Hip Joint DX 612 Orthopedics and Neurology

Transcription

1 Hip Joint DX 612 Orthopedics and Neurology James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic

2 Hip Anatomy

3 Palpation Point tenderness Edema Symmetry

4 Hip ROM

5 Hip Contracture Tests Thomas Test Supine passive hip flexion Contralateral hip and knee flexion indicates a positive test for hip contracture Evaluate rectus femoris tightness

6 Hip Contracture Tests Rectus Femoris Contracture Test Involuntary extension of flexed knee with tightness in rectus femoris indicates a hip flexion contracture

7 Hip Contracture Tests Piriformis Test Piriformis pain with resisted abduction of hip indicates tight piriformis Sciatic pain indicates nerve compression

8 Piriformis Syndrome Palpation of piriformis may produce local and/or sciatic distribution pain Palpation at spinal nerve root may be negative for pain

9 Phelps Test Prone abduction of lower extremities Flex knees Increased abduction indicates gracilis contracture

10 Pes Anserine Bursitis Gracillis contractures might be involved with Pes anserine bursitis

11 Pes Anserinus The pes anserinus is made up of the tendons of the sartorius, gracilis, and semitendinosus muscles.

12 Pes Anserine Bursitis Pain Contusion Tight hamstrings Runners Change in training Osteoarthritis of knee

13 Hip Contracture Tests Ely s Heel to Buttocks Prone heel to contralateral buttocks Ipsilateral pelvis rising from table indicates hip flexion contracture or tight rectus femoris

14 Hip Contracture Tests Ober s Test for TFL or ITB

15 Ober s Test Failure to descend smoothly indicates a positive test for contracture of the TFL or ITB.

16 Trochanteric Bursitis Palpation Patrick s Positive finger point Laguerre s

17 Degenerative Hip Disease

18 Degenerative Hip Disease Patrick s Trendelenburg s Scouring s Laguerre s Difficult to palpate

19 Patrick s Test FABERE & Figure of 4 Flexion Abduction External rotation

20 Patrick s Test Compresses femoral head into acetabulum Positive test with pain in hip, which indicates an inflammatory process

21 Pelvic Obliquity and Postural Imbalance You must determine whether the leg length discrepancy is anatomical or functional

22 Actual Leg-Length Test This is a tape measurement that tests for anatomical leg length discrepancy. ASIS and medial malleolus are the landmarks identified

23 Apparent Leg-Length Test Reveals functional leg length discrepancy Umbillicus and medial malleolus are landmarks

24 Functional Leg-Length Measure length of both lower extremities supine and seated Inferior medial malloli are used as landmarks Read the body language Measurement

25 Functional Leg-Length Measurement Usually the ipsilateral malleolus will measure short when supine if the superior iliac crest appears inferior when standing and long when seated

26 Trendelenburg s Test Standing flexion of hip Downgoing of contralateral hip is a positive test Indicates gluteal motor weakness and/or hip pathology of weight bearing LE

27 Anvil Test Percussion of calcaneus compresses hip joint Positive test with pain, which indicates fracture or hip pathology

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29 Congenital Hip Dysplasia Flattened acetabular cavity permits dislocation or subluxation of the femur head.

30 Congenital Hip Dysplasia

31 Barlow s and Ortolani s Maneuvers

32 Barlow s Test Identifies unstable hip that lies in the reduced position but can be passively dislocated (and hence unstable) Less than 2% of infants will have a positive Barlow test 90% will normalize with no treatment after 9 weeks

33 Barlow s Test Procedure Hips are examined one at a time Hip flexed & thigh adducted, while pushing posteriorly in line of the shaft of femur, causing femoral head to dislocate posteriorly from acetabulum Dislocation is palpable as femoral head slips out of acetabulum Diagnosis is confirmed with Ortolani's test

34 Ortolani Test Identifies dislocated hip that can be reduced in early weeks of life A positive test requires active treatment If hip remains dislocated (for weeks), limitation of abduction becomes more consistent clinical finding

35 Procedure Examine one hip at a time Flex infant's hips & knees to 90 degrees Thigh is gently abducted & bringing femoral head from its dislocated posterior position to opposite the acetabulum, hence reducing femoral head into acetabulum

36 Positive Ortolani Test Palpable & audible clunk as hip reduces

37 Ortolani Test With time, it becomes more difficult to reduce femoral head into acetabulum, and the Ortolani test becomes negative

38 Pavlik Harness An infant with DDH and a negative Ortolani sign would not be a good candidate for a Pavlik harness

39 Congenital Hip Dysplasia DDH Also known as Allis sign It is not used to evaluate functional leg length deficiency

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41 End of Hip Orthopaedic Tests Adios amigos