amc clinical examA 60 year old man with painful and stiff hip .
Task- Examine hipWash hands, ask permission.
Me- Hello Mr X, I have been asked to examine your hip. I will try to be as gentle as possible throughout my examination but if you are uncomfortable for any reason, pls let me know immediately ,ok ? I will look , feel and test some movements of your hip joint. Can I expose you up to your waist? I will give you a sheet for your convenience.
Look- Gait- Antalgic gait.
Trendenlenberg gait and test – Negative
On lying down, hips are not symmetrical. There seems a swelling over the right hip. No redness, no scars. No adduction or abduction deformities. Both ASIS in same level.
Feel- Temperature equal and comparable to other sites. Can’t feel the definite swelling but it seems to be a bony bumb as compared to the left. No tenderness over greater trochanter, lesser trochanter, mid inguinal points.
Move- Addcution , flexion, internal rotation are restricted on right hip as compared with left due to pain.
Measure- True length and apparent length- No discrepancies
Prone position- Test extension . Limited again on right hip. NAD on inspection and palpation from prone position.
Back examination – NAD
I want to complete my examination by doing other joint examinations and neurovascular examination ( Examiner stopped me at this time and asked me D/Dx).
D/Dx- OA is most likely
Less likely causes – Hip fracture, Hip dislocation
Other candidates say Trochanteric burisitis which didn’t cross my mind at all.
Examiner- Talk to patient
Me- Mr X, from my examination, you are most likely to have a condition called OA. Do you know about it ?
RP- Yes
Examiner- What will you do ?
Me- X ray
Examiner- Summarise your examination findings again.
Me- On inspection,.. Bell rang.
Once I come out of room, I realized I forgot “ Thomas Test “.
Feedback- Follow the principle of “ Look, Feel, Move , Measure, X ray “
Add neurovascular testing and special tests in FEEL. Then you won’t miss anything
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