hip examination. basic principles ( prerequisites of examination ) patient must be suitably...
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HIP EXAMINATION
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Basic Principles( Prerequisites of Examination )
Patient must be suitably undressed.
Hard bed.
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Pattern of Examination
Inspection. Palpation. Movements. Measurements. Special tests.
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Inspection
Standing position.
Lying down position.
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Inspection (contd)In standing position Patient able to stand – Yes / No. If yes, patient able to walk – Yes / No. If yes, check Gait. Gait :
– Trendelenburg.– Antalgic– Waddling– Short legged – High stepping
Patient able to squat or not.
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Inspection (contd)In standing position
Trendelenburg test
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Inspection (contd)In standing position Spine. Wasting eg Disuse atrophy, neurological
deficit. Swelling eg Cold abscess, dislocation, lipoma.
– Scarpas triangle.– Greater trochanter.– Gluteal region
Scars / Sinus Level of natal fold eg CDH.
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Inspection (contd)In lying down position
Sequential -
Top to bottom
or
Bottom to top.
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Inspection (contd)In Lying down position Attitude.
Lumbar lordosis.
ASIS.
Greater trochanter– Position
– Prominence
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Inspection (contd)In Lying down position Scarpas triangle
– Fullness.– Scars / sinus.
Skin– Colour, texture, prominent veins.
Thigh– Wasting.
Patella– Position
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Inspection (contd)In Lying down position Calf
– Wasting
Malleoli– Level– Direction.
Heel– Level
SLR
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Palpation
Confirmation of inspection findings in same sequence plus few additions :Temperature, Tenderness & Telescopy
Lumbar lordosis– Thomas’s test for FFD.
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Palpation (contd.) ASIS level
– How to feel ?
– Level.
Greater trochanter– Position, Promince (Bitrochanteric test).
– Tenderness – Antero posterior / Axial.
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Palpation ( contd. ) Temperature Scars Sinuses :
– Margins, Discharge, adherence to bone Tenderness Circumference of thigh / calf Medial malleolus
– How to feel?– Level & direction
Heel– Level
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Palpation ( contd. ) Telescopy
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MovementsSagittal Flexion
Extension
0-90 ext knee
0 – 120 fl knee
0 -15
Coronal Adduction Abduction
0 – 30
0 - 40
Vertical External Internal rotation.
0 – 45
0 – 30
Circumduction Incomplete
In fixed deformities, starting point will be the degree of deformity
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MeasurementsApparent : Lengthening / Shortening.
Pre requisite– Limbs parallel
Measured between midline point - xiphisternum, manubrium sterni or umbilicus
&
medial malleoli
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Measurements Real : Lengthening / Shortening
Pre requisites– Squaring of pelvis.
• ASIS at same level.
– Limbs in identical position.
Measurement from ASIS to medial malleolus.
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Measurements ( contd )
Find level of discrepancy– Leg,
– Thigh or
– Supratrochanteric.
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Measurements( contd ) (How to detect supratrochanteric shortening) Bryants triangle.
Nelaton’s line.
.
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Measurements ( contd ) (How to detect supratrochanteric shortening Schoemaker’s line.
Chiene’s parallelogram
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Special Tests
Narath’s vascular sign.
Ortolani’s test. Barlow’s test.
Ely’s test.
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Examination (contd)
Examination of hip is incomplete without examination of spine & knee.
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Key to Examination findings
ASIS at same level
No adduction or abduction deformity
Apparent measurements = Real measurements
ASIS raised Adduction deformity
Apparent shortening > Real shortening
ASIS lower Abduction deformity
Apparent lengthening > Real lengthening
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