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) Email: anilarora@delhiorthojournal.com
Background Skeletal Anatomy
Background Hip Flexors Hip flexors Ilio-psoas Accessory M.
Background Hip Extensors: Gluteus Max Hamstrings Abductors: Medius, Minimus Adductors: Brevis, longus and magnus
Hip Examination Introduce yourself Take Consent for Examination Expose the patient
Always remember Inspection Palpation Movements Measurements Special tests Introduction
Inspection Scan patient from head to toe
Inspection Pre - requisites Flat bed / couch Adequate exposure Comfortable painless position
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.
Standing- from front Scars Sinuses Fullness / swelling Muscle wasting Abnormal position / pulsations
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
Standing- from back Imaginary plumb line Shoulders, trunk, spine PSIS Gluteal folds- level Back of thigh Knee, ankle, feet
Standing- from back Posterior thigh muscle wasting Swelling Sinuses Scars Contractures
Note the scar
Gait Use of support Walk without support Swing phase Stance phase Time spent in each phase Level of shoulders, trunk. Hip, knee, ankle, feet
Gait Antalgic Short Limb Trendelenburg Waddling Stiff hip In-toeing Out-toeing
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.
Standing on normal side
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.
Trendelenberg Test
Indirect Trendelenberg
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
Trendelenberg Test Disturbance in effort Myopathy, neuropathy- abductors Disturbance in effort (lever) arm Fracture neck femur, I/T #
Trendelenberg Test Fallacies Bear wt on affected extremity for at least 30 seconds Bilateral cases- difficult to interpret Grotesque deformity (Mainly fixed abduction deformity)
Sitting Squatting Sitting cross-legged ( For functional assessment)
Inspection-lying down-supine Exaggerated lumbar lordosis ASIS level Swelling/ scar/ sinuses in Iliac fossae Attitude of limb
Attitude
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
Level of patellae, tibial tuberosities
Patella : assess rotation of the limb
Foot Size
Inspection-lying down-side Iliac crest Lumbar lordosis Trochanteric region
Increased lumbar lordosis
Inspection-Sides
Inspection from Side
Inspection-lying down-prone Level of PSIS Gluteal folds Wasting of glutei Swelling, scar, sinuses, MASS?? Wasting of hams Popliteal fossa Calf wasting
Popliteal Fossae
Gluteal Wasting
Palpation
Lumbar Lordosis
Iliac Fossae
Iliac crest
ASIS
Temperature
Tenderness
Narath s sign
Greater Trochanter
GT Palpation
GT Palpation
Gluteal palpation
Femur
Knee
Tibial Tubercle
Tibia
Medial Malleolus
Palpatory Bryant s
Palpatory Bryant s
Deformities
Performing Thomas test
FFD- Alternative method Alternative Method
Fallacies of Thomas test Hurts an already painful hip Difficult in obese patient Inaccurate in Bilateral FFD Falters with Ankylosed Knee
Squaring the pelvis- Revealing the deformity
Kothari s Angle
Kothari s Angle
Movements
Hip Flexion
Flexion
Hip Abduction and Adduction
Extension
Movements- Rotations
ROTATIONS- in extension
ROTATIONS- in flexion
ROTATIONS- in prone
ROTATIONS- in sitting
Measurements
Apparent Length
Apparent Measurements
Compare with opposite side
TRUE LENGTH
True Length
True Length
True Length
True Length- Alternative method
True Length- normal limb
True Length-normal limb
Where is the shortening
Bryant s Triangle
Bryant s Triangle
Supratrochanteric shortening
Pelvis should be square
Supratrochanteric Shortening..? Has the Trochanter gone up
Schoemaker s line
Schoemaker s line
Chiene s test
Nelaton s Line- Lateral position
ALLEN S TEST
Special Tests
Guavain s Test
FABER Test
Others. Opposite Hip SI joints Spine Both Knees Distal Neurovascular status Per Rectal Examination
Chest Expansion
Thank You