few of the tests are missing

1. EXAMINATION OF
THE
HIP JOINT

2. CLINICAL EXAMINATION OF
HIP USEFUL IN
 DDH  SCFE
 NEONATAL SEPTIC  TUBERCULOSIS
ARTHRITIS  OSTEOAARTHROSI
 TRANSIENT S
SYNOVITIS  TRAUMATIC
 PERTHES DISEASE CONDITIONS

3. EXAMINATION OF HIP
Traditional steps
 Palpation
 History of  Looking for Fixed
symptoms deformities
 Relevant general  Movements
examination  Measurements
 Gait  Special tests
 Inspection  Tests for
instability

4. History
 Age & sex
 Occupation
 Pain
 Limp
 Amount & nature of violence
 Deformity & swelling
 locking

5.  Past history
ask for previous H/O trauma or
contact with TB
Family history
TB and rheumatism run in families

6. RELEVANT GENERAL
EXAMINATION
 For the diagnosis
&
 Its management

7. RELEVANT GENERAL
EXAMINATION
For the diagnosis

8. RELEVANT GENERAL
EXAMINATION

9. General examination
 In suppurative arthrits of hip , evidence of
toxaemia in other parts of body should be noted
 In TB – hip look for generalised wasting,
cachexia and evening rise of temperature
 In rheumatoid arthritis look for rheumatoid
stigmata in other parts of body
 Look for external iliac & inguinal nodes

10. GAIT
 Simplest of all definitions “mode of
walking”

11. GAIT
 Normal gait is rhythmical bipedal
biphasic walking in which the
lumbar spine, hip and legs move in
unison

12. LIMPING
 Limping is the most common
abnormality
 Can be defined as any abnormality
of normal rhythmic biphasic walking

13. Types of gait
 Antalgic gait
in painful hip conditions
pt lurches on the same side
 Trendelenberg gait
pt lurches to the affected side
seen in hip dislocation, coxa vara
 Waddling gait
Body sways from side to side on a wide base
Seen in b/l CDH & b/l coxa vara

14. Cont’d…
 Short limb gait-
When the affected limb becomes short
Up and down movement of half of the body
 Circumduction gait-
In fixed abduction deformity
 Gluteus maximus gait-
In paralysis of gluteus maximus
Pt lurches backward during stance phase

15. Gait cont’d..
Toe gait
Pt walks with both feet turned inwards- seen
in femoral anteversion

16. Inspection
 From front-
Pelvic tilting, muscle wasting
Rotational deformities, front of thigh,
ASIS
Pubic symphysis, pubic tubercle
Dilated veins, swellings
Scars & sinuses

17. Inspection from front

18. Inspection from side

19. Inspection from behind

20. From side
 Increased lumbar lordosis
 Greater trochanter
 Iliac crest
 Supra & infra trochanteric depression
 Lateral thigh muscle mass

21. From back
 Scoliosis,
 gluteal muscle wasting
 PSIS
 Back of iliac crest
 Scars and sinuses

22. INSPECTION
 Attitude
Lumbar lordosis
ASIS
Lower limbs

23. INSPECTION
Muscle wasting

24. Palpation
Local temperature
Increased in acute arthritis
Tenderness
Anteriorly-below and lateral to mid- inguinal point
Laterally-by steady inward pressure over two
greater trochanters
Posteriorly- centre of the line joining tip of
trochanter & ischial tuberosity

25. PALPATION
 TENDERNESS
 ANTERIOR
 Posterior & lateral
 Bitrochanteric compression

26. Palpation cont’d…
 For greater trochanter
Broadening,thickeneing, ternderness or
dispalcemenrt.
Head of femur-
Especially in dislocations
In dorsum illii ( post dislocation )
In groin ( pubic type of anterior dislocation)
In perinium ( obturator type of anterior
dislocations )

27. Palpation cont’d
 For hip joint
Just below inguinal ligament and lateral to
femoral artery
Swelling

28. PALPATION
 Femoral artery
pulsation
Weak or absent

29. FIXED DEFORMITIES
 Fixed flexion
deformity
Concealed during walking by increase in lumbar
lordosis

30. FFD DEMONSTRATION
HUGH OWEN THOMAS’S TEST

31. Alternate method for assessing
FFD

32. Fixed abduction & adduction
deformity
 Fixed abduction is compensated by scoliosis
with convexity towards the affected side & by the
pelvis being tilted down causing apparent
lengthening of limb
 Fixed aadduction is compensated by scoliosis
with convexity towards the normal side & by the
pelvis being tilted up causing apparent
shortening of limb

33. FIXED ABDUCTION &
ADDUCTION DEFORMITY
 Pelvic tilt indicated by ASIS at
different level

34. FIXED ABDUCTION &
ADDUCTION DEFORMITY
N D

35. FIXED ABDUCTION &
ADDUCTION DEFORMITY
D
N

36. FIXED ABDUCTION & ADDUCTION
DEFORMITY-
N D
Measured by squaring of pelvis

37. Alternate method for determing
Fixed abduction & adduction
deformity
 Kothari’s method

38. Fixed external & internal rotation
deformity
Always remains revealed
Determined by noting the direction of
anterior surface of patella or the toes
when the foot is held at right angle to the
leg

39. Movements
 During the measurement of movements always
fix the pelvis
Flexion- 0 to 140 degree
Extension- 0 to 15 degree
Abduction- 0 to 40 degree
Adduction- 0 to 30 degree
Internal rotation- 0 to 30 degree
External rotation- 0 to 45 degree
Circumduction-

40. MOVEMENT
Normal range
Normal flexion

41. MOVEMENT
Axis deviation

42. MOVEMENTS
Extension

43. MOVEMENTS
Normal range
ADDUCTION

44. MOVEMENTS
In flexion
Abduction
Normal range

45. MOVEMENTS
In flexion
Internal rotation
Normal range

46. MOVEMENTS
In flexion
External rotation
Normal range

47. MEASUREMENTS
 Shortenin
g
 Apparent
 True

48. Apparent measurement
Shows the compensation that
the pt has developed to
conceal any fixed deformity
Here both limbs should
be kept parallel to
each other
 Measured from xiphisternum
or umbilicus to medial
malleolus

49. MEASUREMENTS
True shortening
Square the pelvis
ASIS  MEDIAL JOINT LINE KNEE  MEDIAL MALLEOLUS

50. MEASUREMENTS
True shortening
Supra trochanteric Infra trochanteric
 Coxa Vara  Malunion
 Perthes  Fracture femur &
 SCFE tibia
 Malunited basal #  Growth arrest from
NOF polio
 Congenital Coxa  Trauma and
Vara infective sequale
 Arthritis
 Dislocation

51. MEASUREMENT-
circumferential
 Muscle wasting

52. For injuries/pathologies around the
hip
Bryant’s
triangle

53. Nelaton’s line

54. Schoemaker’s line
Chiene’s test
Morris bitrochanteric test

55. Tests for stability
 SLR
 Telescopy
 Trendelenburg test
 Otolani test
 Barlow test

56. SPECIAL TESTS
 Trendeleberg Test
 Fulcrum  socket
 Lever  length of head
and neck
 Force  Gluteus
Medius

57. HIP ABDUCTION
MECHANISM
2 1
3

58. SPECIAL TESTS
Trendelenberg test
Normal hip Positive test
SOUND SIDE SAGS IN POSITIVE TRENDELENBERGS TEST

59. SPECIAL TESTS
Telescoping test

60. Thank you