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2. Observasi umum :
Ensure the joints you wish to examine are appropriately
exposed, in this case the patient will probably be wearing
shorts, although in reality they should be exposed from the
waist down.
3. Pemeriksaan
hip examination should begin with asking the patient to
walk for you. This allows you to assess muscle bulk around
the hip joint, ensure that you check both hips from behind,
the side and in front
perform the test for Trendelenburg’s Sign. Ask the patient to
alternately stand on one leg. Stand behind the patient and feel the
4.
pelvis. It should remain level or rise slightly. If the pelvis drops
markedly on the side of the raised leg, then it suggests abductor
muscle weakness in the leg the patient is standing on
5. Check muscle bulk and symmetry as well as any obvious
abnormalities such as scars.Now check both the apparent and true
length of the leg. True leg length discrepancy is found by
measuring from the anterior superior iliac spine to the medial
malleolus. Apparent leg length discrepancy is measured from the
xiphisternum or umbilicus to the medial malleolus.
Movements to be assessed at the hip are:
◦ flexion
◦ extension
6.
◦ internal rotation
◦ external rotation
Thomas’ test. Place your hand under the patient’s lumbar spine
7. to stop any lumbar movements and fully flex one of the hips.
Observe the other hip; if it lifts off the couch then it suggests a
fixed flexion deformity of that hip
8.
Ucapkan terima kasih kepada pasien
9.
Sampaikan resume hasil pemeriksaan
Keterangan :
0 = Tidak dilakukan Nama Instruktur :
1 = Dilakukan dengan perbaikan
2 = Dilakukan dengan sempurna
NIP :
Hip Examination
Hip complaints in adults are often related to pain e.g. arthritis or bursitis,
however in children can occur in a well child e.g. “irritable hip” or in more
serious conditions e.g. Perthes disease or slipped upper femoral epiphysis. Hip
pain can also be referred pain from another joint, most commonly knee and
spine.
The hip examination, along with all other joint examinations, is commonly
tested on in OSCEs. You should ensure you are able to perform this
confidently.
The examination of all joints follows the general pattern of “look, feel, move”
and occasionally some special tests.
Subject steps
2.Start by washing your hands and introduce yourself to the patient. Clarify the
patient’s identity and explain what you would like to examine, gain their
consent.Ensure the joints you wish to examine are appropriately exposed,
in this case the patient will probably be wearing shorts, although in reality
they should be exposed from the waist down. Therefore you should offer
a chaperone.
◦ Introduce yourself to the patient
◦ Wash your hands
3.
4.A hip examination should begin with asking the patient to walk for you. This
allows you to assess muscle bulk around the hip joint, ensure that you
check both hips from behind, the side and in front. Compare both hips for
any asymmetry. Check the gait for: an antalgic gait, limp or a
Trendelenburg gait, and waddling due to proximal muscle wasting.
5.
6.
7.Whilst the patient is still standing, perform the test for Trendelenburg’s Sign.
Ask the patient to alternately stand on one leg. Stand behind the patient
and feel the pelvis. It should remain level or rise slightly. If the pelvis
drops markedly on the side of the raised leg, then it suggests abductor
muscle weakness in the leg the patient is standing on.
◦ The Trendelenburg test
8.
9.Now ask the patient to lie flat on the bed. Begin with a general observation of
the hip and legs. Check muscle bulk and symmetry as well as any
obvious abnormalities such as scars.Now check both the apparent and
true length of the leg. True leg length discrepancy is found by measuring
from the anterior superior iliac spine to the medial malleolus. Apparent
leg length discrepancy is measured from the xiphisternum or umbilicus to
the medial malleolus.
◦ True leg length measurement
◦ Apparent leg length measurement
10.
11. As the hip joint lies deeply there is little to palpate. However as always
you should assess the temperature of the joint compared to surrounding
tissue and palpate the greater trochanter as any tenderness here could
suggest trochanteric bursitis.
◦ Palpate the Greater Trochanter
12.
13. Movements to be assessed at the hip are:
◦ flexion
◦ extension
◦ internal rotation
◦ external rotation
14. Flexion is performed by flexing the knee to 90 degrees and passively
flexing the hip by pushing the knee towards the chest.Extension is
performed by placing your hand under the patient’s ankle and asking
them to push your hand into the bed.Internal and external rotation are also
performed with the knee flexed and by inverting the knee for internal
rotation and everting it for external rotation.
◦ Hip flexion
◦ Hip extension
◦ Hip internal rotation
◦ Hip external rotation
15.
16. The final specialised test to be performed is Thomas’ test. Place your
hand under the patient’s lumbar spine to stop any lumbar movements and
fully flex one of the hips. Observe the other hip; if it lifts off the couch
then it suggests a fixed flexion deformity of that hip.
◦ Thomas' test
◦ Place your hand under the patients
lumbar spine
17.
18. Allow the patient to dress and thank them. Wash your hands and report
your findings to the examiner
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