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Hip Examination. Dr. Sam Byott FY1. Introduction. Common exam question Aims: Revision of Hip exam Revision of Knee exam PATHOLOGY Wash hands, Introduce, Consent, Inspection Look, Feel, Move, Special Tests. LOOK. Expose pt to underwear Scars, swelling, deformity, muscle wasting

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hip examination

Hip Examination

Dr. Sam Byott

FY1

introduction
Introduction
  • Common exam question
  • Aims:
          • Revision of Hip exam
          • Revision of Knee exam
          • PATHOLOGY
  • Wash hands, Introduce, Consent, Inspection
  • Look, Feel, Move, Special Tests
slide3
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
slide4
FEEL
  • Not much!
  • ASIS – pelvic tilt
  • Greater trochanter – Tenderness
  • Joint – Temperature, (tenderness)
slide5
MOVE
  • Flexion 120 °
  • Extension – Prone
  • Internal rotation 45 °
  • External rotation 60 °
  • Abduction 45 °
  • Adduction 30 °
special tests
SPECIAL TESTS
  • Trendelenburg
  • Thomas
  • Leg Length
  • Gait
thomas test
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
trendelenburg s test
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
knee examination

Knee Examination

By Dr. Sam Byott

FY1

slide10
LOOK
  • Expose
  • All joints: Swelling, erythema, scars, deformity, muscle bulk
  • Knee-specific:
    • Effusion
    • Patella position
    • Valgus / Varus deformity
    • Baker’s cyst
    • Arthroscopy scar
slide11
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)
knee effusion
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
slide13
MOVE
  • ROM:
      • 3° Hyperextension, 140° Flexion
      • <115° - significant
  • Passive + hand on joint line
          • Crepitus
  • Active
special tests1
SPECIAL TESTS
  • Ligament stability: Lachmans, Valgus/Varus stress test
  • ?Mcmurrays
  • Gait!
lachman s test
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
varus valgus stress
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
mcmurrays test
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
osteoarthritis
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
oa conservative vs surgical
OA: Conservative vs Surgical
  • Conservative
        • Weight loss
        • Orthotics
        • Knee brace
        • Analgesia
  • Surgical
        • Arthrodesis
        • Arthroscopy
        • High tibial osteotomy
        • Unicondylar replacement
        • Total knee replacement
dupuytrens contracture1
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