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Hip Joint Orthopaedic Tests Orthopedics DX 611

Hip Joint Orthopaedic Tests Orthopedics DX 611. James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic. Hip Anatomy. Palpation. Point tenderness Edema Symmetry. Hip ROM. Hip Contracture Tests Thomas Test. Supine passive hip flexion

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Hip Joint Orthopaedic Tests Orthopedics DX 611

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  1. Hip Joint Orthopaedic TestsOrthopedics DX 611 James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic

  2. Hip Anatomy

  3. Palpation • Point tenderness • Edema • Symmetry

  4. Hip ROM

  5. Hip Contracture TestsThomas Test • Supine passive hip flexion • Contralateral hip and knee flexion indicates a positive test for hip contracture • Evaluate rectus femoris tightness

  6. Hip Contracture TestsRectus Femoris Contracture Test • Involuntary extension of flexed knee with tightness in rectus femoris indicates a hip flexion contracture

  7. Hip Contracture TestsPiriformis Test • Piriformis pain with resisted abduction of hip indicates tight piriformis • Sciatic pain indicates nerve compression

  8. Piriformis Syndrome • Palpation of piriformis may produce local and/or sciatic distribution pain • Palpation at spinal nerve root may be negative for pain

  9. Hip Contracture TestsEly’s Heel to Buttocks • Prone heel to buttocks • Ipsilateral pelvis rising from table indicates hip flexion contracture or tight rectus femoris

  10. Hip Contracture TestsOber’s Testfor TFL or ITB

  11. Ober’s Test • Failure to descend smoothly indicates a positive test for contracture of the TFL or ITB.

  12. Trochanteric Bursitis • Palpation • Patrick’s • Positive finger point • Laguerre’s

  13. Degenerative Hip Disease

  14. Degenerative Hip Disease • Patrick’s • Trendelenburg’s • Scouring’s • Laguerre’s • Difficult to palpate

  15. Patrick’s TestFABERE & Figure of 4 • Flexion • Abduction • External rotation

  16. Patrick’s Test • Compresses femoral head into acetabulum • Positive test with pain in hip, which indicates an inflammatory process

  17. Trendelenburg’s Test • Standing flexion of hip • Downgoing of contralateral hip is a positive test • Indicates contralateral gluteal motor weakness and/or hip pathology

  18. Anvil Test • Percussion of calcaneus compresses hip joint • Positive test with pain, which indicates fracture or hip pathology

  19. Congenital Hip Dysplasia • Flattened acetabular cavity permits dislocation or subluxation of the femur head.

  20. Congenital Hip Dysplasia

  21. Barlow’s and Ortolani’s Maneuvers

  22. Barlow’s Test • Identifies unstable hip that lies in the reduced position but can be passively dislocated (and hence unstable) • Less than 2% of infants will have a positive Barlow test • 90% will normalize with no treatment after 9 weeks

  23. Barlow’s Test Procedure • Hips are examined one at a time • Hip flexed & thigh adducted, while pushing posteriorly in line of the shaft of femur, causing femoral head to dislocate posteriorly from acetabulum • Dislocation is palpable as femoral head slips out of acetabulum • Diagnosis is confirmed with Ortolani's test

  24. Ortolani Test • Identifies dislocated hip that can be reduced in early weeks of life • A positive test requires active treatment • If hip remains dislocated (for weeks), limitation of abduction becomes more consistent clinical finding

  25. Procedure • Examine one hip at a time • Flex infant's hips & knees to 90 degrees • Thigh is gently abducted & bringing femoral head from its dislocated posterior position to opposite the acetabulum, hence reducing femoral head into acetabulum

  26. Positive Ortolani Test • Palpable & audible clunk as hip reduces

  27. Ortolani Test • With time, it becomes more difficult to reduce femoral head into acetabulum, and the Ortolani test becomes negative

  28. Pavlik Harness • An infant with DDH and a negative Ortolani sign would not be a good candidate for a Pavlik harness

  29. Congenital Hip DysplasiaDDH • Also known as Allis’ test • It is not used to evaluate functional leg length deficiency

  30. End of Hip Orthopaedic Tests • Adios amigos…

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