What happens to length in Abduction deformity?

-There is apparent lengthening in Abduction deformity. -If the difference of apparent and true length is taken, apparent shortening is less than true shortening. e.g. If the True Length of affected side is 68 cms the unaffected is 72 cms. The apparent Length be 108 cms on affected and 110 on unaffected. Hence the difference of True Length is 4 cms and Apparent Length is 2 cms. Hence the difference of True Length is more than the Apparent.

Why does there occur Apparent Lengthening in Abduction deformity?

In order to bring both legs to touch the ground, there occurs an apparent Lengthening.

What is Full Abduction, Free Abduction and Fixed Abduction deformity? 

-The Total Abduction is the degree of abduction possible without Pelvic movements.

-The free abduction is the abduction which is possible without pelvic movements, once the pelvis has been squared.

-fixed abduction deformity is the degree of movement of Abduction, when the Pelvis Squares.

What are the different means of measuring Abduction deformity?

When the limb is squared position draw a vertical line from ASIS and another line along axis of this and mid line of body will be the fixed abduction deformity. M.L.Kothari’s angle In this could be measured without squaring Pelvis from both the ASIS,In the position of comfort. Then from each ASIS draw a perpendicular to mid line of body.This angle gives the idea of Pelvis tilt.

What is the meaning of that the Limb is fixed in abduction?

When the Limb is an attitude of abduction and no other movement is possible.

What could be the fallacies in Squaring of Pelvis?

-Due to fixed pelvic obliquity of scoliosis-ASIS has been removed by grafting

-Maldeveloped Pelvis

-PPRP

-Unreduced dislocations

-Malunions of Fracture Ilium

What is the Compensatory Mechanism in Adduction deformity?

The scoliosis which has convexity towards unaffected side.

What are the free Adduction, Full Adduction and Fixed Adduction? 

Free Adduction=Full adduction-Fixed adduction deformity or, in other words Full adduction=Free + Fixed Adduction But this movement occurs without Pelvis jog.

What is the meaning that Limb is fixed in adduction?

This is the attitude of adduction in which the limb is fixed and no other movement is possible.

What are the causes of True Shortening?

True shortening could be, Supra trochanteric as in, # Neck femur Coxa Vara S.C.F.E Perthes disease Loss of cartilage Infection ArthritisDislocation of Hip After Girdlestone procedure Absorption of Head InfratrochantricCongenital. # shaft Femur # Subtrochantric Femur Growth disturbance-Epiphyseal traumaBone infection.

Name Causes of Supra trochanteric lengthening- 

Coxa Volga

Coxa Magna

Malunited Fracture,

Prosthesis with improperly cut neck.

What are Fallacies in Measuring Segmental length ( infratrochantric)

-When joint line is damaged.

-Effusion of joint.

-Inability to keep knee extended.

When was the Fixed Flexion deformity Test described and by whom?

It was described by Sir Huge Owen Thomas in 1876.

What is the first movement to be lost in hip?

It is Extension, i.e backward movement from zero position.

What angle do you measure in a Thomas Test?

The angle subtended by Long axis of bone with that of the Bed.

What is the basis of Fixed Flexion Deformity Test or Thomas Test?

In order to gain asses to ground due to loss of extension. The Pelvis tilts forward in sagittal plane. By this the lumbar lordosis is increased as a compensation. While doing Thomas Test, this pelvic obliquity is reverted back and this is revealed in the form of fixed flexion deformity of hip.

If there is No Hip Pathology and patient has Lumbar Lordosis, what does it suggest of?

That the deformity is either in Pelvis or Spine.

In a patient with fixed flexion deformity of Hip and Knee. How do you test for FFD at Hip?

We ask the patient to lie on the edge of the couch with both the knee dangling down then measure for FFD of Hip by Thomas Test.

What is drawback of Thomas Test?

-It is easy to perform in painful hip

-Obese patient.

-It cannot be easily performed in ankylosed knee.

-It is difficult to perform in bilateral case.

How do you measure fixed flexion deformity in bilateral affection?

In prone position, making the patient to lie with trunk on the couch and asking him to support his knees on the examiner’s hand. Now on gradually extending the thigh, the resistance is felt. At this point mark and angle between trunk and thigh. In supine position lift both the limbs together without flexion the knee and see for obliteration of lordosis.

What are the conditions of false position Thomas Test? 

In cases of

-Fixed pelvic obliquity as in Scoliosis and Polio.

-Exaggerated lordosis due to

-Pregnancy

-Postural abnormalities

-Spondylolisthesis

What is free flexion?

It is the range of flexion beyond the fixed flexion deformity.

What is the range of flexion?

It is sum total of fixed flexion + free flexion.

How do you measure for rotation? 

From the zero position, where patella is horizontal and great toe upwards, the internal and external rotation are measured by rolling or it could be measured by flexing hip and knee by 90° and a outward rotator movement is internal rotation and vice versa.

What are the prerequisites of Telescopic Test?

 -The hip and knee fixed to 90° after taking patient on hard bed.

-Adduct Limb by 5-15°

-Secure the hand posteriorly and over the trochanter

-push and pull maneuver is done to feel the recoil over the hand.

Which Maneuver is more important in Telescopic Test, Pull or Push?

Push is more important. Telescopic test is used to detect discontinuity or dislocation at the hip joint and to diagnose both these conditions; exaggerated downward displacement of the greater trochanter (compared to the other side) is the key element. This downward displacement is elicited by the push maneuver.

In what conditions you get Telescopic Test positive? 

In CDH

Old dislocation

Pathological dislocation

Non union

# Neck Femur

Charcot’s joints

Post girdlestone’s arthroplasty

What is the basis of Telescopic Test? 

Whenever the head is pushed and pulled it being, in the plane other than acetabulum moves away from the acetabulum to strike over the hand in posterior fossa.

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