CLINICAL EXAMINTION OF OSTEOARTHRITIS OF HIP
Author: admin // Category: Clinical Skills, MRCSANOTHER MOST COMMON CASE WHICH COMES IN ORTHOPAEDICS BAY IN MRCS CLINICAL EXAM.
USUALLY CANDIDATES ARE TOLD TO DO THE FOLLOWING IN THIS:
A MEASURING TAPE IS GIVEN TO CANDIDATES AND THEY ARE TOLD TO TAKE THE REAL AND APPARENT LIMB LENGTHS.
OR SIMPLY ASKED TO ASSESS THE ABDUCTORS OF HIP WHILE THE PATIENT IS STANDING IN OTHER WORDS DO THE TRENDELENBURGS TEST
OR ASSESS MOVEMENTS OF HIP AND MENTION THE ROM ie RANGE OF MOVEMENT IN THE HIP.
INSTRUCTION: EXAMINE THE RIGHT HIP OF THIS GENTLEMAN
TO PATIENT:
HELLO MR SMITH. MY NAME IS DR. NAZISH GHAZANFAR. HOW ARE YOU FEELING TODAY? REPLY ACCORDINGLY (THAT’S GREAT OR OK).
SIR PLEASE MAY I EXAMINE YOUR HIPS PLEASE.
THANK YOU. LET ME JUST DRAW THE CURTAINS TO ENSURE PRIVACY. I HAVE ALREADY WASHED MY HANDS.
COULD YOU PLEASE TAKE OFF YOUR TROUSERS AND KEEPING YOUR UNDERWEAR ON, PLEASE STAND FACING ME WITH YOUR LEGS TOGETHER.
ARE YOU COMFORTABLE SIR.
DO YOU MIND IF I TALK ABOUT THE FINDINGS TO THE EXAMINERS AS I GO ALONG?
I AM JUST GOING TO HAVE A LOOK FIRST OF ALL.
OBSERVE AND ACT: FROM FRONT KNEEL DOWN AND LOOK AT THIGH FOR ANY PELVIC TILTING THAT IS ABDUCTION OR ADDUCTION, LOOK AT POSITION OF PATELLA AND FOOT FOR ROTATIONAL DEFORMITY THAT IS EXTERNAL OR INTERNAL ROTATION AND FINALLY AT THE ANKLES FOR ANY OBVIOUS SHORTENING.
TO EXAMINER: THERE IS ON INSPECTION IN THIS GENTLEMAN ADDUCTION AND EXTERNAL ROTATION WITH OBVIOUS SHORTENING OF RIGHT LEG. MILD MUSCLE WASTING IS DETECTABLE. THE CONTRALATERAL LIMB APPEARS TO BE NORMAL.
TO PATIENT:
NOW PLEASE TURN TO YOUR SIDE SO THAT I CAN HAVE A SIDE VIEW OF YOUR HIP AND SPINE.
TO EXAMINER: THERE IS / IS NO EVIDENCE OF EXAGGERATED LUMBAR LORDOSIS AND SCARS OF PREVIOUS SURGERY ARE NOT PRESENT.
TO PATIENT: NOW PLEASE TURN YOUR BACK TO ME.
TO EXAMINER: THERE IS NO EVIDENCE OF SCOLIOSIS, GLUTEAL MUSCLE WASTING OR ANY SCARS OVER BUTTOCK AND POSTERIOR ASPECT OF UPPER THIGH.
THE CONTRALATERAL LIMB APPEARS TO BE NORMAL.
TO PATIENT: NOW PLEASE SIR WILL YOU LIE ON THE BED COMFORTABLY STRAIGHT. ARE YOU COMFORTABLE SIR.
TO EXAMINER: THERE IS/ IS NO OBVIOUS SHORTENING. IDEALLY I WOULD LIKE TO MEASURE THE TRUE AND THE APPARENT LIMB LENGTH.
TO PATIENT: I AM JUST GOING TO MEASURE THE LIMB LENGTH WITH THIS MEASURING TAPE. JUST LIE COMFORTABLY STRAIGHT.
ACT: MEASURE FROM THE UMBILICUS TO TIP OF MEDIAL MALLEOLUS OF BOTH RIGHT AND LEFT LIMBS. (FOR DIAGRAM FIG. 4.10, 4.11 PAGE 115 NORMAN BROWSE LATEST EDITION).
TO EXAMINER: I AM MEASURING THE APPARENT LIMB LENGTH USING THE UMBILICUS AS THE MEASURING POINT.
from
http://www.surgical-tutor.org.uk/data/forum/forum_posts.asp?TID=10
Related Posts
Tags: abduction, abductors, Arthritis, clinical, gluteal muscle, joint exam, lumbar lordosis, measuring tape, MRCS, mrcs surgery viva, muscle wasting, orthopedics, part 3 mrcs, part B MRCS, scars, scoliosis, surgery, viva