Hip Flashcards
What is the normal ROM for flexion/extension of the hip in a newborn, 4 y.o. and 10 y.o.?
Flexion: 130, 150, 120 degrees
Extension: 0 degrees - should never be able to extend the newborn hip, 30, 30
What is the normal ROM for abduction/adduction of the hip in a newborn, 4 y.o. and 10 y.o.?
Abd: 80, 55, 45 degrees
Add: 20, 30, 30 degrees
What is the normal ROM for internal rot/external rot of the hip in a newborn, 4 y.o. and 10 y.o.?
IR: 80, 55, 45 degrees
ER: 90, 45, 45 degrees
Describe the position of the hip in a newborn child.
- flexion contracture of 30 degrees
- total ROM 170 degrees
- small posteriorly tilted pelvis
- shallow acetabular cup, angled downwards 7 degrees
- resting position of hip is flexion, ext rotation and abduction
Describe the development of the hip in a child.
4-6 months - HJ can be extended, tummy time contributes to reduction of flexion contracture
1 y.o. - flexion contracture and excessive rotation reduced
3 y.o. - acetabular cup deepens and angles downwards 17 degrees, making HJ much more stable
What happens to the acetabular cup by 3 years old?
- depends and angles downwards 17 degrees
- child starts to gain hip extensor activation, the pelvic capsular ligaments lengthen, motor milestones push HoF into acetabulum
How is the trendelenberg test conducted?
- pt standing with examiner standing behind
- hands on PSIS or iliac crests
- go from DLS to SLS
- watch for dropping of the pelvis on the side of the elevated side +/- lateral arching to the supported leg
- positive test is hip dropping on the unsupported side
What are unexpected findings at the HJ?
- Developmental dysplasia of the hip
What is DDH?
- a condition in which the femoral head has an abnormal relationship to the acetabulum
What are the aetiologies of DDH?
- ligamentous laxity: genetic predisposition and maternal relaxin crossing the placenta
- racial predilection: asians and blacks have low incidence, whites and native Americans have higher incidence
- prenatal positioning: double flexed breech, single footling breech, frank breech, large baby, oligohydramnios
- postnatal positioning: swaddling in HJ extension position is detrimental
What is double flexed breech, single footling breech and frank breech?
- feet first, both legs flexed to torso
- feet first, one leg extended
- butt first, hips flexed, knees extended
What assessments can be done to test for DDH?
- Barlow test, ortolani test, klisic test, decreased abduction, galeazzi’s sign, asymmetry of thigh folds and gluteal creases
What would you expect to see in an assessment of a <3 month old child with DDH?
- hip is dislocatable but reducible
- positive kilsic’s sign
What would you expect to see in an assessment of a >3 month old child with DDH?
- not as clear cut
- sometimes dislocatable, sometimes reducible
- positive klisic’s sign
- decreased abduction
- Galeazzi’s sign
What would you expect to see in an assessment of a walking child with DDH?
- harder to find a DDH
- remains dislocated
- positive Klisic’s sign
- decreased abduction
- galeazzi’s sign
- limp
- shortened leg
- increased lordosis
