HIP ASSESSMENTHIP ASSESSMENTFahad zakwanFahad zakwanMD5MD5

HistoryHistory•AgeAge• infancy: congenital hip dysplasiainfancy: congenital hip dysplasia• 3-12 year old boys: Legg-Calve-Perthes Dz3-12 year old boys: Legg-Calve-Perthes Dz•middle age & elderly: osteoarthritismiddle age & elderly: osteoarthritis

•Mechanism of injuryMechanism of injury•MVAMVA• land on outside hipland on outside hip• land on kneeland on knee• repetitive loadingrepetitive loading

HistoryHistory•Pain detailsPain details• locationlocation•snappingsnapping•progression of symptomsprogression of symptoms•exacerbating factorsexacerbating factors•alleviating factorsalleviating factors

•WeaknessWeakness•Occupation, SportOccupation, Sport

ObservationObservation1.1. GaitGait2.2. PosturePosture3.3. BalanceBalance4.4. Limb positionLimb position• shortened, adducted, medially rotatedshortened, adducted, medially rotated• abducted, laterally rotatedabducted, laterally rotated• shortened, laterally rotatedshortened, laterally rotated

5.5. Leg shorteningLeg shortening

ExaminationExamination•Active Range of MotionActive Range of Motion• FlexionFlexion: 110 to 120 : 110 to 120 degreesdegrees

• ExtensionExtension: 10 to 15 : 10 to 15 degreesdegrees

ExaminationExamination•Active Range of MotionActive Range of Motion•AbductionAbduction: 30 to 50 : 30 to 50 degreesdegrees

•AdductionAdduction: 30 degrees: 30 degrees

ExaminationExamination

•Active Range of MotionActive Range of Motion• External rotationExternal rotation: 40 to 60 : 40 to 60 degreesdegrees• Internal rotationInternal rotation: : 30 to 40 30 to 40 degreesdegrees

ExaminationExamination•Passive Range of MotionPassive Range of Motion• Intra-abdominal inflammationIntra-abdominal inflammation may cause pain with may cause pain with passive medial & lateral hip rotationpassive medial & lateral hip rotation•Hip pathologyHip pathology indicated by groin discomfort and indicated by groin discomfort and decreased ROM on medial rotationdecreased ROM on medial rotation•Acetabular rim or labral problemsAcetabular rim or labral problems with click and with click and painful hip flexion, abduction, andpainful hip flexion, abduction, andmedial rotationmedial rotation

ExaminationExamination•Strength Strength testingtesting•isometricisometric•eccentriceccentric•knee extensionknee extension•knee flexionknee flexion

ExaminationExamination•Functional TestingFunctional Testing•squattingsquatting•up & down stairs one at a timeup & down stairs one at a time•crossing legscrossing legs•up & down stairs two at a timeup & down stairs two at a time• running straight aheadrunning straight ahead• running and deceleratingrunning and decelerating• running and twistingrunning and twisting•one-legged hopone-legged hop

Special TestsSpecial Tests•Patrick’s TestPatrick’s Testsupinesupine•foot on opposite foot on opposite kneeknee•hip involvementhip involvementiliopsoas spasmiliopsoas spasmSI joint SI joint involvementinvolvement

Ortolani’s & Barlow’sOrtolani’s & Barlow’s•Assess for congenital Assess for congenital dislocation of hipsdislocation of hips•Valid for first 6 monthsValid for first 6 monthsof lifeof life•Positive test is Positive test is “clunck” not “click”“clunck” not “click”

•knees & hips flexed to 90 knees & hips flexed to 90 degreesdegrees•positive test: one knee higherpositive test: one knee higher

•Telescoping SignTelescoping Sign•knee & hip flexed to 90 degrees, knee & hip flexed to 90 degrees, axial load and distraction appliedaxial load and distraction applied•positive test: increased relative positive test: increased relative movementmovement

Galeazzi TestGaleazzi Test

•true leg length discrepancy congenital true leg length discrepancy congenital maldevelopment traumamaldevelopment trauma•functional leg length discrepancy scoliosisfunctional leg length discrepancy scoliosis•Measured from Measured from ASISASIS to to medial malleolusmedial malleolus•Functionally measuredFunctionally measured•knees & hips flexed with thumbs on medial knees & hips flexed with thumbs on medial malleolus then knees and hips extendedmalleolus then knees and hips extended

Leg lengthLeg length

•FlexibilityFlexibility•modified Thomas modified Thomas TestTest•assesses both assesses both hip flexor and hip flexor and quad flexibilityquad flexibility

•FlexibilityFlexibilityOber’s TestOber’s Test•assesses iliotibial band flexibilityassesses iliotibial band flexibility

•FlexibilityFlexibilityPiriformis TestPiriformis Test•Assesses Assesses flexibility of flexibility of piriformis musclepiriformis muscle•““Piriformis Piriformis Syndrome”Syndrome”

•FlexibilityFlexibility•Popliteal Popliteal AngleAngle•Assesses Assesses hamstring hamstring flexibilityflexibility

PalpationPalpation• Iliac crest Greater trochanterIliac crest Greater trochanter•ASIS Ischial tuberosityASIS Ischial tuberosity•PSISPSIS

Diagnostic ImagingDiagnostic Imaging•RadiographsRadiographs•Anterior-Posterior Anterior-Posterior viewview•Frog leg viewFrog leg view

•CTCT•MRIMRI•ArthrogramArthrogram