Congenital Coxa Vara• Arthritis• Dislocation
Infra trochanteric
– Malunion – Fracture femur & tibia– Growth arrest from
polio– Trauma and infective
sequale
True shortening
MEASUREMENT
• Muscle wasting
SPECIAL TESTS
• Trendeleberg Test
• Fulcrum socket• Lever length of head
and neck• Force Gluteus Medius
HIP ABDUCTION MECHANISM
123
SPECIAL TESTSTrendelenberg test
Normal hip Positive test
SPECIAL TESTSTelescoping test
SPECIAL TESTS
• Ortolani test• Barlow’s test• Patrick test• Febere sign• Duchnne sign
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