Professional Documents
Culture Documents
Hip
Hip
Stinchfield Test
o Px: supine; knee straight to 30° of hip flexion against resistance
o Positive: hip or groin pain or back pain
Indication: Lumbar or SI pathology,
o Stresses hip, SI, Lumbar Spine
Nelaton’s Line
o Ischial Tuberosity to ASIS
o Greater Trochanter above the line
Indication: Dislocated Hip or Coxa Vara
o Two sides – compare
Bryant’s Triangle
o Px: supine
o 1ST Imaginary line: ASIS to Table (Perpendicular line)
o 2ND Imaginary line: Tip of Greater Troch and first line (Right angle)
o Differences: Indications – Congenital Dislocated hip, Coxa Vara
Rotational Deformities
o Occur anywhere between the hip and foot
o Hereditary – many
o Px: supine; LE straight while examiner looks at patellae
o Patellae face in (squinting table) – Medial rotation of femur or the tibia
o Patellae face out, away and up (“Frog-eyes” or Grasshopper Eyes) – Lateral Rotation
o Tibia affected – feet face in (pigeon toes) for medial rotation
o Tibia affected – feet face out (>10°) for excessive lateral rotation of tibia
o Fick Angle – 5°-10°
Ortolani’s Sign
o For Congenital Dislocation of Hip
o Infant: supine
o Examiner: flexes hip & grasps legs (thumb – against the insides of knees and thighs; fingers –
along outsides of thighs to buttocks)
(Gentle Traction) – Abduct thighs, Pressure applied against greater trochanters
o Resistance to abduction and lateral rotation – felt at ≈ 30° to 40°.
o Positive: click, clunk, jerk; hip has reduced; increased abduction of hip is obtained
Sof click – may occur without dislocation; caused by iliofemoral ligament
o Repeat rotation of hip to palpate location of click
o Normal abduction: 70° to 90° (femoral head slipped over acetabular ridge into acetabulum)
o Valid only:
First few weeks afer birth
Dislocated and lax hips (not for dislocations that are difficult to reduce)
o Can damage the articular cartilage of femoral head
Barlow’s Test
o Modification of Ortolani’s Sign
o For development dysplasia of the hip
o Infant: supine; legs facing the examiner
Hips are flexed to 90°, knees fully flexed
o Examiner: Other hand – steadies the femur and pelvis (opposite side)
Middle finger – over greater trochanter
Thumb – adjacent to the inner side of the knee and thigh opposite to greater troch
Abduct hip, Middle finger applies forward pressure behind greater troch
o Positive: Femoral head slips forward the acetabulum with click, clunk, or jerk
Indication: Hip was dislocated
o For infants up to 6months
o Articular damage to femoral head
Galeazzi Sign (Allis or Galeazzi Test)
o Assesses unilateral congenital dislocation of hip or unilateral developmental dysplasis of hip
o Children (3 to 18 months)
o Child: supine; knees flexed; hip flexed to 90°
o Positive: one knee is higher
Telescoping Sign (Piston’s or Dupuytren’s Test)
o Evident in child with dislocated hip
o Child: supine
o Examiner: flexes knee and hip to 90°
Femur pushed down onto examining table
Femur and leg are then lifed up and away from the table
o Positive: lot of relative movement (excessive movement – telescoping or pistoning)
Abduction Test (Hart’s Sign)
o CDH – not diagnosed early or (+) developmental dysplasia of hup
o Parent’s note: (Changing diapers) – one leg does not abduct as far as the other one
o Child: supine; hips and knees flexed to 90°
o Examiner: passively abduct both legs (note asymmetry and limitation of movement)
o If one hip is dislocated:
Demonstrates asymmetry of fat folds in gluteal and upper leg area because of “riding
up” of femur on the affected side.
OTHER TESTS
Fulcrum Test
o Assess for possible stress fracture of the femoral shaf
o Px: sit; knees bent over the end of the bed with feet dangling
o Examiner: places an arm under px’s thigh (fulcrum)
o Fulcrum – moved distal to proximal
o Stress Fracture present – px c/o sharp pain and expresses apprehension when fulcrum is under
the fractured site