Hip case discussion

History Pain/limp/decreased ROM Inability to sit/squat ADL affected Trauma Childhood history

Limp/surgery Sports/playing

Drug history Other joints Systemic symptoms

Malaise/Fever

Alcohol intake

Age of patient

OCCUPATION/NEEDS/DEMANDS

Medical history Cardiac Neurological

spastic Meningocele

Trauma Type – low/high energy Any surgeries/treatment

General Examination

PICKLE Brief systemic examination

PAChestSkin/eyes

GAIT

NORMAL CYCLE ½ CYCLE PER SECONDLENGTH OF STANCE PHASE ON

AFFECTED LIMBPELVISSHOULDERWALKING AIDS

NO GAIT/TRENDLENBERG

GAIT

Pain – antalgic gait – DEC STANCE PHASE Shortening – same side dips Abductor def – opposite side dips Stiffness Neurological

Spastic Scissoring Fesitinanat

Waddling Bilat cases Abd def

Hip examination

LOOK TOUCH MOVE MEASURE

Inspection

StandingFrom frontFrom sidesFrom back

Alignment of ASISBlock test

Supine (FROM SIDE/ABOVE/FOOT END OF TABLE)

Check for lumbar lordosisAttitude of limbBoth ASIS levelsswelling/scars/sinus

femoral triangle region GT region/lateral aspect of joint

ProneGluteal foldsdimplesswelling/scars/sinus in gluteal region

Muscle wasting Thigh/leg

Palpation

Rise of temperature Tenderness Confirm both ASIS at same level Greater trochanter

prominentThickening/irregularityPalpatory bryant’s

Feel for any mass/swelling in gluteal region

Femoral Pulses

? Mid inguinal point/mid point of inguinal ligament

Movements Thomas flexion test

Part 1Part 2

Free ROM Supine

Flexion Abduction/adduction Rotation

With hip/knee extended (log rolling) With hip/knee flexed 900

Prone Extension Rotation

With hip extended/knee flexed

AXIS DEVIATION

ROM

MEASUREMENTS

Apparent length True length- Supratrochanteric

Bryant’s triangle Nelaton’s line Shoemaker’s line

Infratrochanteric segmental lengths femur, tibia

Thigh & calf girth Galeazzi test

Block test

SPECIAL TESTS

TRENDLENBERG TELESCOPY

TRENDLENBERG

Sound Side SINKS

APLEY’S TEST

Telescopy

OTHER JOINTS/TESTS

SI JOINTS Pelvis MUSCLE TIGHTNESS Contralateral hip Ipsilateral knee Both feet SPINE

SI Joints

FABER/PATRICK TEST

GAENSLEN’S TEST

OBER’S TEST

ELY’S TEST

TRIPOD SIGN

Bilateral hip case

Find out the worse affected side – pain on movt/restricted ROM

Block test to ascertain fixed add/abd deformity First thomas test

Flex the less affected hip first Repeat on other side If FFD then confirm at end of examination by putting

patient prone at edge of table

Bilateral hip case

Measurements: always square pelvis for true measurementsCan be done only if some free ROM on one

side If bilat fixed only seg measurements

Bryants Femur tibia Mention the relative discrepancies