CLINICAL EXAMINATION OF HIP JOINT

CHANDRASEKHAR M

 AGE 0-5 YRS- CDH, TOMSMITH ARTHRITIS TB HIP #SRARE 5-10 YRS INFECTIONS, TB, PERTHES, #NECK FEMUR 10-15 ADOLSCENT COXAVERA , SCFE, TB , PYOGENIC INFECTIONS 15-35 YRS ANKYLOSING SPONDYLITIS,RA TB OA ELDERLY- DEGENARATIVE OA,TB

CHEIF COMPLAINTS
PAIN DEFORMITY LIMP SWELLING

 PAIN-ONSET , DURATION, CHARECTER, DIURNAL VARIATION, AGGRIVATING RELEIVING FACTORS, RADIATING PAIN, ASSOCIATED JOINT INVOLVEMENT WHETHER PT ABLE TO GET UP OR NOT

 2 LIMP-LOCALIZES PATHOLOGY PAINLESS/PAINFUL PAINLESS LIMP- CDH, COXAVARA NEUROMUSCULAR DS IF PAINFUL-RELATION TO ONSET OF PAIN 3 DEFORMITY- TYPE TIME OF NOTICE ASSOCIATION WITH PAIN , PROGRESSSION

 STIFFNESS-INFLAMATORY DS CARTILAGE EBNURATION, PROLONGED IMMOBILIZATION, MORNING STIFFNESS SWELLING SIZE SITE,LOCATION,PROGREESION TRAUMA-MODE,SITE,POST INJURY MOBILITY,ABILITY TO BEAR WEIGHT INJURY TO OTHER REGIONS H/O CONTACTS FOR TB, TREATMENT H/O INVOLVEMENT OF OTHER JOINTS

 PAST H/O-CONGENITAL/DEVOLOPMENTAL DS MEDICAL DS-DM/HTN/RENAL ETC TRUAMA,TREATMENT, SURGERYS AROUND HIP PERSONAL H/OOCCUPATION/DIET/SMOKING/ALCHOHOL/ FAMILY H/ODYSPLASIAS,INFLAMATORYDS/STORAGE DS

PRE REQUISITES FOR HIP EXAMINATION

CONSENT FOR EXAMINATION SUPINE ON FLAT BED OR ON COUCH LOWER LIMB HIP ABDOMEN MUST EXPOSED WITH COVERING PRIVATE PARTS NOTE THE ATTITUDE PT SHOULD ASKED TO LIE COMFORTABELY IN AS FAR NEUTRAL POSITION AS POSSIBLE

 HIP PATHOLOGY EXAMINE LOWER LUMBAR SPINE TO ANKLE &FOOT ATTITUDE

ATTITUDE
CDH-BROADNING OF TROCHANTER,WIDENED PERINEUM,ASYMMETRY DISRUPTION OF GLUTEAL FOLDS

SYNOVITIS-FLEXION,ABDUCTIN,EXTERNAL ROTATON
TRUE ARTHRITIS-FLEXON,ADDUCTION,INTERNAL ROTATION, PURE POSTERIOR DISLOCATON-FLEXION ADDUCTION, INTERNAL ROTATION APPARENT&TRUE SHORTNING ANTERIOR DISLOCATION low type FLEXION ABDUCTION,EXTERNAL ROTATION high type-external rotation,extention,some abduction

INSPECTION
FRONT,SIDE ,BACK FRONT- BONY POINTS- LEVEL ASIS PELVIC TILT SOFT TISSUES-ILIAC FOSSA GROIN FOLDS FEMORAL TRIANGLE FRONT OF THIGH HERNIA SITES PERINEAL WIDINEING

 FROM SIDE

LORDOSIS OF SPINE PELVIC TILT TROCHANTERIC PROMINENCE GLUTEAL BULGE

FROM BACK

-ILIAC CREST, PSIS, ISCHIAL TUBEROSITY GLUTEAL BULGE BACK OF THIGH

MUSCLEWASTING SWELLING, SINUSES, SCARS, ULCERS, VISABLE PULSATIONS ENGORGED VEINS, ABNORMAL SKIN CONDITIONS

PALPATION
CONFORM THE INSECTORY FINDINGS DIFFERENT SIDES MARK THE BONY POINTS-ASIS TROCHANTERIC TIP PUBIC TUBERCLE ISCHIAL TUBEROSITY

 SUPERFICIAL PALPATIONLOCAL RISE OF TEMARATURE, SKIN SURFACE, VENOUS PROMINENCE HYPERASTHESIAS, DEEP PALPATION H0LLOW NESS FULLNESS TENDER NESS ILIAC FOSSA ,FEMORAL PULSATIONS IN SCARPA TRIANGLE

TENDERNESS
ANTERIORLY-JUST BELOW LATERALLY TO MIDINGUINAL POINT AT BASE OF SCARPAS TRIANGLE LATERALLY- TIP OF GREATER TROCHANTER POSTERIOR-CENTRE OF LINE JOINING TROCHANTER TO TIP OF ISCHIAL TUBEROSITY CENTRE OF LINE JOINING THE ISCHIALTUBEROSITY TO PSIS

 MEDIALLY

-JN OF GROIN TO MEDIAL ASPECT OF THIGH ILIAC FOSSA- BASE OF ILIAC FOSSA MORE INFERIORLY FOR COLD ABCESSBASE OF SCARPASTRIANGLE, GLUTEAL REGION, SUPRA TROCHANTERIC REGION, ILIAC FOSSA, ANTERIO MEDIAL ASPECT OF MID THIGH LYMPH NODE-INGUINAL NODES EXTERNAL ILIAC NODES

MOVEMENTS
FLEXION NORMAL-0 TO110-130 MUSCLES-PSOAS MAJOR (PRIMARY) RECTUS, SARTORIUS, TENSOR FASCIALATA ADDUCTORS NERVE SUPPLY-L2-3

EXTENTION
RANGE 0-20 DEG MUSCLES-GLUTEUS MAXIMUS(L5S1,2) SEMITENDINOSUS SEMIMEMBRANOSUS-SCIATIC BICEPS FEMORIS

ABDUCTION
AP AXIS PASSING THROUGH HEAD OF FEMUR RANGE 0-45 MUSCLES-GLUTEUS MEDIUS(L4,5 S1) GLUTEAUS MAXIMUS

ADDUCTION
AP AXIS RANGE 0-35 DEG MUSCLES-ADDUCTOR LONGUS BREVIS MAGNUS(L3,4) PECTINEUS GRACILIS

EXTERNAL ROTATION
VERTICAL AXIS PASSING THROUGH CENTRE OF HEAD TO MID PATELLAR POINT RANGE 0-45 MUSCLES-OBTURATOR EXTEMUS ,INTEMUS QUADRATUS FEMORIS PIRIFORMIS

INTERNAL ROTATION
VERTICAL AXIS RANGE 0-35 DEG GLUTEUS MINIMUS ,TENSOR FASCIA LATA(L4,5S1)

FIXED DEFORMITY
FIXED POSITION OF JOINT FROM WHERE LIMB CANNOT BROUGHT BACK TO NEUTRAL POSITION BUT FURTHER MOVEMENTS IN SAME AXIS IS POSSIBLE CAUSES-PERSISTANT MUSCLE SPASM,PERSISTANT POSTURE TO AVOID PAIN,CONCEAL DEFORMITY,DISPARITY OF LIMB LENTGHS

FIXED DEFORMITIES
FLEXION ADDUCTON OR ABDUCTION EXTERNALOR INTERNAL ROTATION COMBINATIONS-1FLEXION ADDUCTION,INTERNAL ROTATION FLEXION ABDUCTION EXTERNAL ROTATION

FIXED FLEXION DEFORMITY

THOMAS TEST-HUGH OWEN THOMAS(1876) METHOD-

HIP EXAMINATION

THOMAS TEST

Flexion deformity

NORMAL LIMB

DISEASED LIMB

FALLACIES
BILATERAL FFD DIFFICULT TO PERFORM OBESE AND HEAVIELY BUILT PERSONS DIFFICULTY TO PERRFORM CASUSES FURTHER PAIN IN PAIN FUL HIP PRESENCE OF ANKYLOSING HIP DIFFICULTY TO PERFORM

FIXED ABDUCTION DEFORMITY

DOWNWARD TILT OF PELVIS COMPLIMENTARY TO SHORTENED LIMB FOR EACH 1 CM OF SHORTNING 10 DEG OF ABDUCTION DEFORMIY

FIXED ADDUCTION DEFORMITY

PELVIS IS ELEVATED COMPARED TO OPPOSITE SIDE COMPLIMENTARY TO LENTGHNING,

FALLACICES
SQURING IS POSSIBLE INFIXED SCOLIOSIS DUE TO FIXED OBLIQUITY IF PELVIS MAL/ILL DEVOLOPED PELVIS(RESIDUAL POLIO ) IATROGENIC UNREDUCED DISLOCATION OF SI JOINT

 HUMAN BODY HAS VARIOUS COMPENSATORY MEASURES TO COMPENSATE DEFORMITY TILTING THE PELVIS DOWN GRADUALLY AQUIRING EQINUS POSITION OF FOOT

THESE COMPENSATORY MEASURES F0R CONCEAL DEFORMITY MAINTAIN EQUILIBRIUM STABILISES UNSTABLE HIP MAKE UP THE DISPARITY OF LIMB LENGTH

APPERENT MEASUREMENT
ASSES THE EXTENT OF NATURAL COMPENSATION DEVOLOPED FOR CONCEALING THE ACTUAL DEFORMITY PRE REQUSITES-LYING SUPINE COMFORTABLE POSTURE WITH AFFECTED LIMB IN LINE OF TRUNK LL SHOULD BE IN PARALLEL IN POSITION PROXIMALLY CENTRAL FIXEDPOINT OF TRUNK, DISTALLY-MEDIAL MALLEOLUS

TRUE MEASUREMENT
SQURE THE PELVIS MEASUREMENT FROM ASIS-MEDIAL MALLEOLAR TIP SHOULD DONE FIRST ON NORMAL SIDE

 TRUE SHORTINING=APPARENT SHORTININGNO COMPENSATION TRUE>APPARANT=PART OF SHORTNING COMPENSATED BY PELVIC TILTING(FIXED ABDUCTION DEFORMITY TRUE SHORTNING<APPARENT-SHORTNING WITH OUT COMPENSATION

LOCALISATION OF DISPARITY
LEG LENGTH -MEDIAL KNEE JOINT LINE TO TIP OF MEDIAL MALLEOLUS THIGH LENGTH-1 INFRA TROCHANTEIRIC 2 SUPRA TROCHANTERIC SUPRA TROCHANTERIC DISPARITY ASSESED BY DRAW COMPARE THE BRYANTS TRIANGLE

 SHORTING AT BASE EX-#NECK FEMUR # DISLOCATION OF HIP SHORTINING OF HEIGHT POSTERIODISLOCATION CENTRAL DISLOCATION OF HIP LENGTHNING-TROCHANTERIC #,FLEXION CONTRACTURES OF HIP, OLD#S & DESTRUCTIVE LEISIONS OF HIP SHORTINING OF HYPOTENUSE CENTRAL DISLOCATION OF HIP #NECK FEMUR WITH NECK ABSORPTION ABSENCE OF HEAD,PROTRUSIO ACETABULI

 B/L AFFECTION HIP EXCISSION OF ASIS

 NELATONS LINE-ASIS TO ISCHIAL TUBEROSITY NORMAL-LINE PASSES THROUGH TIP OF TROCHANTER SUPRA TROCHANTERIC SHORTENING-GT LIES ABOVE THE LINE SCHOEMAKER LINE- NORMAL-MEET COUNTER PART AT CENTRAL LINE AT OR ABOVE UMBILICUS SUPRA TROCHANTERIC SHORTNING-MEET BELOW THE UMBILICUS

SPECIAL TESTS
1 TELESCOPING TEST 2 TRENDLENBERG TEST 3 ORTOLANTS TEST BARLOWTEST GALEAZZI TEST

TELESCOPING TEST
INTACTNESS AND ADAPTATION OF HEAD OF AND ACETABULUM ARE ASSESED NORMALSMALL EXTRUSUON INSTABLE HIP-EXCURSION MORE-OLD UNREDUCED POSTERIOR DISLOCATION PARALYTIC HIP,LOSSOF NECK AND OR HEAD

TRENDELENBURG TEST
FREDRICH TRENDELENBURG 1895 FOR ASSESMENT OF CDH DONE TO ASSESS THE INTEGRITY OF ABDUCTOR MECHANISM OF HIP ABDUCTOR MECHANISM FOR NORMAL RHYTHAMIC GAIT WITH ALTERNATE MEASURE CONTROL WEIGHT BEARING FULCRUM-HIP LEVER ARM-HEADNECK SHAFT OF FEMUR INTACTNESS POWER CONTROLING GROUP-GLUTEAS MEDIUS

 TRENDELENBERG TEST POSITIVE FAILURE OF LEVER -# NECK FEMUR COXAVARA , TROCHANTERIC AVULSION DISRUPTION OF FULCRUM-DDH , SUBLUXATION PERTHES DS OSTEONECROSIS DEFECTIVE MUSCLE POWER-POLIO,SHOULDER GIRDLE MUSCLE DYSTROPHY,L5 RADICULOPATHY

FALLICES
FALSE POSITIVE IN PAIN FUL HIP DEFECT IN QUADRATUS LUMBORUM -FALSE POSITIVE RESULTS SACRO ILITIS MAY GIVES FALSE POSITIVE OBESE, PATIENTS WITH MEDIAL SHIFT OF LOWER LIMB AXIS MAY PROUDUCE PSUEDO POSITIVE IN PRENCE OF ADDUCTION ABDUCTION DEFORMITY-FALSE POSITIVE

ORTOLANTS TEST
FOR DIAGNOSING CDH

ORTOLANTS TEST

GALAEZZI TEST