what is the position of the hip at birth?
flexed, abducted, laterally rotated
at what age does the acetabular cup deepend and angle downward? and why
by 3 y/o because:
- hip extension activation
- lengthening of pelvic ligaments
- motor learning/mm activation
- head of femur being pushed into acetabulum from WB fun
how do you test hip SP ROM - flexion (there are a few different ways just tell me the supine one)
- pt supine
- flex knee to 90
- flex hip and watch for pelvis movement/hiking/lordosis
how do you test hip SP ROM extension(not stahili)
- pt supine and just check out their lordosis angle. look for flexion contracture
with legs flat on the plynth there shouldn’t be a space between the lumbar spine and the plynth
how do you test hip SP ROM extension (staheli)
pt. prone HJs flexed over the end of the plynth (flattens lordosis) hand over lumbosacral region lift thigh (leg kinda straight) wait for HJ hike = end point
how do we test for hip FP: adduction
- pt supine
- keep hand over opposite ASIS to monitor pelvic movement
- knees can be flexed(90) or straight
- raise one limb above the one to be tested. adduct the lower leg.
- measure from the midline of the body (?)
how do we test for hip FP: abduction
- pt supine
- knees can be flexed(90) or straight
- hand on opposite ASIS to monitor pelvic movement:
how do we test from hip TP rotation (pretty easy and a gr8 place to start with all assessments) supine
HJ flexed to 90
foot inwards for external rotation
foot outwards for internal rotation
watch/feel for HJ hike (this is end point)
measure from middle of leg at neutral position
how do we test from hip TP rotation (pretty easy and a gr8 place to start with all assessments) prone
hj extended
kj flexed (90)
foot inwards = ext rotation
foot outwards = internal rotation
watch and feel for HJ hike –> this is the end point
measure from middle of leg at neutral position
when testing HJ TP rotation what position do you put the foot in if you want to test internal v. external rotation
foot inward = external rotation
foot outward = internal rotation
besides all the planes of HJ - what is another fun test we can do on a patient’s hip?
trandelenburg sign
name the (1) hip pathology
DDH:
developmental dysplasia of the hip
define DDH: developmental dysplasia of the hip
a condition in which the femoral head has an abnormal relationship to the acetabulum
what’s the aetiology of DDH
lig lax
prenatal positioning (i.e. breech, oligohydramnios, big babies, 1st born)
post natal positioning (i.e. swaddling)
what is meant by the term oligohydramnios
when there is less fluid in the placenta so it makes the baby heaps more tightly packed in the uterus
what are some conditions that are associated with DDH?
torticollis (neck twisted to the side)
metatarsus adductus
oligohydramnios
name some of the assessments that can be done (usually by paediatrician) to test for DDH
barlow ortolani klisic decreased abd galeazzi's sign (telescoping knees) US x-ray @ 3-6 months **note that different ages need different combos of positive tests for dx.
outline the rx for DDH for:
birth- 6 months
6-18 months
18 months- 2 years
neonates-6months: pavlik harness (6 weeks)
6-18 months : closed reduction + plaster cast (3 months) –> if unsuccessful: open reduction
18 months-2 years : primary open reduction
