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Examination of the hip
The document discusses the clinical examination of the hip joint. It outlines the traditional steps which include history taking, inspection, palpation, assessment of range of motion and special tests. Under history, it notes important details to ask such as pain, limping, deformities. Examination involves inspecting from the front, side and back for signs like muscle wasting. Palpation focuses on areas of tenderness. Range of motion is measured for flexion, extension etc. Special tests evaluate stability including the Trendelenburg test. The examination allows for diagnosis of conditions affecting the hip joint.
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Examination of the hip
- 1. EXAMINATION OF THE HIP JOINT
- 2. CLINICAL EXAMINATION OF HIP USEFUL IN DDH SCFE NEONATAL SEPTIC TUBERCULOSIS ARTHRITIS OSTEOAARTHROSI TRANSIENT S SYNOVITIS TRAUMATIC PERTHES DISEASE CONDITIONS
- 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. History Age & sex Occupation Pain Limp Amount & nature of violence Deformity & swelling locking
- 5. Past history ask for previous H/O trauma or contact with TB Family history TB and rheumatism run in families
- 6. RELEVANT GENERAL EXAMINATION For the diagnosis & Its management
- 7. RELEVANT GENERAL EXAMINATION For the diagnosis
- 8. RELEVANT GENERAL EXAMINATION
- 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. GAIT Simplest of all definitions “mode of walking”
- 11. GAIT Normal gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison
- 12. LIMPING Limping is the most common abnormality Can be defined as any abnormality of normal rhythmic biphasic walking
- 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. Cont’d… Short limbgait- When the affected limb becomes short Up and down movement of half of the body Circumduction gait- In fixed abduction deformity Gluteus maximus gait- In paralysis of gluteus maximus Pt lurches backward during stance phase
- 15. Gait cont’d.. Toe gait Ptwalks with both feet turned inwards- seen in femoral anteversion
- 16. Inspection From front- Pelvictilting, muscle wasting Rotational deformities, front of thigh, ASIS Pubic symphysis, pubic tubercle Dilated veins, swellings Scars & sinuses
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- 20. From side Increased lumbar lordosis Greater trochanter Iliac crest Supra & infra trochanteric depression Lateral thigh muscle mass
- 21. From back Scoliosis, gluteal muscle wasting PSIS Back of iliac crest Scars and sinuses
- 22. INSPECTION Attitude Lumbar lordosis ASIS Lower limbs
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- 24. Palpation Local temperature Increased inacute arthritis Tenderness Anteriorly-below and lateral to mid- inguinal point Laterally-by steady inward pressure over two greater trochanters Posteriorly- centre of the line joining tip of trochanter & ischial tuberosity
- 25. PALPATION TENDERNESS ANTERIOR Posterior & lateral Bitrochanteric compression
- 26. Palpation cont’d… Forgreater trochanter Broadening,thickeneing, ternderness or dispalcemenrt. Head of femur- Especially in dislocations In dorsum illii ( post dislocation ) In groin ( pubic type of anterior dislocation) In perinium ( obturator type of anterior dislocations )
- 27. Palpation cont’d Forhip joint Just below inguinal ligament and lateral to femoral artery Swelling
- 28. PALPATION Femoral artery pulsation Weak or absent
- 29. FIXED DEFORMITIES Fixed flexion deformity Concealed during walking by increase in lumbar lordosis
- 30. FFD DEMONSTRATION HUGH OWEN THOMAS’S TEST
- 31. Alternate method forassessing FFD
- 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. FIXED ABDUCTION & ADDUCTIONDEFORMITY Pelvic tilt indicated by ASIS at different level
- 34. FIXED ABDUCTION & ADDUCTIONDEFORMITY N D
- 35. FIXED ABDUCTION & ADDUCTIONDEFORMITY D N
- 36. FIXED ABDUCTION &ADDUCTION DEFORMITY- N D Measured by squaring of pelvis
- 37. Alternate method fordeterming Fixed abduction & adduction deformity Kothari’s method
- 38. Fixed external &internal rotation deformity Always remains revealed Determined by noting the direction of anterior surface of patella or the toes when the foot is held at right angle to the leg
- 39. Movements During themeasurement of movements always fix the pelvis Flexion- 0 to 140 degree Extension- 0 to 15 degree Abduction- 0 to 40 degree Adduction- 0 to 30 degree Internal rotation- 0 to 30 degree External rotation- 0 to 45 degree Circumduction-
- 40. MOVEMENT Normal range Normal flexion
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- 43. MOVEMENTS Normal range ADDUCTION
- 44. MOVEMENTS In flexion Abduction Normal range
- 45. MOVEMENTS In flexion Internal rotation Normal range
- 46. MOVEMENTS In flexion External rotation Normal range
- 47. MEASUREMENTS Shortenin g Apparent True
- 48. Apparent measurement Shows thecompensation that the pt has developed to conceal any fixed deformity Here both limbs should be kept parallel to each other Measured from xiphisternum or umbilicus to medial malleolus
- 49. MEASUREMENTS True shortening Square the pelvis ASIS MEDIAL JOINT LINE KNEE MEDIAL MALLEOLUS
- 50. MEASUREMENTS True shortening Supra 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. MEASUREMENT- circumferential Muscle wasting
- 52. For injuries/pathologies aroundthe hip Bryant’s triangle
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- 54. Schoemaker’s line Chiene’s test Morris bitrochanteric test
- 55. Tests for stability SLR Telescopy Trendelenburg test Otolani test Barlow test
- 56. SPECIAL TESTS Trendeleberg Test Fulcrum socket Lever length of head and neck Force Gluteus Medius
- 57. HIP ABDUCTION MECHANISM 2 1 3
- 58. SPECIAL TESTS Trendelenberg test Normal hip Positive test SOUND SIDE SAGS IN POSITIVE TRENDELENBERGS TEST
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