Hip Examination

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Hip Examination
Dr. Sam Byott FY1
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Introduction

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

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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

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FEEL

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

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MOVE

• Flexion 120
• Extension Prone
• Internal rotation 45
• External rotation 60
• Abduction 45
• Adduction 30

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SPECIAL TESTS

• Trendelenburg
• Thomas
• Leg Length
• Gait

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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

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Trendelenburgs 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

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Knee Examination
By Dr. Sam Byott FY1
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LOOK

• Expose
• All joints Swelling, erythema, scars, deformity,
  muscle bulk
• Knee-specific
• Effusion
• Patella position
• Valgus / Varus deformity
• Bakers cyst
• Arthroscopy scar

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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)

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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

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MOVE

• ROM
• 3 Hyperextension, 140 Flexion
• lt115 - significant
• Passive hand on joint line
• Crepitus
• Active

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SPECIAL TESTS

• Ligament stability Lachmans, Valgus/Varus stress
  test
• ?Mcmurrays
• Gait!

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Lachmans 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

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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

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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

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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

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OA Conservative vs Surgical

• Conservative
• Weight loss
• Orthotics
• Knee brace
• Analgesia
• Surgical
• Arthrodesis
• Arthroscopy
• High tibial osteotomy
• Unicondylar replacement
• Total knee replacement

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Dupuytrens Contracture
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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