8_Hip.pdf

Mr Georgios Arealis, MD, PhD, FRCS -Consultant Trauma & Orthopaedic Surgeon Shoulder & Upper Limb Specialist East Kent Hospitals University NHS Foundation Trust - Visiting Professor, Faculty of Medicine, Health and Social Care Canterbury Christchurch University -Honorary Researcher, School Of Engine...

Mr Georgios Arealis, MD, PhD, FRCS -Consultant Trauma & Orthopaedic Surgeon Shoulder & Upper Limb Specialist East Kent Hospitals University NHS Foundation Trust - Visiting Professor, Faculty of Medicine, Health and Social Care Canterbury Christchurch University -Honorary Researcher, School Of Engineering and Digital Arts University Of Kent - Clinical tutor Clinical and Educational Supervisor, Stage 3, Year 5 medical students, King's College London - Clinical tutor, Sutgical group, Kent and Medway Medical School Hip STRUCTURE INTRODUCTION Look Feel Move Function Special Tests Neurology THANK THE PATIENT COMPLETE EXAMINATION PRESENT EXAMINATION FINDINGS Introduction (WIPE) Wash hands, Intro, ?Patient (DOB, Name), Explain/ consent Expose lower limb, undress to underwear Respect privacy, ask for chaperone General inspection, including walking aids around bedside LOOK Observe gait Inspect lying, compare sides Inspect standing, if possible Scars Swelling Muscle wasting Trendelenburg Gait GAIT Abnormal gait resulting from a defective hip abductor mechanism, weakness of these muscles causes drooping of the pelvis to the contralateral side while walking and patient leaning to the affected side to maintain balance Unilateral = lurching gait Bilateral = waddling gait. Antalgic Abnormal pattern of walking secondary to pain that ultimately causes a limp, whereby the stance phase is shortened relative to the swing phase Patient leans to the affected sied to achieve this Inspect standing Front Lateral pelvic tilt Deformity Side Pelvic tilt Lordosis Posterior Lateral pelvic tilt Scoliosis Gluteal wasting, Trendelenburg Inspect lying Compare sides: Symmetry Rotation short and external rotation= NOF Short and internal rotation = dislocation Length Leg length measurement Apparent: umbilicus to medial malleolus Spinal or pelvic deformity True: ASIS to medial malleolus True shortening, dysplasia- fracture FEEL Skin temperature, effusion Examine surgical scar if present: ? Pain & Swelling Palpate bony landmarks Symphysis pubis: common in pregnancy Greater trochanter ?trochanter bursitis MOVE Active & Passive SPECIAL TESTS Trendelenburg’s Test: similar to gait Thomas Test: The patient lies supine on the examination table and holds the uninvolved knee to his or her chest, while allowing the involved extremity to lie flat. Holding the knee to the chest flattens out the lumbar lordosis and stabilizes the pelvis. Positive: a. the lower extremity on the involved side will be unable to fully extend at the hip b. j-sign= abducts  ITB tightness Fabers Test Hip and SIJ Straight leg raise Trendelenburg’s Test The patient is asked to stand on one leg for 30 seconds without leaning to one side the patient can hold onto something if balance is an issue. A positive Trendelenburg Test is indicated if during unilateral weight bearing the pelvis drops toward the unsupported side Complete the examination Complete with joint above and below and neurological examination (= similar to spine) and vascular examination Thank the patient Dispose of PPE appropriately and wash your hands Present your findings Imaging and tests Common pathology Hip osteoarthritis Pain Reduced ROM (starts with loss of IR) Thomas + Trendelenburg + Bursitis Pain over the greater trochander Paediatric hip problems Mnemonic for Kocher Criteria: Walk FEW 1. Walking or weight bearing inability 2. Fever > 101.3°F or > 38.5°c 3. ESR >40 mm/hr 4. WBC >12,000/cu.mm Hip OA