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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
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
MeasurementsApparent : 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
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