Hip examination

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In the world of medicine, physiotherapy, chiropractic, and osteopathy, hip examination, or hip exam, is performed when the patient has hip and/or signs and/or symptoms suggestive of joint pathology pelvis. This is a physical examination maneuver.

Hip examination, like all joint examinations, is usually divided into the following sections:

• Position/lighting/draping
• Checkout
• Palpate
• Motion
• Custom maneuvers

The middle three steps are often remembered with the proverb look, feel, move .

Video Hip examination

Position/lighting/draping

Position - for most examinations the patient should be supine and the bed or examination table should be flat. Patients' hands should remain on their side with their heads resting on pillows. Knees and hips should be in anatomical position (knee lengthened, hip not flexed or extended).

Lighting - adjustable so it is ideal.

Draping - both of the patient's hip should be exposed so that the quadriceps muscles and the larger trochanter can be assessed.

Maps Hip examination

Inspection

Examination done while patient is standing

View

Front and back of hips/hip and legs and commentary

1. Ischemic or trophic changes Ã, Â ·
2. ASIS level (anterior superior iliac spine)
3. Swelling (soft tissue, bony swelling)
4. Scars (old wounds, previous surgery)
5. Sinus (infection, neuropathic ulcer)
6. Wasting (old polio, Carcot-Marie-Tooth) or hypertrophy (eg pseudo-hypertrophy muscle dystrophy)
7. Deformity (leg length difference, pes cavus, scoliosis, lordosis, khyphosis)

Feel

1. Any swelling  · Anterior in a steep triangle, Trochanteric region or gluteal region
2. Pelvic tilt with palpating ASIS level (anterior superior central spine)

Move  ·

Gait: Observe

1. The smoothness and development of the gait cycle phase
2. Comments on attitude, foot-off, heel strike swing, step and step length
3. Adequate flexion/extension on the ankle and leg/knee:
4. All the continuous contractures?
5. Swing your arms and balance the direction  ·

Abnormal Gait Patterns

1. Trendelenburg (pelvic sway/tilt, aka gesture if bilateral)
2. Widely-based (ataxia)
3. High-jump (loss of proprioception/drop foot)
4. Antalgic (specify "with stance stage decreased on the left/right")
5. In-toeing (persistent femoral anteversion)

Inspection done on supine

Hips should be checked for:

• Mass
• Used
• Lesions
• Signs of previous trauma/surgery
• Bone alignment (rotation, leg length)
• Big muscles and symmetry in the hips and knees

Size

• The right leg length - Larger Trochanter from the femur or Iliac Spine in front of the pelvic spine into the medial malleolus of the ipsilateral foot.
• The length of the visible leg - umbilicus or xiphisternum (which records the used) to the medial malleolus of the ipsilateral foot.

In hip fractures affected legs are often shortened and rotated externally.

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Palpate

The hip joint lies deep inside the body and usually can not be palpated immediately.

To assess a pelvic fracture one must feel:

• Iliac spikes
• Superior and inferior pubic rami

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Movement

• Internal rotation - with both knees and hips bent until 90 degrees of ankle is kidnapped.
• External rotation - with both knees and hips bent at 90 degrees of ankle attached. (Also done with Patrick's FABER test)
• Flex (also known as Gaenslen test)
• Extension - done with the patient at his side. Alignment should be assessed by palpation of ASIS, PSIS and the major trochanter.
• Abduction - assessed while feeling a contralateral ASIS.
• Adduction - assessed while ASIS ipsilateral palpation.
• Assessment for flexion contractures concealed from hip-hip flexion contractions may be unseen, as compensated by the back. They are judged by:
  1. Place your hands behind your back lumbar
  2. Make the patient fully contralateral hips flex.
  3. The hand in the lumbar area is used to ensure the back is straightened (flexion relative to the anatomical position). If there is flexion contracture in the ipsilateral hip then it should be clear, because the hip will appear to be flexed.

Normal range of motion

• Internal rotation - 40Ã, Â °
• External rotation - 45Ã, Â °
• Flexion - 125 Â °
• Extensions - 10-40Ã, Â °
• Abduction - 45Ã, Â °
• Additions - 30Ã, Â °

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Custom maneuvers

• Trendelenburg test/sign:

1. Make sure the pelvis is horizontal by palpating ASIS.
2. Have the patient stand on one leg and then on the other.
3. The value of any pelvic slope by maintaining the index finger on each ASIS.
4. Normal (Trendelenburg negative): In the position of one leg, the unsupported side of the pelvis remains at the same level as the patient's side stands or even rises slightly, due to the strong contraction of the hip captor at the foot position.
5. Abnormal (Positive Trendelenburg): In the position of one leg, the unsupported side of the pelvis drops below the level as the side facing the patient. This is due to (abnormal) weakness of the kidnapper's hips at the hooves. The last hip joint may become abnormal.
6. Trendlenburg Assisted Tests If balance is a problem, confront the patient and ask them to put their hands in your hands to support him as he takes turns one-legged. Increased asymmetrical pressure on one side shows a positive Trendelenburg test, on the abnormal side of the hip
7. The 'pending' trendelenburg has also been described, in which the pelvic tilt appears after one minute or more: this indicates the abnormal flexibility of the pelvic abductor.

Romberg Test It assesses the propioception/balance (dorsal column of the spinal cord/spino-cerebellarpathways).

1. Ask the patient to stand with heels together and hands on the side. Have the patient close his eyes and observe a swaying motion for about 10 seconds.
2. Most people sway a little but then quickly reduce the amplitude of wobble. However, if the wobble is not corrected, or the patient opens the eye or takes steps to regain the balance, Romberg test is positive.
3. While performing this test, standing facing the patient with outstretched hand and hand is at the patient's shoulder level to capture or stabilize him in the case of a positive Romberg test.

• The Ober test for tight ITB (IlioTibial Band, also called IlioTibial Tract) is done with the patient side lying on the unaffected side and providers expanding affected hips. Stabilize the pelvis and let the affected legs. A positive test is indicated if the foot does not enter the table.
• The Thomas test for a tight hip flexor is either performed by a provider that holds the foot that is not exposed to the chest and leaves the affected foot on the table. If the affected foot can not lie flat on the table, this is a positive test.
• Kendall tests are similar, but the patient holds the unaffected legs in the chest.
• Testing Rectus Femoris Contracts for rectal femoris is done like a Thomas test, but with the affected leg bent at the end of the table. a positive test is indicated if the thighs are not aligned with the table.

Kaltenborn or Hip Lag Sign test for kidnapping hip function. To perform the Kaltenborn test, the patient should lie laterally, neutral position with the affected foot on top. The examiner then places one arm under this foot to restrain and control the limb relaxed, while the other hand stabilizes the pelvis. The next step is to extend passively to 10 Â ° in the hip, abduct to 20 Â ° and rotate internally as far as possible, while the knee remains in a bent position of 45 Â °. After the patient is asked to hold the foot actively in this position, the examiner releases the legs. The Hip Lag Sign is considered positive if the patient is unable to keep the foot in a previously abducted position, its position is rotated internally and the foot decreases by more than 10 cm. To ensure accurate results, tests must be repeated three times.

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More tests

Knee examination should be performed on ipsilateral knee for knee pathology out.

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See also

• The term anatomical location
• The term anatomical motion

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References

src: bmjopen.bmj.com

External links

• Test Trendelenburg - gpnotebook.co.uk.
• Clinical Hip Examination - Australian Orthopedic Research Institute.

Source of the article : Wikipedia