Examination of the hip
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This document discusses the examination of the hip joint. It outlines the traditional steps in examining the hip, including taking a history, inspecting for deformities, palpating for tenderness, and measuring range of motion. Special tests are also described, such as the Trendelenberg test to assess abduction weakness. A variety of hip conditions can be evaluated through clinical examination, including developmental dysplasia of the hip, Perthes disease, tuberculosis, and traumatic injuries. Proper examination of gait, identification of fixed deformities, and use of special tests remains an important orthopedic skill.
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Examination of the hip
- 1. EXAMINATION OF THE HIP JOINT
- 2. CURRENT TREND Clinical examination Early imaging
- 3. IN ORTHOPAEDIC TRAINING • The skill in eliciting/demonstrating abnormalities of the hip remains as the mainstay in assessment of orthopaedic trainee
- 4. CLINICAL EXAMINATION OF HIP USEFUL IN • DDH • NEONATAL SEPTIC ARTHRITIS • TRANSIENT SYNOVITIS • PERTHES DISEASE • SUFE • TUBERCULOSIS • OSTEOAARTHROSIS • TRAUMATIC CONDITIONS
- 5. EXAMINATION OF HIP Traditional steps • History of symptoms • Relevant general examination • Gait • Inspection • Palpation • Looking for Fixed deformities • Movements • Measurements • Special tests • Tests for instability
- 6. HISTORY • Pain • Felt in groin, thigh or knee • Limping • Also an early symptom
- 7. RELEVANT GENERAL EXAMINATION • For the diagnosis & • Its management
- 8. RELEVANT GENERAL EXAMINATION For the diagnosis
- 9. RELEVANT GENERAL EXAMINATION Not relevant for diagnosis
- 10. RELEVANT GENERAL EXAMINATION For his management
- 11. GAIT • Simplest of all definitions “mode of walking”
- 12. GAIT • Normal gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison
- 13. GAIT
- 14. LIMPING • Limping is the most common abnormality • Can be defined as any abnormality of normal 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 GAIT Three point gait Swing through gait Swing to gait
- 21. INSPECTION • Swelling • Scars • Sinuses
- 22. PALPATION • TENDERNESS – ANTERIOR – Posterior & lateral – Bitrochanteric compression
- 24. PALPATION • Femoral artery pulsation Weak or absent
- 25. FIXED DEFORMITIES • Fixed flexion deformity Concealed during walking by increase in lumbar lordosis
- 26. FFD DEMONSTRATION HUGH OWEN THOMAS’S TEST
- 28. FIXED ABDUCTION & ADDUCTION DEFORMITY • Pelvic tilt indicated by ASIS at different level
- 29. FIXED ABDUCTION & ADDUCTION DEFORMITY DN
- 30. FIXED ABDUCTION & ADDUCTION DEFORMITY N D
- 31. FIXED ABDUCTION & ADDUCTION DEFORMITY N D
- 32. FIXED ABDUCTION & ADDUCTION DEFORMITY N D
- 41. MEASUREMENTS • Apparent shortening • Due to pelvic tilt or FFD • Measured from xiphisternum to medial malleolus
- 42. MEASUREMENTS True shortening Square the pelvis ASIS MEDIAL JOINT LINE KNEE MEDIAL MALLEOLUS
- 43. MEASUREMENTS True shortening- Supra Trochanteric Bryants triangle Nelatons line
- 44. MEASUREMENTS Supra trochanteric • Coxa Vara • Perthes • SCFE • Malunited basal # NOF • Congenital Coxa Vara • Arthritis • Dislocation Infra trochanteric – Malunion – Fracture femur & tibia – Growth arrest from polio – Trauma and infective sequale True shortening
- 46. SPECIAL TESTS • Trendeleberg Test • Fulcrum socket • Lever length of head and neck • Force Gluteus Medius
- 48. SPECIAL TESTS Trendelenberg test Normal hip Positive test
- 50. SPECIAL TESTS • Ortolani test • Barlow’s test • Patrick test • Febere sign • Duchnne sign
- 51. Thank you