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Hip case discussion
History Pain/limp/decreased ROM Inability to sit/squat ADL affected Trauma Childhood history
Limp/surgery Sports/playing
Drug history Other joints Systemic symptoms
Malaise/Fever
Alcohol intake
Age of patient
OCCUPATION/NEEDS/DEMANDS
Medical history Cardiac Neurological
spastic Meningocele
Trauma Type – low/high energy Any surgeries/treatment
General Examination
PICKLE Brief systemic examination
PAChestSkin/eyes
GAIT
NORMAL CYCLE ½ CYCLE PER SECONDLENGTH OF STANCE PHASE ON
AFFECTED LIMBPELVISSHOULDERWALKING AIDS
NO GAIT/TRENDLENBERG
GAIT
Pain – antalgic gait – DEC STANCE PHASE Shortening – same side dips Abductor def – opposite side dips Stiffness Neurological
Spastic Scissoring Fesitinanat
Waddling Bilat cases Abd def
Hip examination
LOOK TOUCH MOVE MEASURE
Inspection
StandingFrom frontFrom sidesFrom back
Alignment of ASISBlock test
Supine (FROM SIDE/ABOVE/FOOT END OF TABLE)
Check for lumbar lordosisAttitude of limbBoth ASIS levelsswelling/scars/sinus
femoral triangle region GT region/lateral aspect of joint
ProneGluteal foldsdimplesswelling/scars/sinus in gluteal region
Muscle wasting Thigh/leg
Palpation
Rise of temperature Tenderness Confirm both ASIS at same level Greater trochanter
prominentThickening/irregularityPalpatory bryant’s
Feel for any mass/swelling in gluteal region
Femoral Pulses
? Mid inguinal point/mid point of inguinal ligament
Movements Thomas flexion test
Part 1Part 2
Free ROM Supine
Flexion Abduction/adduction Rotation
With hip/knee extended (log rolling) With hip/knee flexed 900
Prone Extension Rotation
With hip extended/knee flexed
AXIS DEVIATION
ROM
MEASUREMENTS
Apparent length True length- Supratrochanteric
Bryant’s triangle Nelaton’s line Shoemaker’s line
Infratrochanteric segmental lengths femur, tibia
Thigh & calf girth Galeazzi test
Block test
SPECIAL TESTS
TRENDLENBERG TELESCOPY
TRENDLENBERG
Sound Side SINKS
APLEY’S TEST
Telescopy
OTHER JOINTS/TESTS
SI JOINTS Pelvis MUSCLE TIGHTNESS Contralateral hip Ipsilateral knee Both feet SPINE
SI Joints
FABER/PATRICK TEST
GAENSLEN’S TEST
OBER’S TEST
ELY’S TEST
TRIPOD SIGN
Bilateral hip case
Find out the worse affected side – pain on movt/restricted ROM
Block test to ascertain fixed add/abd deformity First thomas test
Flex the less affected hip first Repeat on other side If FFD then confirm at end of examination by putting
patient prone at edge of table
Bilateral hip case
Measurements: always square pelvis for true measurementsCan be done only if some free ROM on one
side If bilat fixed only seg measurements
Bryants Femur tibia Mention the relative discrepancies