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10-minute examination of the…

Before the patient climbs on the couch remember a few points from the patient's history and to be aware of the capsular pattern.

•Hip pain can radiate to the groin, buttock or thigh but not usually below the knee

(referred pain from the back is more likely).

•Capsular pattern theory is based on the view that when a joint is irritated from trauma, disease or degeneration, the inflamed capsule contracts producing loss of range. Each joint has its own particular pattern.

What you're looking for

•With hip pathology such as osteoarthritis, range loss is greatest with internal rotation; to a lesser degree of abduction and flexion.

•If a patient has full internal rotation of the hip they don't have osteoarthritis.

•You may not know what pathology they have but you can start examining the back or the abdomen, and you may save the patient and your budget an unnecessary X ray.

Quick checklist

•Take a careful history for hip pain

•Learn the capsular patterns for the hip, knee and shoulder (my registrars have a list near the computer they can look at while the patient is getting on the couch)

•Assess the hip by internal rotation first then flexion and abduction

•Practise looking for capsular patterns on patients you know have osteoarthritis

Best reference:

Steve Brown is a GP trainer in Beaconsfield, Buckinghamshire

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