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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 pulsations Positive in Post. dislocation of hip Excised or dissolved head and neck Burger’s disease Lymph nodes-Inguinal and External iliac
  10. 10. Flexion 0-110/130 Psoas major Rectus femoris,Sartorius,Pecti nius,TFL,Adductors Ext 0-20 Gl.max.,Gl.med.,Semi tendinosis,Semimembr anous,Biceps femoris Abd. 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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