Examination of the hip

15,940 views

Published on

few of the tests are missing

Published in: Health & Medicine
1 Comment
65 Likes
Statistics
Notes
  • nice but not comprehensive
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
15,940
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
1,378
Comments
1
Likes
65
Embeds 0
No embeds

No notes for slide

Examination of the hip

  1. 1. EXAMINATION OF THE HIP JOINT
  2. 2. CLINICAL EXAMINATION OF HIP USEFUL IN DDH  SCFE NEONATAL SEPTIC  TUBERCULOSIS ARTHRITIS  OSTEOAARTHROSI TRANSIENT S SYNOVITIS  TRAUMATIC PERTHES DISEASE CONDITIONS
  3. 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. 4. History Age & sex Occupation Pain Limp Amount & nature of violence Deformity & swelling locking
  5. 5.  Past history ask for previous H/O trauma or contact with TBFamily historyTB and rheumatism run in families
  6. 6. RELEVANT GENERAL EXAMINATION  For the diagnosis &  Its management
  7. 7. RELEVANT GENERAL EXAMINATION For the diagnosis
  8. 8. RELEVANT GENERAL EXAMINATION
  9. 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. 10. GAIT Simplest of all definitions “mode of walking”
  11. 11. GAIT Normal gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison
  12. 12. LIMPING Limping is the most common abnormality Can be defined as any abnormality of normal rhythmic biphasic walking
  13. 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. 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. 15. Gait cont’d..Toe gaitPt walks with both feet turned inwards- seen in femoral anteversion
  16. 16. Inspection From front-Pelvic tilting, muscle wastingRotational deformities, front of thigh,ASISPubic symphysis, pubic tubercleDilated veins, swellingsScars & sinuses
  17. 17. Inspection from front
  18. 18. Inspection from side
  19. 19. Inspection from behind
  20. 20. From side Increased lumbar lordosis Greater trochanter Iliac crest Supra & infra trochanteric depression Lateral thigh muscle mass
  21. 21. From back Scoliosis, gluteal muscle wasting PSIS Back of iliac crest Scars and sinuses
  22. 22. INSPECTION Attitude Lumbar lordosis ASIS Lower limbs
  23. 23. INSPECTION Muscle wasting
  24. 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. 25. PALPATION TENDERNESS  ANTERIOR  Posterior & lateral  Bitrochanteric compression
  26. 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. 27. Palpation cont’d For hip jointJust below inguinal ligament and lateral to femoral arterySwelling
  28. 28. PALPATION Femoral artery pulsation Weak or absent
  29. 29. FIXED DEFORMITIES  Fixed flexion deformityConcealed during walking by increase in lumbar lordosis
  30. 30. FFD DEMONSTRATION HUGH OWEN THOMAS’S TEST
  31. 31. Alternate method for assessing FFD
  32. 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. 33. FIXED ABDUCTION &ADDUCTION DEFORMITY Pelvic tilt indicated by ASIS at different level
  34. 34. FIXED ABDUCTION &ADDUCTION DEFORMITY N D
  35. 35. FIXED ABDUCTION &ADDUCTION DEFORMITY D N
  36. 36. FIXED ABDUCTION & ADDUCTION DEFORMITY- N D Measured by squaring of pelvis
  37. 37. Alternate method for determing Fixed abduction & adduction deformity Kothari’s method
  38. 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. 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. 40. MOVEMENT Normal rangeNormal flexion
  41. 41. MOVEMENT Axis deviation
  42. 42. MOVEMENTS Extension
  43. 43. MOVEMENTS Normal rangeADDUCTION
  44. 44. MOVEMENTS In flexionAbduction Normal range
  45. 45. MOVEMENTS In flexionInternal rotation Normal range
  46. 46. MOVEMENTS In flexionExternal rotation Normal range
  47. 47. MEASUREMENTS  Shortenin g  Apparent  True
  48. 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. 49. MEASUREMENTS True shorteningSquare the pelvisASIS  MEDIAL JOINT LINE KNEE  MEDIAL MALLEOLUS
  50. 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. 51. MEASUREMENT- circumferential  Muscle wasting
  52. 52. For injuries/pathologies around the hip Bryant’s triangle
  53. 53. Nelaton’s line
  54. 54. Schoemaker’s line Chiene’s testMorris bitrochanteric test
  55. 55. Tests for stability SLR Telescopy Trendelenburg test Otolani test Barlow test
  56. 56. SPECIAL TESTS Trendeleberg Test Fulcrum  socket Lever  length of head and neck Force  Gluteus Medius
  57. 57. HIP ABDUCTION MECHANISM 2 1 3
  58. 58. SPECIAL TESTS Trendelenberg test Normal hip Positive testSOUND SIDE SAGS IN POSITIVE TRENDELENBERGS TEST
  59. 59. SPECIAL TESTSTelescoping test
  60. 60. Thank you

×