HIP EXAMINATION Basic Principles Prerequisites of Examination Patient

HIP EXAMINATION

Basic Principles ( Prerequisites of Examination ) ¨ Patient must be suitably undressed. ¨ Hard bed.

Pattern of Examination ¨ Inspection. ¨ Palpation. ¨ Movements. ¨ Measurements. ¨ Special tests.

Inspection ¨ Standing position. ¨ Lying down position.

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.

Inspection (contd) In standing position ¨ Trendelenburg test

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.

Inspection (contd) In lying down position Sequential Top to bottom or Bottom to top.

Inspection (contd) In Lying down position ¨ Attitude. ¨ Lumbar lordosis. ¨ ASIS. ¨ Greater trochanter – Position – Prominence

Inspection (contd) In Lying down position ¨ Scarpas triangle – Fullness. – Scars / sinus. ¨ Skin – Colour, texture, prominent veins. ¨ Thigh – Wasting. ¨ Patella – Position

Inspection (contd) In Lying down position ¨ Calf – Wasting ¨ Malleoli – Level – Direction. ¨ Heel – Level ¨ SLR

Palpation Confirmation of inspection findings in same sequence plus few additions : Temperature, Tenderness & Telescopy ¨ Lumbar lordosis – Thomas’s test for FFD.

Palpation (contd. ) ¨ ASIS level – How to feel ? – Level. ¨ Greater trochanter – Position, Promince (Bitrochanteric test). – Tenderness – Antero posterior / Axial.

Palpation ( contd. ) ¨ Temperature ¨ Scars ¨ Sinuses : – Margins, Discharge, adherence to bone ¨ Tenderness ¨ Circumference of thigh / calf ¨ Medial malleolus – How to feel? – Level & direction ¨ Heel – Level

Palpation ( contd. ) ¨ Telescopy

Movements Sagittal Flexion Coronal Extension Adduction Abduction Vertical External Internal rotation. Circumduction 0 -90 ext knee 0 – 120 fl knee 0 -15 0 – 30 0 - 40 0 – 45 0 – 30 Incomplete In fixed deformities, starting point will be the degree of deformity

Measurements Apparent : Lengthening / Shortening. ¨ Pre requisite – Limbs parallel ¨ Measured between midline point - xiphisternum, manubrium sterni or umbilicus & medial malleoli

Measurements Real : Lengthening / Shortening ¨ Pre requisites – Squaring of pelvis. • ASIS at same level. – Limbs in identical position. ¨ Measurement from ASIS to medial malleolus.

Measurements ( contd ) ¨ Find level of discrepancy – Leg, – Thigh or – Supratrochanteric.

Measurements( contd ) (How to detect supratrochanteric shortening) ¨ Bryants triangle. ¨ Nelaton’s line.

Measurements ( contd ) (How to detect supratrochanteric shortening ¨ Schoemaker’s line. ¨ Chiene’s parallelogram

Special Tests ¨ Narath’s vascular sign. ¨ Ortolani’s test. ¨ Barlow’s test. ¨ Ely’s test.

Examination (contd) ¨ Examination of hip is incomplete without examination of spine & knee.

Key to Examination findings ASIS at same level ASIS raised ASIS lower No adduction or Apparent abduction measurements = deformity Real measurements Adduction Apparent deformity shortening > Real shortening Abduction deformity Apparent lengthening > Real lengthening