Examination of the hip

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