infant hip exam for profesionals

[Tutterkop]

At my university they teach the technique with baby dolls, and we have to do it simmultaniously.

But that's definetly wrong then?

[barenakedrachel]

Great videos, thank you! I am a student nurse in a pediatric rotation and have found that the typical videos are not as helpful as your live demonstrations with real world babies.

[kmwindisch]

@barenakedrachel you are welcome

[MrVickydoc]

excellent video doctor

[kmwindisch]

@MrVickydoc Thank you.

[shimusuru]

Thanks Dr Windisch...

wish doctors in Malaysia are good heart like you, offering a class to help....now at least i know how to do it....and understand that my previous attempt exam on that question was disastrous

[kmwindisch]

@shimusuru glad to have helped



[PureChiropractic]

Nice video. I didn't know about doing the exam one side at a time. I think parents often note clicking of the hip with diaper change so talking with the parents is important. Also, I have heard that false negatives are common if the baby is crying as they tense their muscles when they do so. Is this true in your experience?

[kmwindisch]

@PureChiropractic You are correct about the high false negative rate for the exam. that is one reason we repeat the exam at birth,3-5 days, 2 wks, 2 4 and 6 months, 12 15 18 and 24 months as well.

Try to get the child relaxed. sometimes that is easier said than done.

[pabsw]

Thanks. You've posted some very useful videos. Best wishes from the uk.

[kmwindisch]

@pabsw Thanks.

[pabsw]

Thanks. We (in the uk) medical students get taught to examine both hips at the same time using ortolani and barlows. What is the rationale for doing one at a time? Is it evidenced? Thanks again.

[kmwindisch]

@pabsw most docs here in the us are taught the same thing. If you don't stabalize the pelvis, all you do is push the hip into the exam table and thus miss sublte subluxations. You would have to do a lit search to see the evidence for yourself. Personally, I recommend, don't cut corners, your patients' hips deserve a thorough eval.

[pabsw]

@kmwindisch hi thanks for your reply. I checked with the paediatric consultant and they recommend testing each leg individually whilst stabalising the pelvis as you show, the general practitioners tend to check both at the sametime and their rationale was that the test looses sensitivity after a couple of months age and they are really looking for crepitation and performing Allis's test as well.

So thanks and I'll sure be looking at each hip individually.

[kmwindisch]

@pabsw I'm glad to have bee of help. I learn from these discussions too. Remember that hopefully you are picking up the dysplasia in the first 2-4 months when these tests are more sensitive if done each side separately. after 6 months, you aren't really doing ortolani and barlow's maneuvers anyway.

[anomoorthy]

u completely got mixed up! abduction is ortolani test and adductios is barlow test

[kmwindisch]

@anomoorthy you are right, I got my ab's and ad's backward. The description in the video is correct.

[kmwindisch]

@anomoorthy you are right, I got my ab's and ad's backward. The description in the video is correct not the description in some of the comments.

[MininoStar]

@anomoorthy

He is right, you miss understood. Barlow is abduction of the limbs but adduction of the hip /means that femur goes into the cotile

[AMDOCTOR]

i'm from Saudi Arabia and i have final pedia osce exam 2 days later

this video is very useful

thx man =)

[kmwindisch]

@AMDOCTOR You are welcome. Good luck on the OSCE- I don't miss those days.

[EsotericStudent]

Maybe my anatomic terms are messed up and that is why I am confused. For Barlow's you say "pressing gently into the table and then flexing the hip" which to me looks like abduction, not adduction.

I didn't mean to sound like I was calling you out, simply a misunderstanding on my part.

[kmwindisch]

@EsotericStudent no offense taken, it's all good. I don't know why your posts are getting flagged as spam, sorry about that.

You start with the knee flexed and adducted and push into the table that is barlow, then abduct and pull toward you for ortolani.

[338888]

@EsotericStudent i think ur connection got some problem. There are repeated post in here.

[EsotericStudent]

Maybe my anatomic terms are messed up and that is why I am confused. For Barlow's you say "pressing gently into the table and then flexing the hip" which to me looks like abduction, not adduction.

I didn't mean to sound like I was calling you out, simply a misunderstanding on my part.

[EsotericStudent]

Dr. Windisch,

Thank you for taking the time to post this video. I am afraid I might be confused, but I feel like what you are saying in the video and what the books say are contradicting. Could you help clarify this? Nelson's 17th ed says:

Barlow's performed by stabilizing the pelvis, flexing the thigh and adducting the hip while applying posterior pressure.

Ortoloni's performed by flexing of the thigh and abducting the hip with gentle traction to relocate a recently dislocated hip.

[kmwindisch]

@EsotericStudent that is exactly what I'm saying. Barlows= Burst the femoral head out, Ortolani=relocate the femoral head.

[EsotericStudent]

@kmwindisch

Maybe my anatomic terms are messed up and that is why I am confused. For Barlow's you say "pressing gently into the table and then flexing the hip" which to me looks like abduction, not adduction.

I didn't mean to sound like I was calling you out, simply a misunderstanding on my part.

[EsotericStudent]

@kmwindisch

Maybe my anatomic terms are messed up and that is why I am confused. For Barlow's you say "pressing gently into the table and then flexing the hip" which to me looks like abduction, not adduction.

I didn't mean to sound like I was calling you out, simply a misunderstanding on my part.

[kmwindisch]

@EsotericStudent i don't know why these got flagged as spam and don't know how to unflag them, sorry.

[EsotericStudent]

@kmwindisch

Maybe my anatomic terms are messed up and that is why I am confused. For Barlow's you say "pressing gently into the table and then flexing the hip" which to me looks like abduction, not adduction.

I didn't mean to sound like I was calling you out, simply a misunderstanding on my part.

[bluedustmite]

Thanks for the video! Very helpful. Just wish I had watched it BEFORE my peds clerkship instead of after. D'oh!

[kmwindisch]

@bluedustmite better late than never. At least you are now ready for the USMLE step III and any clinical skills exam you might ever face. Personally, I find it impressive that you would take the time to look AFTER the rotation instead of saying- who cares, it's over now. Your dedication to learning did not go un-noticed.

[silateer]

Doc, it was almost perfect! I missed one point and I think that's because my docs don't believe we can be perfect at this stage.

Thanks again!

[231mariano]

Thanks

[kmwindisch]

@231mariano you are welcome

[6afashtoony]

doc..the clip is not loading anymore..i hope u didn't remove it :s

[kmwindisch]

@6afashtoony Loaded nicely for me

[silateer]

Dr. Windisch,

Thanks for the great video. I am a DC student and have a practical exam in the morning, and I actually missed how to do Barlow's and Ortolani's in class! Life saver, well grade sever video!

[kmwindisch]

@silateer glad to help.

where do you go to school? My brother and best friend went to Los Angeles College of Chiropractic.

[kmwindisch]

@silateer so how did the practical go?

[6afashtoony]

thnx doc :)

wish u all the best !

[6afashtoony]

thanks a lot..that was very helpful..

i think i just needed a push to make up my mind..

just one last question..what's the precentage for foreign students to be accepted for peds ortho residency in the states?

last , i'm really greatful :)

wish u all the best !

[kmwindisch]

@6afashtoony remember here in the US it is a general orthopedics residency followed by a peds ortho fellowship.

as far as foreign students accepted into ortho residencies, I'm afraid I have no idea, not being in the field of orthopedics myself. Furthermore my country in in the midsts of major health care reform (way over due reform) that may change the specialities people go into so this could shift dramatically in the next 1-2 years.

[6afashtoony]

hello doctor..

i'm a medical student who is really interested in pediatrics orthopedics..u seem like you do u're job very well so i was wondering if you can help..

i would like to hear your advice on that speciality ..plus i have some questions..

p.s.the video was very helpful ..thanks a lot !

[kmwindisch]

@6afashtoony peds ortho is a great speciality, although difficult to get into as the ortho residencies are very competative. What would you like to know?

[6afashtoony]

@kmwindisch well how hard is it to deal with kids in pain? ..i mean im usually good with kids but i'm not sure how hard is it going to be when in pain..

plus how demanding is the job when it comes to working hours? i'm planning on having a family life rather than a 24/7 physician and im not sure if my plans and chosing peds ortho goes 2gether..

and how many years is the residency for it?

[kmwindisch]

@6afashtoony with regards to the pain. It depends upon your perspective. I think of dealing with post op and trauma patients as preventing pain or taking pain away so I find the experience rewarding. If you are somebody who focuses on the pain that is present then this isn't for you.

[kmwindisch]

@6afashtoony @6afashtoony with regards to the pain.

Here in the states, peds ortho is a 5 year residency of general ortho plus 1 more year of peds orthe (fellowship) and often one more of peds spine. The hours aren't the greatest even after training but better than say general surgery or peds surgery but not as good as general peds. I'm not a morning person so anything that involves 5 am pre op rounds was out for me.

[kmwindisch]

@6afashtoony

here in the states, peds ortho's are paid very well but tend to be limited to bigger cities like Los angeles, New York, San Franscisco, Seatle, Chicago, Detroit, etc. Smaller town like Las Vegas and here in Reno don't have any pediatric orthopedic docs so your choice of cities is somewhat limited too.

Hope this helps.

[arayandres]

i have a test in one hour... that's exactly what i needed to know! Thank you, Dr!!

[kmwindisch]

@arayandres Glad to help

[dmsanct]

really helpful, thanks. I read in my texts that "you WILL realize when the maneuver is positive becaue you won' be able to forget it easily once you see it" :P

[kmwindisch]

@dmsanct the sensation is hard to miss after you feel it the first time. next holiday season try disarticulating the turkey legs. it is a similar sensation.

[kmwindisch]

@dmsanct I't's not so much what you see as what you feel. The sensation of grinding will travel up and down your spine. Once you feel it, you'll have nightmares about it for the rest of your life.

[vanerou]

Thanks Dr!! It helped me a lot!!!

[kmwindisch]

@vanerou  you are welcome

[Vickanese7]

Hey Doctor,

As a med student....Thank you.

[kmwindisch]

@Vickanese7 you are welcome

[daniielmx]

Thanks a lot!

There's nothing like seeing it. Verbal explanation is really hard to understand.

In my class (at Mexico) we saw "Rotor" and "Ortolani" maneuvers but i haven't found which one is Rotor.

Wolud be nice to see neurologic response tests like babinsky, of those on ballard score!

(Here in Mexico we use Capurro score so i don't know much about Ballard)

[kmwindisch]

@daniielmx You are welcome. I will be doing one on a complete neurologic exam, nor now check out the one on the cranial nerve exams.

Ballards and Capurro scores are harder to demonstrate because I need premature infants and they are only avaliable to me in the hospital where videotaping is not allowed. I will see what I can do for that one.

[salesmanwho]

ok helped me a lot, thanks

[kmwindisch]

you are welcome.

[shaireenejill]

may i know what is the pathophysiology of DDH.. thank you!

[kmwindisch]

it is a combination of environmental factors like positioning pre and postnatally and intrauterine restriction, and genetic factors.

[yuksh]

thank you! this helps a lot

[kmwindisch]

glad to help

[alz06]

Thanks it helped in my ped rotation.

[kmwindisch]

you are welcome. I love to teach students and teach med, NP, PA students and FP residents (no peds residency in my community). I'm glad to have been able to help.

What else would you like to see?

[phunkboxx]

Thanks for posting!!

[kmwindisch]

thanks for watching. More pediatric content will be coming.