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Hip Examination

Hip Examination

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Hip Examination

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  1. Hip Examination Dr. Sam Byott FY1

  2. Introduction • Common exam question • Aims: • Revision of Hip exam • Revision of Knee exam • PATHOLOGY • Wash hands, Introduce, Consent, Inspection • Look, Feel, Move, Special Tests

  3. LOOK • Expose pt to underwear • Scars, swelling, deformity, muscle wasting • Specifics: Iliac crests, greater trochanter, Alignment, leg length discrepancy, pes cavus, scoliosis • Measure TRUE + APPARENT leg length

  4. FEEL • Not much! • ASIS – pelvic tilt • Greater trochanter – Tenderness • Joint – Temperature, (tenderness)

  5. MOVE • Flexion 120 ° • Extension – Prone • Internal rotation 45 ° • External rotation 60 ° • Abduction 45 ° • Adduction 30 °

  6. SPECIAL TESTS • Trendelenburg • Thomas • Leg Length • Gait

  7. Thomas’ Test • Pt laying on back • One hand under lumbar spine • Other hand, slowly raise one leg off the bed • As lordosis straightens under your fingers look at other leg • If it rises off the bed +ve • FFD of the hip on that side

  8. Trendelenburg’s Test • Sit pt infront of you, with you sitting in chair • Place hands on 2 ASIS • Raise leg off floor • Pelvis rises –ve • Pelvis drops +ve • +ve = Abductor weakness

  9. Knee Examination By Dr. Sam Byott FY1

  10. LOOK • Expose • All joints: Swelling, erythema, scars, deformity, muscle bulk • Knee-specific: • Effusion • Patella position • Valgus / Varus deformity • Baker’s cyst • Arthroscopy scar

  11. FEEL • Temperature • Joint line tenderness (Knee flexed at 90°) • Popliteal tenderness • Medial + Lateral collateral ligament insertion • Patella – tenderess/stability • Effusion: Patella tap test, Bulge test (cross fluctuation)

  12. KNEE EFFUSION • Large Effusion: Patellar tap +ve • Milk suprapatellar pouch • Tap patella • If bounces +ve • Small effusion: Bulge test +ve • Milk suprapatellar pouch • Drain medial component • Brush down lateral compartment • If medial bulge +ve

  13. MOVE • ROM: • 3° Hyperextension, 140° Flexion • <115° - significant • Passive + hand on joint line • Crepitus • Active

  14. SPECIAL TESTS • Ligament stability: Lachmans, Valgus/Varus stress test • ?Mcmurrays • Gait!

  15. Lachman’s Test • 15° flexion, ext rot • Top hand laterally, bottom hand medially • Stress joint anteriorly and posteriorly • Comment on movement in mm • Define end point: Hard or Soft • Hard: Abrupt ACL stops • Soft: No ACL, stopped by soft tissues

  16. Varus/Valgus Stress • Knee flexed to 30 ° • Support calf between hand and torso • Place other hand above knee • Stress the joint medially + laterally • Excessive movement = damage

  17. Mcmurrays Test • Knee flexed fully • Ext rot + valgus stress, extend fully • Clunk = Medial meniscal tear • Int rot + varus stress, extend fully • Clunk = Lateral meniscal tear • Unreliable

  18. Osteoarthritis • OA – Most common, subtle signs • Pain + Crepitus on passive motion • Arthroscopy scar • Varus deformity (medial compartment OA) • Antalgic gait • Spiel: routine bloods, specialist bloods, imaging (XR-bones, MR-soft tissue) • Management: Conservative vs Surgical

  19. OA: Conservative vs Surgical • Conservative • Weight loss • Orthotics • Knee brace • Analgesia • Surgical • Arthrodesis • Arthroscopy • High tibial osteotomy • Unicondylar replacement • Total knee replacement

  20. Dupuytrens Contracture

  21. Dupuytrens Contracture • Fixed flexion contracture of ring, pinky and sometimes middle finger • Thickening of palmar fascia • Slowly progressive and mostly painless • RFs: Men, FH, diabetes, epilepsy, alcohol intake, liver disease • Tx: Conservative vs Surgical • Conservative: Do nothing • Surgical: Palmar fasciectomy