HIP EXAMINATIONand salient points .pptx

Hip examination

1. HIP EXAMINATION  History proper Pain Swelling Loss of function Loss of weight bearing Limp Limb length discrepancy CAUSES OF PAIN Anterior  hip pain : arthritis, hip flexor strain, ilio-psoas bursitis, lebral tear. Lateral hip pain : GT bursitis, GM tear, iliotibial band syndrome(athletes), meralgia paresthetica . Posterior hip pain : hip extensor and external rotators pathology, degenerative disc disease, spinal stenosis .

2.  SWELLING Site Onset Duration Association with pain Progression over time   LIMP is defined as any abnormality  of normal rhythmic biphasic walking. Onset Duration Association with pain Progression Ambulatory status Stiffness Deformity Limb length disparity Paralytic disability

3.   Past history: Trauma Tuberculosis Surgery Neurological disorders Connective tissue disorder Steroid intake 2. PERSONAL HISTORY Occupation  and work tolerance Diet Smoking/alcohol

4. GENERAL EXAMINATION • Ht/wt/BMI •   Fever Vital signs Pallor Inguinal lymph nodes Stigmata of TB Chest expansion  Local examination of hip Inspection Palpation Movements Measurements Special tests

5.  Inspection Should be done from the front, side and back Gait of the patient. Attitude of the upper and lower limb. Gait   “mode of walking” Normal gait is rhythmical bipedal biphasic walking in which the lumbar spine, hip and legs move in unison

6.   Antalgic gait : In painful hip conditions pt walks with reduced stance phase on the affected side . Waddling gait: Body  sways from side to side on a wide base seen in b/l DDH,pregnancy .   Trendelenberg gait : Patient lurches on the affected side and pelvis drops on to sound side.

7.   Attitude and Diagnosis  CDH – Broadening at trochantric level, widening of the perineum, assymetry of gluteal folds Synovitis – mild flexion, abduction, Ext Rotation ,with apparent lengthening True arthritis – Flex Adduc Int Rota(FADIR) with or without true shortening Posterior dislocation – FADIR with apparent and true shortening. Anterior dislocation–  Flex Abd Ext Rota with apparent lengthening

8. Inspection  Inspection (front) Level  of shoulder ASIS level Symphysis pubis Iliac fossa Groin fold Wasting , swelling , sinuses ,abnormal skin condition, obvious pulsations  Inspection (side) Iliac  crest Trochanteric region Lumbar lordosis / Gluteal bulge supra or infratrochanteric depression Level of tip of trochanters

9.  Inspection standing (back ) Scapula , scoliosis Iliac crest / PSIS Ischial Tuberosity region Gluteal bulge / fold /back of thigh Popliteal folds, heal Wasting, swelling , sinus , abnormal pulsation ,contracture Inspection sitting : psis and scolosis Inspection supine : attitude , shortening Inspection prone : bed sores

10. Palpation Marking of bony points. Superficial:Temperatu re ,Tenderness, area of anesthesia etc. Deep palpation: Tenderness over bony pt( ASIS,PSIS,GT,IT,Pub is,iliac crest) ASIS PUBIS GT Anterior hip joint(direct) Bitrochanteric compression test. Iliac crest Femoral pulse(vascular sign of Narah ) Iliac fossa Lymph nodes

11. MOVEMENTS: Should be performed in squaring pelvis. Flexion : 0 to 110-130 deg. Extension : to 20 deg. Abduction: 0 to 45-55 deg Adduction:0 to 35-45 deg Internal rotation : 30-40 deg. External rotation: 40-50 deg.   THOMAS TEST(IN FFD)  

12. MEASUREMENTS   MEASUREMENTS : APPARENT LENGTH MEASURMENTS. TRUE LENGTH MEASURMENTS . SEGMENTAL LENGTH CIRCUMFERRETIAL MEASURMENTS.  Apparent measurement Helps in assessing the extent compensation developed for concealing the actual deformity . Prerequisites Lying supine comfortably Lower limbs parallel Measurement taken from central fixed point on the trunk to tip of medial malleolus No squaring of pelvis

13. True length measurement : Squarring of pelvis Palpate and mark both the ASIS and the tips of both malleoli Non affected lower limb should be placed in exactly same position and then measured Limb length discrepancy Galleazi test

14. Bryants triangle Thumb on asis Middle finger on greater trochanter Index finger vertically below in horizontal plane of gt Nelaton’s line – Ischial tuberosity to ASIS Schoemaker’s line – Troch tip to ASIS Chiene’s line/test both asis line drawn and both gt line drawn , normally parallel

15. Test for sacroilliac joint Pelvic distraction test Patrick test : done in supine position

16. Trendelenburg   test A positive test demonstrates that the hip abductors are not functioning . Causes: • Power : Weakness of the hip abductors e.g. myopathy , neuropathy Lever : # NOF, Troch # etc Fulcrum : Arthritis , RA,dislocation’s Test

17. Ortolani test

18. Barlow (provocative )

19. Telescopic test

20. Neurovascular examination Per rectal examination