Hip examination
- WIPE
- Look
- Stand (Trendenlenburg's)
- Walk
- Measure
- Feel
- Move:
i. Active (Thomas test)
ii. Passive
- Reverse WIPE
W
I
P standing --> supine, PAIN/STIFFNESS?
E remove socks, shoes, expose 1 above (sacroiliac), 1 below (knee)
General observation:
- Surroundings
- Patient
- BED dat ASS
GET LEVEL W. PT'S HIPS
Standing tests/Gait
- Trendenlenburg's
- Romberg's
- Gait
After testing: pt to be SUPINE
To-do list on supine pt:
- Measure
- Feel
- Move
i. Active (Thomas)
ii. Passivez
Measure
- True : ASIS to medial malleolus
- Apparent: Xiphoid process to medial malleolus
Feel
- ALWAYS ASK FOR PAIN?
- Temperature (w. back of hand)
- COMMENT ON MUSCLE BULK
- Tenderness @ greater trochanter
- Trochanteric bursitis
Move
- Active
- Passive (min 1:08)
- Pain?
- RoM?
- Stiffness?
- Crepitus?
Thank the pt.
Reverse WIPE
Summarize.
W/up (down, up)
- Knee examination
- Neuro examination
- Imaging
Normal surface anatomy
Anterior
Lateral
Posterior
Knee examination:
WIPE
Look
Walk
Measure/Feel
Move
Special
Reverse WIPE
W
I
P Standing --> lying; PAIN/STIFFNESS?
E Ankles & Hip exposed
General observation:
- Surroundings
- Patient
- BED dat ASS
GET LEVEL W. PT'S KNEES
Gait
Measure (PT. TO BE LYING DOWN NOW)
- True vs apparent
Feel
- ASK ABOUT PAIN BEFORE STARTING
- Temperature, Surface anatomy
- Pop. fossa: Baker's cyst, aneurysm
- Bulk (offer to measure)
- Anterior effusions
- Patella tap
- Bulge test
- Patellofemoral lesions
Temp/Bulk/Anatomy/Pop fossa
Effusions/Lesions
Move
- Active 1st
- Then passive
ALWAYS:
- Compare both sides.
- Comment on:
- Crepitus, Pain/stiffness, RoM
ACTIVE 1ST
- Flxn:
1. bring heel to butt
2. Patella moves down and medially
- Extn:
1. Contract quads - watch for heel lifting off table
2. Patella moves out and laterally
Passive movement
- Flxn:
1. 1 hand ant to ankle, 1 hand above patella
2. Move knee to butt slowly
3. Look at pt's face for pain
- Extn:
1. 1 hand cupping ankle (post), 1 hand above patella
2. Press thigh down onto couch
3. Gently extend knee (pull ankle up skywards)
4. Look at pt's face for pain.
- Medial collateral ligament (valgus stress test)
- Lateral collateal ligament (Varus stress test)
Special tests
- Post. sag
- Drawer
- McMurray's/Grind
- Apprehension
Posterior sag
Drawer tests
Testing meniscus:
McMurray's (hyperlink)
BTW, IF NO TIME, OR CAN'T REMEMBER, OFFER APLEY'S GRIND TEST (note). Instructor will most probably just ask you to explain it.
Offer to do APPREHENSION TEST