Examination

Pelvis Hip & Thigh Examination

 
  • History of hip replacements / operations /  dislocations (if has a THR)
  • If a mechanism or pattern:
    • When did it happen?
    • What happened exactly?  Try to understand the mechanism and forces involved (if present)
    • What symptoms initially?
      • Where were the symptoms initially?
      • Describe pain – sharp / superficial / deep / ache / burning etc
      • What aggravates and what eases?
      • For LL problems, include ability to WB
    • What symptoms now?
      • Have the symptoms changed? Better / Worse? Location?
  • If no mechanism
    • How long has it been there?
    • Is there anything that they believe may have contributed to the development of the problem? Recent activity / inactivity
    • What symptoms are present?
    • Are they there all the time?
    • Clicking / Catching / Locking
    • Giving Way
  • What treatment has been sought so far?
    • Assessment
    • Investigations
      • If imaging, do they have it with them?
      • If not, can we view it?
        • Private providers use online applications
        • If in another public hospital in Victoria, then can use the “Synapse Mix” service to get the images temporarily put on local network diagnostic imaging servers.
  • What management has been undertaken? Has it been effective
    • Splinting
    • Ice
    • Medications
  • History of problems in that area before
    • When?
    • How was it managed?
      • Assessment undertaken?
      • Investigations
      • Medications
    • Any ongoing problems?
  • Any associated symptoms (if a non mechanical cause or if at all suspicious)
    • Recent illness / fevers / sweats
    • Recent overseas / long haul travel / immobilisation (eg for suspected DVT)
    • Loss of appetite / loss of weight, etc
  • If has a wound
    • Tetanus status
  • If potentially needing procedural sedation or surgery (and consider this for anyone you are contemplating an x-ray for)
    • Fasting status (and tell them not to eat and drink until you tell them it is ok to do so
Goals
  • Normal neurovascular function
  • No fractures / dislocations
Distal Neurovascular function
  • Colour, Movement, Warmth, Sensation
  • Capillary return
  • Dorsalis Pedis, Posterior Tibial pulses
  • Common Peroneal / Superficial Peroneal / Tibial Nerve function
Active Range of Motion
  • Hip Flexion / Extension
  • Internal / External Rotation
  • (Hip Abduction / Adduction)
Palpation
  • Palpate femur down to knee
  • Palpate pelvis, including pubic rami (and posteriorly if symptoms there)
Special Tests
  • FABER
  • FADIR
  • Ability to SLR
  • Pelvic springing / compression
Imaging
  • X-ray
    • Low threshold for imaging for older patients
    • Significant trauma with debility in younger patients
    • Children with suspicion of:
      • Avulsion fractures from the pelvis
      • Slipped Upper Femoral Epiphysis
      • Perthes
  • CT / MRI
    • If unable to WB with normal gait aid, has pain on hip rotation, unable to SLR and tenderness in the groin even with a normal x-ray = chances are still has a fracture
    • If suspicious of stress fracture or labral tear