Examination of the hip
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Transcript of Examination of the hip
![Page 1: Examination of the hip](https://reader036.fdocuments.net/reader036/viewer/2022062303/556c7f7fd8b42ac71e8b4d74/html5/thumbnails/1.jpg)
EXAMINATION OF THE HIP JOINT
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CURRENT TREND
Clinical examinationEarly imaging
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IN ORTHOPAEDIC TRAINING• The skill in
eliciting/demonstrating abnormalities of the hip remains as the mainstay in assessment of orthopaedic trainee
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CLINICAL EXAMINATION OF HIP USEFUL IN
• DDH• NEONATAL SEPTIC
ARTHRITIS• TRANSIENT
SYNOVITIS• PERTHES DISEASE
• SUFE• TUBERCULOSIS• OSTEOAARTHROSIS• TRAUMATIC
CONDITIONS
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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
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HISTORY
• Pain
• Felt in groin, thigh or knee
• Limping
• Also an early symptom
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RELEVANT GENERAL EXAMINATION
• For the diagnosis&
• Its management
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RELEVANT GENERAL EXAMINATION
For the diagnosis
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RELEVANT GENERAL EXAMINATION
Not relevant for diagnosis
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RELEVANT GENERAL EXAMINATION
For his management
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GAIT
• Simplest of all definitions “mode of walking”
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GAIT
• Normal gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison
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GAIT
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LIMPING
• Limping is the most common abnormality
• Can be defined as any abnormality of normal rhythmic biphasic walking
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GAIT
• Types– Painless limping– Painful limping– Stiff hip– High stepping – Crutch gait
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STIFF HIP GAIT
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CRUTCH WALKING
– Two point– Three point– Swing to– Swing through
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CRUTCH GAIT
Three point gait Swing through gait Swing to gait
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INSPECTION
• Attitude
Lumbar lordosis
ASISLower limbs
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INSPECTION
Muscle wasting
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INSPECTION
• Swelling
• Scars
• Sinuses
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PALPATION• TENDERNESS
– ANTERIOR– Posterior & lateral– Bitrochanteric compression
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PALPATION
• Swelling
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PALPATION
• Femoral artery pulsation
Weak or absent
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FIXED DEFORMITIES• Fixed flexion deformity
Concealed during walking by increase in lumbar lordosis
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FFD DEMONSTRATION
HUGH OWEN THOMAS’S TEST
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FFD DEMONSTRATION
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FIXED ABDUCTION & ADDUCTION DEFORMITY
• Pelvic tilt indicated by ASIS at different level
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FIXED ABDUCTION & ADDUCTION DEFORMITY
DN
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FIXED ABDUCTION & ADDUCTION DEFORMITY
N
D
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FIXED ABDUCTION & ADDUCTION DEFORMITY
N D
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FIXED ABDUCTION & ADDUCTION DEFORMITY
ND
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MOVEMENT
Normal flexion
Normal range
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MOVEMENT
Axis deviation
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MOVEMENTS
Extension
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MOVEMENTS
ADDUCTION
Normal range
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MOVEMENTS
Abduction
In flexion
Normal range
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MOVEMENTS
Internal rotation
In flexion
Normal range
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MOVEMENTS
External rotation
In flexion
Normal range
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MEASUREMENTS
• Shortening–Apparent
–True
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MEASUREMENTS
• Apparent shortening
• Due to pelvic tilt or FFD
• Measured from xiphisternum to medial malleolus
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MEASUREMENTSTrue shortening
Square the pelvis
ASIS MEDIAL JOINT LINE KNEE MEDIAL MALLEOLUS
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MEASUREMENTSTrue shortening- Supra Trochanteric
Bryants triangle
Nelatons line
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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
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MEASUREMENT
• Muscle wasting
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SPECIAL TESTS
• Trendeleberg Test
• Fulcrum socket• Lever length of head
and neck• Force Gluteus Medius
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HIP ABDUCTION MECHANISM
123
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SPECIAL TESTSTrendelenberg test
Normal hip Positive test
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SPECIAL TESTSTelescoping test
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SPECIAL TESTS
• Ortolani test• Barlow’s test• Patrick test• Febere sign• Duchnne sign
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Thank you