Examination of the hip

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Examination of the hip

  1. 1. EXAMINATION OF THEHIP JOINT
  2. 2. CURRENT TRENDClinical examinationEarly imaging
  3. 3. IN ORTHOPAEDIC TRAINING• The skill ineliciting/demonstratingabnormalities of the hipremains as the mainstayin assessment oforthopaedic trainee
  4. 4. CLINICAL EXAMINATION OF HIPUSEFUL IN• DDH• NEONATAL SEPTICARTHRITIS• TRANSIENTSYNOVITIS• PERTHES DISEASE• SUFE• TUBERCULOSIS• OSTEOAARTHROSIS• TRAUMATICCONDITIONS
  5. 5. EXAMINATION OF HIPTraditional steps• History ofsymptoms• Relevant generalexamination• Gait• Inspection• Palpation• Looking for Fixeddeformities• Movements• Measurements• Special tests• Tests for instability
  6. 6. HISTORY• Pain• Felt ingroin, thighor knee• Limping• Also an earlysymptom
  7. 7. RELEVANT GENERALEXAMINATION• For the diagnosis&• Its management
  8. 8. RELEVANT GENERALEXAMINATIONFor the diagnosis
  9. 9. RELEVANT GENERALEXAMINATIONNot relevant for diagnosis
  10. 10. RELEVANT GENERALEXAMINATIONFor his management
  11. 11. GAIT• Simplest of all definitions “mode ofwalking”
  12. 12. GAIT• Normal gait is rhythmical bipedalbiphasic walking in which the lumbarspine, hip and legs move in unison
  13. 13. GAIT
  14. 14. LIMPING• Limping is the most commonabnormality• Can be defined as any abnormality ofnormal rhythmic biphasic walking
  15. 15. GAIT• Types– Painless limping– Painful limping– Stiff hip– High stepping– Crutch gait
  16. 16. STIFF HIP GAIT
  17. 17. CRUTCH WALKING– Two point– Three point– Swing to– Swing through
  18. 18. CRUTCH GAITThree point gait Swing through gait Swing to gait
  19. 19. INSPECTION• AttitudeLumbar lordosisASISLower limbs
  20. 20. INSPECTIONMuscle wasting
  21. 21. INSPECTION• Swelling• Scars• Sinuses
  22. 22. PALPATION• TENDERNESS– ANTERIOR– Posterior & lateral– Bitrochanteric compression
  23. 23. PALPATION• Swelling
  24. 24. PALPATION• Femoral arterypulsationWeak or absent
  25. 25. FIXED DEFORMITIES• Fixed flexion deformityConcealed during walking by increase in lumbarlordosis
  26. 26. FFD DEMONSTRATIONHUGH OWEN THOMAS’S TEST
  27. 27. FFD DEMONSTRATION
  28. 28. FIXED ABDUCTION &ADDUCTION DEFORMITY• Pelvic tilt indicated by ASIS atdifferent level
  29. 29. FIXED ABDUCTION &ADDUCTION DEFORMITYDN
  30. 30. FIXED ABDUCTION &ADDUCTION DEFORMITYND
  31. 31. FIXED ABDUCTION &ADDUCTION DEFORMITYN D
  32. 32. FIXED ABDUCTION &ADDUCTION DEFORMITYND
  33. 33. MOVEMENTNormal flexionNormal range
  34. 34. MOVEMENTAxis deviation
  35. 35. MOVEMENTSExtension
  36. 36. MOVEMENTSADDUCTIONNormal range
  37. 37. MOVEMENTSAbductionIn flexionNormal range
  38. 38. MOVEMENTSInternal rotationIn flexionNormal range
  39. 39. MOVEMENTSExternal rotationIn flexionNormal range
  40. 40. MEASUREMENTS• Shortening–Apparent–True
  41. 41. MEASUREMENTS• Apparentshortening• Due to pelvic tilt orFFD• Measured fromxiphisternum tomedial malleolus
  42. 42. MEASUREMENTSTrue shorteningSquare the pelvisASIS  MEDIAL JOINT LINE KNEE  MEDIAL MALLEOLUS
  43. 43. MEASUREMENTSTrue shortening- Supra TrochantericBryantstriangleNelatonsline
  44. 44. MEASUREMENTSSupra trochanteric• Coxa Vara• Perthes• SCFE• Malunited basal # NOF• Congenital Coxa Vara• Arthritis• DislocationInfra trochanteric– Malunion– Fracture femur & tibia– Growth arrest frompolio– Trauma and infectivesequaleTrue shortening
  45. 45. MEASUREMENT• Muscle wasting
  46. 46. SPECIAL TESTS• Trendeleberg Test• Fulcrum  socket• Lever  length of headand neck• Force  Gluteus Medius
  47. 47. HIP ABDUCTION MECHANISM123
  48. 48. SPECIAL TESTSTrendelenberg testNormal hip Positive test
  49. 49. SPECIAL TESTSTelescoping test
  50. 50. SPECIAL TESTS• Ortolani test• Barlow’s test• Patrick test• Febere sign• Duchnne sign
  51. 51. Thank you

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