Orthopaedics

OrthopaedicsHip ExaminationShoulder ExaminationInspectionPalpationRange of motionActive and passiveInspectionAnteriorSymmetry, pelvic tilt, joint level , short limb, limb rotationLateralabnormal lumbar curve eg. excessive lordosis, hip flexion, knee flexionPosteriorpelvic tilt, scoliosis, joint level, both heels touching floor .Also look for scar, swelling, muscle wasting, wound, discolouration ( erythema, pigmentation).

GaitLook for short limb gait, antalgic gait, trendelenburg gait etc.Trendelenburg Test Ask patient to stand on the good leg first, then stand on the affected leg. Look for sagging of the non weight bearing hip/ or excessive body tilt.PalpationFeel for tenderness, warmth, swelling, deformed bone/ joints.Hip joint - just distal to mid point of inguinal ligament. Also palpate ASIS, iliac crest, greater trochanter, pubic symphysis.

MeasurementsApparent length Umbilicus to medial malleolus. Can be caused by hip contracture, pelvic tilt, scoliosis True length ASIS to medial malleolus. ( can be caused by any pathology that cause shortening of the femur or tibia)

Range of MotionCompare active and passive motion, both sidesActive (Patient lying supine)Flexion (0-120)*Abduction ( 45 )*Adduction (across the other leg 30)*Internal rotation (30)External rotation (45)Passive(patient lying supine)repeat the above movements.Special TestsThomas Test for fixed flexion deformity. One hand under the lumbar spine, flex the good hip with the other hand until the lumbar curvature is fully obliterated. If the affected hip rises from the couch, this indicates loss of extension in that hip.

Posterior ROMNow, turn the patient prone. Palpate the posterior structures eg. PSIS, SI joints. Then perform the active and passive hip extension.