Pediatric Tests for Hip Pathology (Ortolani’s Sign,Barlow’s Test,Galeazzi Sign,Telescoping Sign (Piston or Dupuytren’s Test),Abduction Test (Harts’ Sign),..

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Pediatric Tests for Hip Pathology

 

Orthopedic tests are commonly performed in newborns to detect problems, especially congenital dislocation of the hip (CDH) or developmental dysplasia of the hip (DDH) that covers more than congenital problems, which may be amenable to conservative treatment if caught early.

Ortolani's Sign.

Ortolani's test can determine whether an infant has a congenital dislocation of the hip . With the infant supine, the examiner flexes the hips and grasps the legs so that the examiner's thumbs are against the insides of the knees and thighs and the fingers are placed along the outsides of the thighs to the buttocks. With gentle traction, the thighs are abducted, and pressure is applied against the greater trochanters of the femora. Resistance to abduction and lateral rotation begins to be felt at approximately 30° to 40°. The examiner may feel a click, clunk, or jerk, which indicates a positive test and that the hip has reduced; in addition, increased abduction of the hip is obtained. The femoral head has slipped over the acetabular ridge into the acetabulum, and normal abduction of 70° to 90° car. be obtained. This test is valid only for the first few weeks afte: birth and only for dislocated and lax hips, not fiX dislocations that are difficult to reduce. The examine should take care to feel the quality of the click. So'='clicks may occur without dislocation and are thoughto be caused by the iliofemoral ligament's clicking O'e the anterior surface of the head of the femur as it laterally rotated. Soft clicking usually occurs withouthe prior resistance that is seen with dislocations. B repeated rotation of the hip, the exact location of th click can be palpated. However, Ortolani's test shoul . not be repeated too often because it could lead damage of the articular cartilage of the femoral heaD. As with all clinical tests, if the test is positive, it _ highly suggestive that the problem (i.e., congenital dIlocation of the hip) exists, but if it is negative, it dID not necessarily rule out the problem



Barlow's Test.

Barlow's test is a modification Onolani's test35 . used for develo mental dysplasia of the hip.41 The infant lies supirER. with the legs facing the examiner. The hips are flexeX to 90°, and the knees are fully flexed. Each hip evaluated individually while the examiner's other har- . steadies the opposite femur and the pelvis. The exarriner's middle finger of each hand is placed over greater trochanter, and the thumb is placed adjacent the inner side of the knee and thigh opposite the Ie trochanter. The hip is taken into abduction while examiner's middle finger applies forward pressurehind the greater trochanter. If the femoral head sh: forward into the acetabulum with a click, clunk, jerk, the test is positive, indicating that the hip  dislocated. This part of the test is identical to On lani's test. The examiner then uses the thumb to aprpressure backward and outward on the inner thigh. the femoral head slips out over the posterior lip of acetabulum and then reduces again when pressure removed, the hip is classified as unstable. The hip not dislocated but is dislocatable. The procedure repeated for the other hip. This test may be used for infants up to 6 month age. It should not be repeated too often because may result in a dislocated hip as well as articular dar!' age to the head of the femur. 42 head has slipped over the acetabular ridge into the acetabulum, and normal abduction of 70° to 90° car. be obtained. This test is valid only for the first few weeks afte: birth and only for dislocated and lax hips, not fi dislocations that are difficult to reduce. The examine should take care to feel the quality of the click. So'='clicks may occur without dislocation and are thoughto be caused by the iliofemoral ligament's clicking O'e the anterior surface of the head of the femur as it laterally rotated. Soft clicking usually occurs withouthe prior resistance that is seen with dislocations. B repeated rotation of the hip, the exact location of thE click can be palpated. However, Ortolani's test should .not be repeated too often because it could lead damage of the articular cartilage of the femoral head As with all clinical tests, if the test is positive, it _highly suggestive that the problem (i.e., congenital dIlocation of the hip) exists, but if it is negative, it do not necessarily rule out the problem.

Galeazzi Sign (Allis or Galeazzi Test).

The Galeazzi test is good only for assessing unilateral congenital dislocation of the hip or unilateral developmen dysplasia of the hip and may be used in children from 3 to 18 months of age.41 The child lies supine Y the knees flexed and the hips flexed to 90°. A posintest is indicated if one knee is higher than the other

Telescoping Sign (Piston or Dupuytren's Test).

The telescoping sign is evident in a child with a dislocated hip. The child lies in the supine position. The xaminer flexes the knee and hip to 90°. The femur is ushed down onto the examining table. The femur and leg are then lifted up and away from the table . With the normal hip, little movement curs with this action. With the dislocated hip, howeYer, there is a lot of relative movement. This excessive movement is called telescoping, or pistoning.

 

Abduction Test (Harts' Sign),

If congenital disocation of the hip is not diagnosed early or there is developmental dysplasia of the hip, parents often note mat when they change the child's diapers, one leg does not abduct as far as the other one.4! This is the asis for this test. The child lies supine with the hips and knees flexed to 90°. The examiner then passivelyabducts both legs, noting any asymmetry or limitationof movement. In addition, if one hip is dislocated, the-hild often demonstrates asymmetry of fat folds in the gluteal and upper leg area because of the "riding up"of the femur on the affected side.

Pediatric Tests for Hip Pathology

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