hip

Question 1

what is the position of the hip at birth?

Answer 1

flexed, abducted, laterally rotated

Question 2

at what age does the acetabular cup deepend and angle downward? and why

Answer 2

by 3 y/o because:

• hip extension activation
• lengthening of pelvic ligaments
• motor learning/mm activation
• head of femur being pushed into acetabulum from WB fun

Question 3

how do you test hip SP ROM - flexion (there are a few different ways just tell me the supine one)

Answer 3

• pt supine
• flex knee to 90
• flex hip and watch for pelvis movement/hiking/lordosis

Question 4

how do you test hip SP ROM extension(not stahili)

Answer 4

• pt supine and just check out their lordosis angle. look for flexion contracture
  with legs flat on the plynth there shouldn’t be a space between the lumbar spine and the plynth

Question 5

how do you test hip SP ROM extension (staheli)

Answer 5

pt. prone
HJs flexed over the end of the plynth (flattens lordosis)
hand over lumbosacral region
lift thigh (leg kinda straight)
wait for HJ hike = end point

Question 6

how do we test for hip FP: adduction

Answer 6

• pt supine
• keep hand over opposite ASIS to monitor pelvic movement
• knees can be flexed(90) or straight
• raise one limb above the one to be tested. adduct the lower leg.
• measure from the midline of the body (?)

Question 7

how do we test for hip FP: abduction

Answer 7

• pt supine
• knees can be flexed(90) or straight
• hand on opposite ASIS to monitor pelvic movement:

Question 8

how do we test from hip TP rotation (pretty easy and a gr8 place to start with all assessments) supine

Answer 8

HJ flexed to 90
foot inwards for external rotation
foot outwards for internal rotation
watch/feel for HJ hike (this is end point)
measure from middle of leg at neutral position

Question 9

how do we test from hip TP rotation (pretty easy and a gr8 place to start with all assessments) prone

Answer 9

hj extended
kj flexed (90)
foot inwards = ext rotation
foot outwards = internal rotation
watch and feel for HJ hike –> this is the end point
measure from middle of leg at neutral position

Question 10

when testing HJ TP rotation what position do you put the foot in if you want to test internal v. external rotation

Answer 10

foot inward = external rotation

foot outward = internal rotation

Question 11

besides all the planes of HJ - what is another fun test we can do on a patient’s hip?

Answer 11

trandelenburg sign

Question 12

name the (1) hip pathology

Answer 12

DDH:

developmental dysplasia of the hip

Question 13

define DDH: developmental dysplasia of the hip

Answer 13

a condition in which the femoral head has an abnormal relationship to the acetabulum

Question 14

what’s the aetiology of DDH

Answer 14

lig lax
prenatal positioning (i.e. breech, oligohydramnios, big babies, 1st born)
post natal positioning (i.e. swaddling)

Question 15

what is meant by the term oligohydramnios

Answer 15

when there is less fluid in the placenta so it makes the baby heaps more tightly packed in the uterus

Question 16

what are some conditions that are associated with DDH?

Answer 16

torticollis (neck twisted to the side)
metatarsus adductus
oligohydramnios

Question 17

name some of the assessments that can be done (usually by paediatrician) to test for DDH

Answer 17

barlow
ortolani
klisic
decreased abd
galeazzi's sign (telescoping knees)
US
x-ray @ 3-6 months
**note that different ages need different combos of positive tests for dx.

Question 18

outline the rx for DDH for:
birth- 6 months
6-18 months
18 months- 2 years

Answer 18

neonates-6months: pavlik harness (6 weeks)
6-18 months : closed reduction + plaster cast (3 months) –> if unsuccessful: open reduction
18 months-2 years : primary open reduction