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Examination of the hip

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few of the tests are missing …

few of the tests are missing

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  • 1. EXAMINATION OF THE HIP JOINT
  • 2. CLINICAL EXAMINATION OF HIP USEFUL IN DDH  SCFE NEONATAL SEPTIC  TUBERCULOSIS ARTHRITIS  OSTEOAARTHROSI TRANSIENT S SYNOVITIS  TRAUMATIC PERTHES DISEASE CONDITIONS
  • 3. EXAMINATION OF HIP Traditional steps  Palpation History of  Looking for Fixed symptoms deformities Relevant general  Movements examination  Measurements Gait  Special tests Inspection  Tests for instability
  • 4. History Age & sex Occupation Pain Limp Amount & nature of violence Deformity & swelling locking
  • 5.  Past history ask for previous H/O trauma or contact with TBFamily historyTB and rheumatism run in families
  • 6. RELEVANT GENERAL EXAMINATION  For the diagnosis &  Its management
  • 7. RELEVANT GENERAL EXAMINATION For the diagnosis
  • 8. RELEVANT GENERAL EXAMINATION
  • 9. General examination In suppurative arthrits of hip , evidence of toxaemia in other parts of body should be noted In TB – hip look for generalised wasting, cachexia and evening rise of temperature In rheumatoid arthritis look for rheumatoid stigmata in other parts of body Look for external iliac & inguinal nodes
  • 10. GAIT Simplest of all definitions “mode of walking”
  • 11. GAIT Normal gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison
  • 12. LIMPING Limping is the most common abnormality Can be defined as any abnormality of normal rhythmic biphasic walking
  • 13. Types of gait Antalgic gait in painful hip conditions pt lurches on the same side Trendelenberg gait pt lurches to the affected side seen in hip dislocation, coxa vara Waddling gait Body sways from side to side on a wide base Seen in b/l CDH & b/l coxa vara
  • 14. Cont’d… Short limb gait-When the affected limb becomes shortUp and down movement of half of the body Circumduction gait-In fixed abduction deformity Gluteus maximus gait-In paralysis of gluteus maximusPt lurches backward during stance phase
  • 15. Gait cont’d..Toe gaitPt walks with both feet turned inwards- seen in femoral anteversion
  • 16. Inspection From front-Pelvic tilting, muscle wastingRotational deformities, front of thigh,ASISPubic symphysis, pubic tubercleDilated veins, swellingsScars & sinuses
  • 17. Inspection from front
  • 18. Inspection from side
  • 19. Inspection from behind
  • 20. From side Increased lumbar lordosis Greater trochanter Iliac crest Supra & infra trochanteric depression Lateral thigh muscle mass
  • 21. From back Scoliosis, gluteal muscle wasting PSIS Back of iliac crest Scars and sinuses
  • 22. INSPECTION Attitude Lumbar lordosis ASIS Lower limbs
  • 23. INSPECTION Muscle wasting
  • 24. PalpationLocal temperatureIncreased in acute arthritisTendernessAnteriorly-below and lateral to mid- inguinal pointLaterally-by steady inward pressure over two greater trochantersPosteriorly- centre of the line joining tip of trochanter & ischial tuberosity
  • 25. PALPATION TENDERNESS  ANTERIOR  Posterior & lateral  Bitrochanteric compression
  • 26. Palpation cont’d… For greater trochanterBroadening,thickeneing, ternderness or dispalcemenrt.Head of femur-Especially in dislocationsIn dorsum illii ( post dislocation )In groin ( pubic type of anterior dislocation)In perinium ( obturator type of anterior dislocations )
  • 27. Palpation cont’d For hip jointJust below inguinal ligament and lateral to femoral arterySwelling
  • 28. PALPATION Femoral artery pulsation Weak or absent
  • 29. FIXED DEFORMITIES  Fixed flexion deformityConcealed during walking by increase in lumbar lordosis
  • 30. FFD DEMONSTRATION HUGH OWEN THOMAS’S TEST
  • 31. Alternate method for assessing FFD
  • 32. Fixed abduction & adduction deformity Fixed abduction is compensated by scoliosis with convexity towards the affected side & by the pelvis being tilted down causing apparent lengthening of limb Fixed aadduction is compensated by scoliosis with convexity towards the normal side & by the pelvis being tilted up causing apparent shortening of limb
  • 33. FIXED ABDUCTION &ADDUCTION DEFORMITY Pelvic tilt indicated by ASIS at different level
  • 34. FIXED ABDUCTION &ADDUCTION DEFORMITY N D
  • 35. FIXED ABDUCTION &ADDUCTION DEFORMITY D N
  • 36. FIXED ABDUCTION & ADDUCTION DEFORMITY- N D Measured by squaring of pelvis
  • 37. Alternate method for determing Fixed abduction & adduction deformity Kothari’s method
  • 38. Fixed external & internal rotation deformityAlways remains revealedDetermined by noting the direction of anterior surface of patella or the toes when the foot is held at right angle to the leg
  • 39. Movements During the measurement of movements always fix the pelvisFlexion- 0 to 140 degreeExtension- 0 to 15 degreeAbduction- 0 to 40 degreeAdduction- 0 to 30 degreeInternal rotation- 0 to 30 degreeExternal rotation- 0 to 45 degreeCircumduction-
  • 40. MOVEMENT Normal rangeNormal flexion
  • 41. MOVEMENT Axis deviation
  • 42. MOVEMENTS Extension
  • 43. MOVEMENTS Normal rangeADDUCTION
  • 44. MOVEMENTS In flexionAbduction Normal range
  • 45. MOVEMENTS In flexionInternal rotation Normal range
  • 46. MOVEMENTS In flexionExternal rotation Normal range
  • 47. MEASUREMENTS  Shortenin g  Apparent  True
  • 48. Apparent measurementShows the compensation that the pt has developed to conceal any fixed deformityHere both limbs should be kept parallel to each other Measured from xiphisternum or umbilicus to medial malleolus
  • 49. MEASUREMENTS True shorteningSquare the pelvisASIS  MEDIAL JOINT LINE KNEE  MEDIAL MALLEOLUS
  • 50. MEASUREMENTS True shorteningSupra trochanteric Infra trochanteric Coxa Vara  Malunion Perthes  Fracture femur & SCFE tibia Malunited basal #  Growth arrest from NOF polio Congenital Coxa  Trauma and Vara infective sequale Arthritis Dislocation
  • 51. MEASUREMENT- circumferential  Muscle wasting
  • 52. For injuries/pathologies around the hip Bryant’s triangle
  • 53. Nelaton’s line
  • 54. Schoemaker’s line Chiene’s testMorris bitrochanteric test
  • 55. Tests for stability SLR Telescopy Trendelenburg test Otolani test Barlow test
  • 56. SPECIAL TESTS Trendeleberg Test Fulcrum  socket Lever  length of head and neck Force  Gluteus Medius
  • 57. HIP ABDUCTION MECHANISM 2 1 3
  • 58. SPECIAL TESTS Trendelenberg test Normal hip Positive testSOUND SIDE SAGS IN POSITIVE TRENDELENBERGS TEST
  • 59. SPECIAL TESTSTelescoping test
  • 60. Thank you

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