9/21/2017 Ovid: Operative Techniques in Orthopaedic Surgery

Editors: Wiesel,, Sam W.

Title: Operative Techniques in Orthopaedic Surgery, 2nd Edition

Copyright ©2016 Lippincott Williams & Wilkins

> Table of Contents > Volume 1 > Part 3 ‐ Adult Reconstruction > Exam Table for Adult Reconstruction

Exam Table for Adult Reconstruction

Examination Technique Illustration Grading &

Significance

Anterior The examiner A positive test

impingement simultaneously elicits hip pain
test flexes (90 to that reproduces
100 degrees), symptoms and is
adducts (10 to frequently
20 degrees), associated with
and internally guarding.
rotates (5 to Absence of pain
20 degrees) indicates a
the hip. negative test.
The test is
specific for intra‐
articular
pathology and is
present in the
majority of
patients with a
labral tear.

Apprehension The hip is Test is positive if

test externally the patient
rotated in an complains about
(over‐) the feeling of
extended imminent joint
position. luxation.
Indicates an
insufficient
coverage of the
femoral head.

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Gait Legs should be Trendelenburg

exposed. Gait gait suggests
is observed abductor
with and weakness or hip
without the discomfort.
use of walking Coxalgic gait
aids. suggests hip pain
of any cause.
Stiff hip gait may
be present with
hypertrophic
osteoarthritis.
Short limb gait
may be present
with
developmental
dysplasia of the
hip. No limp is
normal. A slight
abductor lurch or
antalgic gait is
abnormal. Intra‐
articular hip
disease (labral
tear or chondral
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flap) can produce
an early limp. As
secondary
osteoarthritis
progresses, a
limp is common.
The examiner
should look for
varus thrust.
Painful total hip
arthroplasty may
result in
shortened stance
phase or stride
length, or
abnormal pelvic
rotation. May
confirm hip
pathology or
indicate extrinsic
source of pain.
May raise concern
regarding hip
abductor function
that can limit
success of
revision. Pain or
muscle weakness
may cause limp.
Trunk may shift
over affected
hip.

Hip abductor In the lateral Graded using

strength decubitus traditional
position, the manual muscle
patient is testing five‐point
asked to scale. May
elevate the indicate abductor
limb and the weakness,
examiner trochanteric
applies bursitis, abductor
manual avulsion, or loose
resistance. femoral
component.

Leg length, With the Values may be

apparent patient affected by
supine, the atrophy, obesity,
examiner or asymmetric
measures the positioning of the
distance from legs. May indicate
the umbilicus abductor or
to each adductor
medial contractures, or
malleolus.
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pelvic obliquity
due to scoliosis.

Leg length, The patient is A slight

true supine with difference of <1
feet 15 to 20 cm is considered
cm apart. The normal but may
examiner be symptomatic
measures the in some patients.
distance from Progressive leg‐
the anterior length
superior iliac discrepancy
spine to the suggests implant
medial subsidence.
malleolus of Adduction
each leg. In contracture may
obese patients cause apparent
with poor shortening when
pelvic supine, but may
landmarks, elevate the
the examiner hemipelvis when
should line up standing. Pelvic
the medial tilt from spinal
malleoli to get deformity may
an contribute to
approximation functional leg‐
of leg lengths. length inequality.
It is important
to assess the
patient while
standing as
well to
observe for
pelvic
obliquity and
scoliosis.

Logroll The lower Positive if

extremity is maneuver elicits

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rolled side to pain at groin.
side at the Most sensitive
proximal physical finding.
thigh. Side‐to‐side
movement of the
lower extremity
creates shear
forces across a
femoral neck
fracture, leading
to exquisite pain.

Ober Test With the Persistent

patient in the abduction of the
lateral hip reveals
decubitus tightness of the
position, the iliotibial band.
affected hip is This finding is
extended and important to note
abducted and preoperatively so
the knee is it is not
flexed. The misinterpreted as
thigh is then overlengthening
released while intraoperatively.
the foot is
supported.

Patrick test Hip discomfort Negative test is

is assessed no discomfort.

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with the hip in Positive test
flexion, produces groin
abduction, pain that mimics
and external the patient's
rotation with symptoms. This is
the ipsilateral a sensitive
foot placed on screening
the examination for
contralateral hip joint
knee. irritability and
intra‐articular hip
disease.

Posterior The hip is Pain perceived

impingement extended, posteriorly in the
test externally buttock
rotated, and corresponds to a
adducted. This positive
can be tested impingement
in the supine test. The absence
or prone of pain indicates
position. a negative test.
Normal internal
rotation is
considered to be
about 15 to 20
degrees. In
femoroacetabular
impingement,
internal rotation
is decreased.
Normal test is no
pain. Positive
test is groin or
buttock pain that
reproduces
symptoms.
Uncommonly,
patients have
associated
structural
posterior
impingement.
The posterior
impingement test
assists in
identifying the
presence of
associated
posterior disease.

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Straight‐leg The presence The angle of

raise of radicular elevation at
pain with a which straight‐leg
passive raising induces
straight‐leg radicular pain is
raise should measured.
be noted. The Radicular pain
examiner suggests lumbar
assesses pathology. May
active be limited by
straight‐leg pain from
raising. infection or loose
implants.

Trendelenburg The examiner Level pelvis in

test observes and single‐legged
palpates the stance is normal.
pelvis from The test is
behind while positive if the
the patient contralateral hip
performs a drops inferiorly.
single‐legged A positive test
stance. may indicate that
the hip abductors
are
compromised.
Dropping of the
contralateral
hemipelvis
indicates
abductor
weakness of the
symptomatic hip.
Abductor
weakness is
common in
patients with
early intra‐
articular hip
disease and
impingement.
May indicate
abductor
dysfunction; may
be positive
because of pain
or neurologic
problem (superior
gluteal nerve or
L5 nerve root).

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