DR. (PROF.) ANIL ARORA MS
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1 Hip Examination DR. (PROF.) ANIL ARORA MS (Ortho) DNB (Ortho) Dip SIROT (USA) FAPOA (Korea), FIGOF (Germany), FJOA (Japan) Commonwealth Fellow Joint Replacement (Royal National Orthopaedic Hospital, London, UK) Senior Knee and Hip Replacement Surgeon Associate Director Department of Orthopaedics and Joint Replacement Max Superspeciality Hospital, Patparganj, Delhi (India)
2 Background Skeletal Anatomy
3 Background Hip Flexors Hip flexors Ilio-psoas Accessory M.
4 Background Hip Extensors: Gluteus Max Hamstrings Abductors: Medius, Minimus Adductors: Brevis, longus and magnus
5 Hip Examination Introduce yourself Take Consent for Examination Expose the patient
6 Always remember Inspection Palpation Movements Measurements Special tests Introduction
7 Inspection Scan patient from head to toe
8 Inspection Pre - requisites Flat bed / couch Adequate exposure Comfortable painless position
9 Standing- from front Level of shoulders Trunk ASIS level, Pelvic Tilt Iliac fossae Groin fold, Scarpa s Attitude of limb as a whole Knee, ankles, feet.
10 Standing- from front Scars Sinuses Fullness / swelling Muscle wasting Abnormal position / pulsations
11 Standing- from sides Iliac crest- level Supra-trochanteric depression Infra-trochanteric depression Lateral thigh mass Level of GT in relation to ASIS Knee, ankle, feet
12 Standing- from back Imaginary plumb line Shoulders, trunk, spine PSIS Gluteal folds- level Back of thigh Knee, ankle, feet
13 Standing- from back Posterior thigh muscle wasting Swelling Sinuses Scars Contractures
14 Note the scar
15 Gait Use of support Walk without support Swing phase Stance phase Time spent in each phase Level of shoulders, trunk. Hip, knee, ankle, feet
16 Gait Antalgic Short Limb Trendelenburg Waddling Stiff hip In-toeing Out-toeing
17
18 Trendelenberg Test Patient s back to the examiner Patient stands on the normal leg Opposite hip extended Opposite knee flexed Shall stand for 30 seconds. The pelvis should remain level or tilt slightly upwards on the unsupported side.
19 Standing on normal side
20 Trendelenberg Test Patient then stands on affected leg Opposite Hip extendedd, Knee flexed If the pelvis tilts downwards on the unsupported side, then this confirms a positive sign.
21 Trendelenberg Test
22 Indirect Trendelenberg
23
24
25 Trendelenberg Test Assess the ability of the hip abductors to stabilise the pelvis on the femur. Causes of positive test- Disturbance in pivotal mechanism Dislocation or subluxation of hip Shortening of femoral neck
26 Trendelenberg Test Disturbance in effort Myopathy, neuropathy- abductors Disturbance in effort (lever) arm Fracture neck femur, I/T #
27 Trendelenberg Test Fallacies Bear wt on affected extremity for at least 30 seconds Bilateral cases- difficult to interpret Grotesque deformity (Mainly fixed abduction deformity)
28 Sitting Squatting Sitting cross-legged ( For functional assessment)
29
30 Inspection-lying down-supine Exaggerated lumbar lordosis ASIS level Swelling/ scar/ sinuses in Iliac fossae Attitude of limb
31 Attitude
32 Inspection-lying down-supine Swelling/scars/sinuses/abnormal pulsations in Scarpa s triangle Wasting of Quads. Level of patella Tibial Tuberosities Level of medial malleolus
33 Level of patellae, tibial tuberosities
34 Patella : assess rotation of the limb
35
36 Foot Size
37 Inspection-lying down-side Iliac crest Lumbar lordosis Trochanteric region
38
39 Increased lumbar lordosis
40 Inspection-Sides
41 Inspection from Side
42 Inspection-lying down-prone Level of PSIS Gluteal folds Wasting of glutei Swelling, scar, sinuses, MASS?? Wasting of hams Popliteal fossa Calf wasting
43
44
45 Popliteal Fossae
46 Gluteal Wasting
47 Palpation
48 Lumbar Lordosis
49 Iliac Fossae
50 Iliac crest
51 ASIS
52 Temperature
53 Tenderness
54 Narath s sign
55 Greater Trochanter
56 GT Palpation
57 GT Palpation
58 Gluteal palpation
59 Femur
60 Knee
61 Tibial Tubercle
62 Tibia
63 Medial Malleolus
64 Palpatory Bryant s
65 Palpatory Bryant s
66 Deformities
67 Performing Thomas test
68 FFD- Alternative method Alternative Method
69 Fallacies of Thomas test Hurts an already painful hip Difficult in obese patient Inaccurate in Bilateral FFD Falters with Ankylosed Knee
70
71 Squaring the pelvis- Revealing the deformity
72 Kothari s Angle
73 Kothari s Angle
74 Movements
75 Hip Flexion
76 Flexion
77 Hip Abduction and Adduction
78 Extension
79 Movements- Rotations
80 ROTATIONS- in extension
81 ROTATIONS- in flexion
82 ROTATIONS- in prone
83 ROTATIONS- in sitting
84 Measurements
85 Apparent Length
86 Apparent Measurements
87 Compare with opposite side
88 TRUE LENGTH
89 True Length
90 True Length
91 True Length
92 True Length- Alternative method
93 True Length- normal limb
94 True Length-normal limb
95 Where is the shortening
96 Bryant s Triangle
97 Bryant s Triangle
98 Supratrochanteric shortening
99 Pelvis should be square
100 Supratrochanteric Shortening..? Has the Trochanter gone up
101 Schoemaker s line
102 Schoemaker s line
103 Chiene s test
104 Nelaton s Line- Lateral position
105 ALLEN S TEST
106 Special Tests
107 Guavain s Test
108 FABER Test
109 Others. Opposite Hip SI joints Spine Both Knees Distal Neurovascular status Per Rectal Examination
110 Chest Expansion
111
112 Thank You
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