The Hip1

the hip
clinical assessment:
symptoms: pain? hip pain is felt in the groin, front of the thigh
&even the knee, while pain at back of hip is from lumbar spine.
stiffness, deformity & snapping.
signs:
gait? normal gait has 4 phases: heel strike, stance phase,
toe-off & swing phase. any abnormality in gait is called limp.
causes of limping are: 1- pain anywhere( antalgic gait),
2- short leg &
3- hip problems? abductor weakness, dislocation, sub-
luxation, pain, short neck. these cause trendelenburg s gait.
trendelenburg s test: for hip instability: ask the patient to
stand on the normal limb &flex the knee of affected limb?
the pelvis will be raised by abductors of normal side. then,
stand on the affected limb? the pelvis will droping because
the abductors on the affected limb cannot raise the other side.

look: skin? scar, sinus, crease.
shape: wasting, swelling, position of the limb &limb length:
in supine position with both asis at the same level, measure
the distance between medial malleolus & asis.

feel: skin temperature, tenderness, soft tissue &bony points.

move: flexion, extension, abduction, adduction &rotation(in
flexion &in extension) then, thomas test: in supine position,
flex normal hip completely to abolish lumbar lordosis &
look at the thigh of affected side, if the patient has fixed
flexion at the hip? the thigh will be raised from coach.

investigations: x-ray, u/s, ct, mri, arthrogram,
arthroscopy, biopsy.
developmental dysplasia of the hip(ddh)
is a state of hip instability in the newborn. normally, the hips
are stable at birth, but if dislocated, subluxated or dislocatable
with or without acetabular dysplasia, this means hip instability.
incidence:
at birth ?10/1000 after 3 wks( hip become ? stable): 1/1000.
it is ? common in female with a ratio of ?7:1? more on left
side with ratio of lt. 3:1 rt.& bilateral 1 in every 5 cases.