Physical examination

2006 ◽  
pp. 142-163
Author(s):  
David M. B. Hall ◽  
David Elliman
Keyword(s):  
Heart Disease ◽  
Hypertrophic Cardiomyopathy ◽  
Physical Examination ◽  
Developmental Dysplasia ◽  
Congenital Dislocation ◽  
Undescended Testes ◽  
Dysplasia Of The Hip ◽  
Dislocation Of The Hip

Chapter 7 covers the neonatal and 6–8 week examinations, the school entrant examination, and screening by physical examination for developmental dysplasia of the hip (DDH) (previously known as congenital dislocation of the hip), heart disease including hypertrophic cardiomyopathy (HCM), hypertension, asthma, and undescended testes and other genital abnormalities.

Physical examination

2019 ◽  
Author(s):  
Alan Emond
Keyword(s):  
Congenital Heart Disease ◽  
Physical Examination ◽  
Congenital Heart ◽  
Congenital Cataract ◽  
Cleft Lip ◽  
Screening Programme ◽  
Good Practice ◽  
Developmental Dysplasia ◽  
Undescended Testes ◽  
Dysplasia Of The Hip

The NHS newborn and infant physical examination screening programme recommends screening of newborn babies and then once again between 6 to 8 weeks, for conditions relating to their heart, hips, eyes, and testes. The evidence supporting this recommendation is reviewed, and good practice in identifying other common physical abnormalities is described. Congenital heart disease, developmental dysplasia of the hip, congenital cataract, undescended testes, cleft lip, tongue tie, and jaundice are discussed in more detail

Description of the ‘pronation manoeuvre’ for the diagnosis of developmental hip dysplasia

2021 ◽  
Author(s):  
José Fernando de-la-Garza-Salazar ◽  
Julieta Rodríguez-de-Ita ◽  
Bárbara M Garza-Ornelas ◽  
Jorge A Martínez-Cardona
Keyword(s):  
Physical Examination ◽  
Developmental Dysplasia ◽  
Clinical Tool ◽  
Developmental Hip Dysplasia ◽  
Cross Sectional ◽  
Diagnosis And Prognosis ◽  
Screening Strategies ◽  
Hip Ultrasound ◽  
Low Sensitivity ◽  
Dysplasia Of The Hip

Abstract Introduction Without a prompt diagnosis, developmental dysplasia of the hip (DDH) in infants can lead to severe sequelae. Current screening strategies emphasize the use of Ortolani and Barlow physical examination manoeuvres, yet they exhibit low sensitivity. The purpose of this study is to evaluate the performance of a new physical examination tool (the pronation manoeuvre) as a screening tool for DDH. Methods To evaluate the new manoeuvre, a cross-sectional and analytic study was performed with a nonprobabilistic sampling method. Patients with either a positive Ortolani or Barlow manoeuver were evaluated with the new manoeuvre and hip ultrasound. Controls were infants with negative Ortolani, Barlow and pronation manoeuvres and also had ultrasound performed. Results DDH was confirmed in 83 of 130 cases (64%) and 2 of 130 controls (2%). The new pronation manoeuvre had a sensitivity of 76% and a specificity of 94% as compared to the Ortolani and Barlow manoeuvres (sensitivity 31 to 32%, specificity 93 to 100%) (P<0.05). Conclusion This new physical examination manoeuvre could serve as another clinical tool for the initial screening of DDH in newborns. Its promising results against traditional screening procedures might potentially impact diagnosis and prognosis for patients with DDH.

Prevalence of Hip Ultrasound Abnormalities in Newborns With a Hip Click

2020 ◽  
Vol 59 (8) ◽  
pp. 773-777
Author(s):  
John T. Gaffney ◽  
John Spellman
Keyword(s):  
Family History ◽  
Confidence Interval ◽  
Physical Examination ◽  
Prospective Studies ◽  
Hip Dysplasia ◽  
Developmental Dysplasia ◽  
Inclusion Criteria ◽  
History Of ◽  
Hip Ultrasound ◽  
Dysplasia Of The Hip

A hip click on examination of the newborn hip is believed to be the result of a ligament or myofascial structure and thought to be benign. Some studies suggest a link between hip clicks and developmental dysplasia of the hip. The purpose of our study is to estimate the prevalence of ultrasound hip abnormalities in newborns with a hip click and an otherwise normal physical examination. Results. Ninety patients meeting inclusion criteria of a hip click with an otherwise normal physical examination underwent diagnostic ultrasound with a 17.8% prevalence of hip abnormalities found (95% confidence interval ±7.9% [range of 9.9% to 25.7%]). Our study had 64 (71%) females and 26 (29%) males. The prevalence of hip pathology for females was 18.8% (12 of 64 patients) and for males was 15.4% (4 of 26 patients). Thirty-three patients were found to have bilateral hip clicks on presentation, with 21.2% (7 of 33) of those patients found to have hip pathology on ultrasound (3 of the 7 had pathology of both hips). Six patients had a family history of hip dysplasia and 1 of these patients (16.7%) had pathology on ultrasound. The average age to hip sonography was 6.6 weeks. Conclusions. In all, 17.8% of newborns with a hip click were found to have hip abnormalities on ultrasound. The prevalence of hip pathology, on ultrasound, suggests that additional larger, prospective studies are needed to clarify the association between a hip click and abnormal ultrasound found at 6 weeks of age or greater.

scholarly journals Developmental dysplasia of the hip: update of management

2019 ◽  
Vol 4 (9) ◽  
pp. 548-556 ◽  
Author(s):  
Alfonso Vaquero-Picado ◽  
Gaspar González-Morán ◽  
Enrique Gil Garay ◽  
Luis Moraleda
Keyword(s):  
Physical Examination ◽  
Open Reduction ◽  
Acetabular Dysplasia ◽  
Wide Spectrum ◽  
Positive Family History ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Spontaneous Correction ◽  
Hip Reduction ◽  
Dysplasia Of The Hip

The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019

Developmental Dysplasia of the Hip

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 201-208
Author(s):  
David D. Aronsson ◽  
Michael J. Goldberg ◽  
Thomas F. Kling ◽  
Dennis R. Roy
Keyword(s):  
Early Detection ◽  
Physical Examination ◽  
Wide Spectrum ◽  
Developmental Dysplasia ◽  
Health Examination ◽  
Screening Examination ◽  
Neonatal Hip ◽  
Associated Risk Factors ◽  
Dysplasia Of The Hip ◽  
Pelvis Radiograph

Objective. The definition and early treatment of congenital dysplasia of the hip are controversial. The purpose of this study was to discuss the reasons for changing the acronym to developmental dysplasia of the hip (DDH) and to address its early detection and treatment. Design. This multicenter study was designed to provide an updated assessment of the definition, pathologic anatomy, prevalence, etiology, natural history, early detection, and treatment of DDH. Results. DDH more accurately describes the condition previously termed congenital dysplasia of the hip. The disorder is not always present at birth (congenital) and an infant may have a normal neonatal hip screening examination and subsequently develop a dysplastic or dislocated hip. Developmental dysplasia encompasses the wide spectrum of hip problems seen in infants and children. Physicians should understand that a normal neonatal screening examination does not assure normal hip development. The diagnosis of developmental dysplasia is made by physical examination. The Ortolani and Barlow maneuvers were designed to detect a subluxatable, dislocatable, or dislocated hip in the neonatal period. In the older child, limited abduction becomes a more reliable sign. The examination is variable depending on the type of dysplasia and changes with growth. The ultrasound is proving to be a sensitive tool in confirming the diagnosis in newborns and infants from birth to 4 months of age. The ultrasound is also valuable in older infants in terms of documenting that the dysplasia is responding to treatment. However, the ultrasound depends on an experienced sonographer and, in some cases, may be too sensitive, resulting in overtreatment. After 3 to 4 months of age, an anteroposterior pelvis radiograph can confirm the diagnosis. Conclusions. All newborns should have a neonatal hip screening physical examination. After screening, the hips should be re-examined during health examination visits at 2 weeks, 2 months, 4 months, 6 months, 9 months, and 1 year of age. If any question arises during these visits or if there are associated risk factors, we recommend an ultrasound if the infant is <4 months of age or an anteroposterior pelvis radiograph if >4 months of age.

scholarly journals What Is the Important Point Related to Follow-Up Sonographic Evaluation for the Developmental Dysplasia of the Hip?

2017 ◽  
Vol 07 (01) ◽  
pp. e123-e126
Author(s):  
M. Donma ◽  
M. Dogru ◽  
M. Demirkol ◽  
O. Ozcaglayan ◽  
B. Topcu ◽  
...  
Keyword(s):  
Physical Examination ◽  
Developmental Dysplasia ◽  
Childhood Disability ◽  
Sonographic Examination ◽  
Sonographic Screening ◽  
Left And Right ◽  
The Right ◽  
Dysplasia Of The Hip

AbstractDevelopmental dysplasia of the hip (DDH) is an important cause of childhood disability. Subluxation or dislocation can be diagnosed through pediatric physical examination; nevertheless, the ultrasonographic examination is necessary in diagnosing certain borderline cases. It has been evaluated routine sonographic examination of 2,444 hips of 1,222 babies to determine differences in both, developmental dysplasia and types of hips, and evaluated their development on the 3-month follow-up. Evaluating the pathologic “α” angles under 59, there was no statistically significant differences between girls and boys in both right (55.57 ± 3.73) (56.20 ± 4.01), (p = 0.480), and left (55.79 ± 3.96) (57.00 ± 3.84), (p = 0.160) hips on the 45th day of life. Routine sonographic examinations on the 45th day of life revealed that 51 of (66.2%) 77 type 2a right hips were girls and 26 (33.8%) were boys. The number of the right hips that develop into type 1 was 38 (74.5%) for girls and 26 (100%) for boys on the 90th day of life (p = 0.005). A total of 87 type 2a left hips included 64 girls (73.6%) and 23 boys (26.4%). In the 90th day control, 49 right hip of girls (76.6%) and 21 right hip of boys (91.3%) developed into type 1 (p = 0.126). In the assessment of both left and right hips, girls showed a significantly higher frequency in latency and boys showed significantly higher development in the control sonography. A total of 31 girls (2.5%) and 11 boys (0.9%) accounted for a total of 42 (3.4%) cases who showed bilateral type 2a hips in 1,222 infants. On the 90th day control, 26 girls (83.9%) and all 11 boys (100%) developed into type 1 (p = 0.156). The study emphasizes the importance of the sonographic examination on the 90th day of life. Results of the investigation include the data of sonographic screening of DDH on the 45th day, and also stress the importance of the 90th-day control sonography after a close follow-up with physical examination between 45th and 90th days of life.

Developmental dysplasia of the hip

2020 ◽  
Vol 81 (7) ◽  
pp. 1-8
Author(s):  
Stella Zhang ◽  
Konstantinos J Doudoulakis ◽  
Anita Khurwal ◽  
Khaled M Sarraf
Keyword(s):  
Femoral Head ◽  
Physical Examination ◽  
Screening Programme ◽  
Developmental Dysplasia ◽  
Monitoring Tool ◽  
Newborn Screening Programme ◽  
Hip Stability ◽  
Hip Ultrasound ◽  
The Uk ◽  
Dysplasia Of The Hip

Developmental dysplasia of the hip encompasses a range of hip abnormalities in which the femoral head and acetabulum fail to develop and articulate anatomically. Developmental dysplasia of the hip is a clinically important condition, with a prevalence of 1–2/1000 in unscreened populations and 5–30/1000 in clinically screened populations. The pathology is incongruence between the femoral head and the acetabulum, which can be caused by an abnormally shaped femoral head, acetabulum, or both. This results in a spectrum of different hip abnormalities. The precise aetiology behind developmental dysplasia of the hip is unclear, but there are a number of established risk factors. In the UK, universal clinical examination of newborns and 6–8-week-old babies is performed under the national UK newborn screening programme for developmental dysplasia of the hip (part of the Newborn and Infant Physical Examination). The physical examination of the newborn hip involves initial inspection of the infant for any of the clinical features of developmental dysplasia of the hip, followed by hip stability tests (Barlow's and Ortolani's tests). Hip ultrasound is the gold standard diagnostic and monitoring tool for developmental dysplasia of the hip in newborns and infants under 6 months of age, or until ossification of the femoral head. Some mild cases of developmental dysplasia of the hip (and the immature hip) resolve without requiring intervention; however, there are a number of treatments, both non-operative and operative, that may be used at various stages of this condition.

scholarly journals Perception and Awareness about Developmental Dysplasia of the Hip in Children among Pregnant Ladies in the Aseer Region, Southwestern Saudi Arabia

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1384
Author(s):  
Mahdi M. Alqarni ◽  
Ayed A. Shati ◽  
Youssef A. Al-Qahtani ◽  
Wafaa S. Alhifzi ◽  
Wael S. Alhifzi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Demographic Data ◽  
Developmental Dysplasia ◽  
Treatment Modalities ◽  
Congenital Dislocation ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Pregnant Females ◽  
Source Of Information ◽  
Dysplasia Of The Hip

Background: Developmental dysplasia of the hip (DDH) is classified as a group of malformations, varying from abnormal acetabulum (dysplasia) and mild subluxation of the femoral head to fixed displacement (congenital dislocation). This study aimed to assess the knowledge level and its determinants regarding DDH in children among pregnant females in the Aseer region of southwestern Saudi Arabia. Methods: A descriptive cross-sectional study was conducted targeting all pregnant females in the Aseer region between 1 February 2021 and 1 May 2021. A pre-structured online questionnaire was constructed by the researchers to obtain the participating females’ bio-demographic data (including age, education status, and obstetric history) and awareness regarding DDH. The last section asked for their source of information regarding DDH. Results: A total of 253 pregnant females (aged between 18 and 45 years; mean age = 30.5 ± 10.2 years) fulfilling the inclusion criteria completed the study questionnaire. About 5% of the females reported having a child with DDH, and 166 (65.6%) pregnant females knew about DDH. Additionally, 110 (43.5%) females reported that they know about how DDH is treated, and 99 (39.1%) knew about DDH complications. The most commonly reported source of information was relatives and friends (44.3%), followed by social media (11.9%) and study and work (7.1%). Conclusions: Pregnant females in the Aseer region have poor knowledge and awareness about DDH and its causes, treatment modalities, and complications. Higher knowledge was associated with either high parity or having a child with DDH.

scholarly journals Newborn and infant physical examination standards in a dedicated clinic for developmental dysplasia of the hip

2018 ◽  
Vol 100 (7) ◽  
pp. 566-569
Author(s):  
S Humphry ◽  
D Thompson ◽  
R Evans ◽  
N Price ◽  
P Williams
Keyword(s):  
Risk Factors ◽  
Physical Examination ◽  
Multidisciplinary Treatment ◽  
Treatment Compliance ◽  
Developmental Dysplasia ◽  
Expert Consultation ◽  
Prospective Audit ◽  
Invasive Treatment ◽  
The Uk ◽  
Dysplasia Of The Hip

Introduction In 2014 our centre started a dedicated clinic for developmental dysplasia of the hip (DDH). The aim of the clinic was to streamline DDH referrals, enabling timely review, imaging and multidisciplinary treatment. Ongoing audit has been carried out based on the UK National Screening Committee newborn and infant physical examination (NIPE) guidelines, first published in 2008. Methods A three-year prospective audit was undertaken between 2014 and 2016 assessing compliance with NIPE standards (ST2b and ST2d) relating to timeliness of expert consultation following positive ultrasonography findings of DDH with positive examination or risk factors. Results A total of 257 babies born between January 2014 and December 2016 were seen in our dedicated DDH clinic, with 106 with abnormalities on ultrasonography and 54 requiring treatment. Compliance with ‘expert consultation within 4 weeks of age for babies with an abnormality detected on clinical examination and positive ultrasonography’ improved from 50% in 2014 to 53% in 2015 and 71% in 2016. Compliance with ‘expert consultation within 8 weeks of age for babies with positive risk factors, negative examination and positive ultrasonography’ improved from 65% in 2014 to 93% in 2015 and 100% in 2016. Conclusions This prospective audit assessing timeliness of expert consultation has demonstrated ongoing improvements between 2014 and 2016. A greater proportion of babies with ultrasonography evidence of DDH have been seen at the appropriate time. In the majority of cases, this has enabled timely non-invasive treatment with a Pavlik harness rather than surgery.

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