You are seeing Mrs. Goldberg, a 76 year old female from a nursing home who has been well until today. She presents to the Emergency Department after being found on the floor of her room in her nursing home. She was alert and oriented when she was found, and has felt well in recent days. Take a focused history and perform all the relevant physical examination maneuvers.
History
Physical Examination
Inspection
- Examines both hips joints for SEADS (swelling, erythema, muscle atrophy, deformity, skin changes)
- Assesses all active range of motion for both hips (flexion/extension, abduction/adduction, rotation)
- Assesses patient’s gait (patient refuses due to pain)
- States that the lower back and knees should be examined as well
Palpation
- Palpates hips, PSIS, and ASIS for tenderness
- Determines real and apparent leg lengths (notes that there is a significant difference)
- Assesses peripheral pulses
- Assesses neurologic status of effected limb
- Tests all passive range of motion for effected hip
Special Tests
- Performs Trendelenburg’s Test assessing for hip abductor strength
- Assesses for flexion contracture of effected hip while eliminating lumbar lordosis
Case 2 – Hip Pain