Clinical Examination

CLINICAL EXAMINTION OF OSTEOARTHRITIS OF HIP:
Questions to Be Asked
· How long have you had symptoms? (Osteoarthritis usually develops slowly.)
· Are your joints stiff in the morning? If so, for how long?
· Have you tried any medicines that have helped the pain? If yes, how much do they help?
· Do exercises help your pain or make it worse? Which kinds of exercises have you tried? Have you tried bicycling or swimming for your hips or knees?
· Has there been a pattern to your symptoms? (Osteoarthritis symptoms typically begin on one side of the body and often affect just one set of joints.)
· Do you have a family history of arthritis?
· Do you have any general symptoms that seem to affect your whole body, such as fatigue, weight loss, or fever? (Osteoarthritis usually doesn't cause whole-body symptoms.)
· Has there been any recent or past injury to the affected joints, especially a major joint injury or injuries related to repetitive motion? (A recent injury may mean painful symptoms are related to the injury, not an underlying disease.)
During the physical exam, the doctor will look at, feel, and move each joint, evaluating it:
· For swelling, warmth, or tenderness.
· For range of motion.
· To determine the pattern of affected joints (such as one knee, both knees, knuckles, wrists, or shoulders). Often, the pattern of joints affected can help a doctor tell the difference between osteoarthritis and other types of arthritis such as rheumatoid arthritis.





ANOTHER 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.