Hip Examination Flashcards
Systems used in otthopedic examination?
Look
Feel
Move
Special tests
General LOOK of patient?
- lying or sitting uncomfortably
- any walking aids present
General localized LOOK of patient?
local - hip, thigh, leg
1. Position.
2. Major deformity, swelling.
3. Extra: cast, splint, traction, dressing
General anatomic LOOK of the patient?
- Skin
- swelling, scars, color, hair, dryness - Subcutaneous
- LN, veins, nerves, tendons - Muscles
- bulk, wasting, twitches - Bones
- landmarks, swelling, angulation and deformity - Joints
- position, (hip too deep to see swelling)
Note: do not forget to look on the posterior side
Important considerations when looking at the hip?
- Amount of exposure
- Duration of exposure
- Persons present during exposure
- Place of exposure
- Attitude and behavior during exposure
Feel?
- Tenderness:
- Generalized
- Specific - Temperature
- compare distal/proximal, Rt / Lt. - anatomic
What do you feel anatomically?
- Skin
- dryness, hyper/hypothesia, scars - Subcutaneous
- LN, nerves, vessels, tendons, nodules - Muscle
- tone, bulk, twitches, gaps, tenderness - Bone: landmarks (ASIS, Gr Tr. , Isch. Tub.) tenderness, mass, crepitus
- Joint
- swelling, effusion, crepitation, synovial thickening, joint line tenderness (hip joint too deep to elicit)
Move?
- active
- passive
Note: Usually passive unless there is a specific reason:
- Need to assess the painless / painful range of motion
- Need to assess muscle power
Important things to note during movement of hip joint?
- Must differentiate between true hip joint motion and pelvic motion
- Must stabilize the pelvis in neutral position
State range of motion of movements?
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 -
Name the special tests of the joint?
- Thomas test
- Trendelenburgh test
- Leg length assessment
- Gait – walking
What is the Thomas test?
a test used to measure the flexibility of the hip flexor muscles
- its a test for hip flexor tightness
Describe the Thomas Test?
- patient is lying supine on a flat hard surface
- one knee is flexed and being held at the chest at the point where the lumbar spine is felt to flex
- the clinician assesses whether the thigh of the extended leg maintains full contact with the surface of the bed
What is a positive Thomas Test?
if the extended thigh is raised off the surface of the table
What does a positive Thomas Test mean?
indicates a decrease in flexibility in the rectus femoris or iliopsoas muscles or both
- in normal hip extension is only possible up to the neutral position 0 degrees (thigh lies on the table) and further flexion can tilt the pelvis further upright
When should you take precaution when doing the Thomas test and how do you solve the problem?
Precaution = when knee has fixed flexion deformity
Solution = keep knee outside edge of couch
Thomas test in neonates and young children?
Positive Thomas test in neonates and young children is normal
What is the Trendelenburgh test?
- You are testing the hip the patient is standing on
- Normally the pelvis tilts down on the weight-bearing hip
- This is performed by the hip abductors
What is the positive Trendelenburgh test?
- the pelvis on the non weight-bearing hip tilts down
- the trunk has to tilt to the weight-bearing side
What is the Trendelenburgh sign?
loss of abductor function (gluteus medius and minimus) causes the pelvis to tilt down when supporting the body on the affected side
- indicates damage to the superior gluteal nerve
Causes of positive trendelenburgh?
- Weak hip abductors
- paralyzed / wasted - Mechanically inefficient hip abductors
- distance between origin & insertion reduced
e.g. coxa vara - Unstable pivot of motion:
- hip subluxation / dislocation - Inhibited hip abductors: painful to move
- trauma (sprains) / infection / irritation / tumor - Reduced range of motion:
hip incongruent / stiffness / OA
What is the Galeazzi test?
used to assess for hip dislocation primarily in order to test for developmental dysplasia of the hip
Note: also known as Allis sign
How do you perform a Galeazzi test?
flexing an infants knees when they are lying down so that the feet touch the surface and the ankles touch the buttocks
- both heels have to be at the same level
What is a positive Galeazzi sign?
an inequality in the height of the knees
- caused by hip dislocation or congenital femoral shortening
What is leg length assessment?
measuring the leg lenghth
1. apparent length
2. true length
What is apparent length?
can be measured from the umbilicus to the medial malleoli of the ankle
- affected by pelvic tilt
What is true length?
length from the anterior superior iliac spine to the medial malleolus
- not affected by pelvic tilt
Phases of the normal gait cycle?
- stance phase (60%)
- swing phase (40%)
Describe the stance phase?
- Heel strike
- Foot flat - mid-stance
- Push off
Describe the swing phase?
- Acceleration
- Mid-swing
- Deceleration
Normal gait?
Normal stance and swing phases
Antalgic gait?
Painful to weight-bear
– short stance phase
Lurch gait?
Shortening – painless limping – normal stance period
Circumduction gait?
Stiff hip
– motion of pelvis compensates
High step gait?
Foot drop
– more hip & knee flexion needed to free toes from ground
Tip toe gait?
Heel off the ground
