Clinical Examination of the Hip

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Clinical Examination of the Hip

  1. 1. Clinical examination
  2. 2.  Ball and socket, Synovial, Multiaxial joint Compensations for hip deficits Referred pain to knee joint Neck shaft angle Femoral anteversion Arterial supply Calcar femorale Capsular reflections Extension-first movement to be lost Joint space- most accomodative in Fl, Abd,ER
  3. 3.  Pubic tubercle Femoral head Femoral neck Mid inguinal point Mid point of inguinal ligament Line joining PSIS
  4. 4.  Pain – Night cries Limp Trauma Steroid intake Alcohol intake Tuberculosis Bronchial asthma Complaint during childhood
  5. 5.  Gait Trendelenberg’s gait-DDH Short limb gait Antalgic gait-OA hip Waddling gait-osteomalacia High stepping gait-foot drop Scissors gait-cerebral diplegia
  6. 6.  DDH-wide perinium Synovitis-Flex.,Abd.,ER.,App. lenthening Arthritis-Flex., Add.,IR.,+/- True shortening Posterior dislocation-Flex.,Add.,IR.,True and App. shortening Anterior dislocation-Flex.,Abd.,ER.,App. lenthening Fracture trochanter-Marked ER Fracture neck of femur-ER-not so marked- capsular catch
  7. 7.  Skin Exagerrated lumbar lordosis Level of ASIS Wasting Shortening/Lengthening Soft tissue Bony points Swelling
  8. 8.  To confirm the findings of inspection Temperature Tenderness-Ant/Post/Lat/Med/Iliac fossa Bony prominences/Greater trochanter Sites to be palpated for psoas abscess
  9. 9. NARATH’S SIGN Femoral arterial pulsationsPositive in Post. dislocation of hip Excised or dissolved head and neck Burger’s diseaseLymph nodes-Inguinal and External iliac
  10. 10. Flexion 0-110/130 Psoas major Rectus femoris,Sartorius,Pecti nius,TFL,AdductorsExt 0-20 Gl.max.,Gl.med.,Semi tendinosis,Semimembr anous,Biceps femorisAbd. 0-45/55 Gl.Med. Gl.min.,TFL,Gl.max.Add. 0-35/45 Adductors,Pectinius Grasilis 0-40/50 Obt.ext.,internus,Quad .femoris,Piriformis, Sartorius,Long head of Gamelli biceps 0-30/40 Gl.med,semitendinosu Gl.min,TFL s,Semimembranous
  11. 11.  Flexion
  12. 12.  Extension
  13. 13.  Rotation
  14. 14.  Abduction Adduction
  15. 15.  Line joining two ASIS cuts midline at right angle Fallacies-Not possible in fixed scoliosis due to fixed obliquity of pelvis Iatrogenic-ASIS removed for bone grafting Mal or ill development of hemipelvis e.g. residual polio myelitis Unreduced dislocation of SI joint Malunited or unreduced verticle fracture of ilium
  16. 16.  Position from where limb can’t be brought back to neutral position but further movement in same axis is possible Causes-Persistent muscular spasm Persistent posture to avoid pain or to conceal deformity Disparity of limb lengths Destructive changes in joint Fibrotic contractures in periarticular soft tissues Surgical interventions
  17. 17.  To conceal deformity To maintain equilibrium by shifting centre of gravity To apparently make up the disparity of limb lengths To stabilise the unstable hip To assess fixed deformity it is essential to neutralise compensatory mechanisms
  18. 18.  Exagerrated lumbar lordosis Thomas test-Hugh Owen Thomas 1876
  19. 19.  Critisism-Patient is hurt further in painful hip Obese or heavily built individuals Bilateral FFDs Ankylosed knee Inappropriate force for flexion Alternative method-Prone position- Bilat.cases/FFD knee
  20. 20.  Fixed abduction-ASIS at lower level Scoliosis with covexity on affected side 1cm of true shortening-10 degree of fixed abd. Fixed add.-ASIS at higher level Scoliosis with convexity to unaffected side
  21. 21.  Kothari’s angle Rotational deformities are usually revealed due to lack of compensation
  22. 22.  Shortening compensated by-Pelvic tilt,Ankle equinus,Flexion of opposite hip and knee Apparent measurement-To assess extent of natural compensation Pre requisites-Supine with affected limb in line with trunk Both lower limbs in parallel position Supratsernal notch /Xiphisternum to medial malleolus
  23. 23.  From ASIS to medial malleolus Pre requisites-Square the pelvis Both lower limbs in parallel positions True=App. No compensation True>App. Part of shortening compensated(Abd. Defo.) True<App. Add. Defo.+ shortening without compensation
  24. 24.  Leg-Central point on medial joint line to tip of med. Malleolus Thigh-Supratrochanteric- neck and head -Bryant’s triangle Infratrochanteric-Tip of gr. Tr. to knee joint line
  25. 25.  Shortening of base-riding up of tr.,shortening in head neck, dislocation Reversed Bryant’s triangle-Gross overriding of trochanter Perpendicular line-Shortening-Post. and central dislocation Lengthening-FFD hip,Fracture trochanter Hypotenuse- Central dislocation of hip Old fracture neck of femur with neck absorption Absence of head due to disease or surgery
  26. 26.  Fallacies of Bryant’s triangle-Bilateral affection Excision of ASIS e.g. for bone graft Limb disarticulated at hip Lines-Nelaton’s line-Supra trochanteric shortening
  27. 27.  Schoemaker’s line- DDH, Bilat. Coxa vara Chine’s test-Lines coverge on that side Morris’s bitroch. Test- Tr. Ext. rotated or displaced back or vice versa Bilateral affe.-Seg. Meas. Circum. Meas. At mid thigh level
  28. 28.  Trendelenberg’s sign Friedrich Trendelenberg’s 1895 Fulcrum-DDH Leverarm- # N/F Power-Polio myelitis
  29. 29.  Fallacies- Intact Quadratus lumborum Incoordination of muscles-Cerebral palsy Affection of SI joint Medial shift of mechanical axis of leg below hip-bow knee Obese and bulky persons
  30. 30.  Dislocatable hip Adduction and posterior push Relaxed baby preferably in mother’s lap
  31. 31.  Marino Ortolani 1937 Dislocated hip Abduction and lifting the trochanter Palpable clunk
  32. 32.  To calculate femoral anteversion
  33. 33.  Non union fracture neck of femur Old unreduced posterior dislocation Paralytic hip
  34. 34.  Hip-60 degree Knee-90 degree Foot planted over bed Tibial shortening Femoral shortening
  35. 35.  IT band contracture Hip abducted knee flexed 90 Polio myelitis Meningomyelocele
  36. 36.  Flexion Abduction External rotation Extension
  37. 37.  Hart’s sign-Limitation of abduction Klisick’s sign Asymmetrical gluteal folds-Pelvic obliquity -Limb length discrepancy - Muscular atrophy Ortolani’s and Barlow’s tests
  38. 38. THAN X

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