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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