THE LOWER LIMB

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THE LOWER LIMB

• PELVIC GIRDLE
• HIP JOINT
• KNEE JOINT
• LOWER LEG
• ANKLE
• FOOT
• TOES

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Examination of the hip and knee

• Revision of anatomical structures
• Revision of anatomical movements
• Clinical relevance of examination

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MOVEMENTS OF HIP JOINT

• FLEXION
• EXTENSION
• ROTATION MEDIALLY
• LATERALLY

• ILIO-PSAOS RECTUS FEMORIS
• GLUTEUS MAX HAMSTRINGS AND GRAVITY
• GLUTEUS MEDIUS AND MINIMUS
• GLUT MAX PIRIFORMIS OBTURATORS

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OTHER MOVEMENTS

• ABDUCTION - GLUT MAX MIN MED
• TENSOR LATA
• SARTORIUS
• ADDUCTION ADDUCTORS GRACILIS PECTINEUS QUAD
  FEMORIS
• CIRCUMDUCTION COMBINATION OF MOVEMENTS
  

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STEPS IN HIP EXAMDetailed history of injury

• POSITION PELVIS
• INSPECTION
• PALPATOION
• MEASUREMENT OF LIMB LENGTH
• EXAM FOR FIXED DEFORMITY
• GENERAL EXAM

• MOVEMENTS
• POWER AGAINST RESITANCE
• ABNORMAL MOBILITY
• POSTURAL STABILITY
• GAIT

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PELVIC TILT

• TRUE LENGTH
• APPARENT LENGTH
• NB hip dislocation or neck of femur

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HIP FLEXION
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TRENDELENBERG TEST

• WHEN ONE LEG IS LIFTED THE PELVIS IS TILTED
  HIGHER ON THAT SIDE NEGATIVE
• IF PELVIS DROPS ON THAT SIDE TEST IS POSITIVE

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THOMASS TEST

• FIXED FLEXION DEFORMIY IS MASKED BY ARCHING BACK
• REVEALED BY FLEXING SOUND HIP TO CORRECT ARCHING

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EXAMINATION OF THE KNEE AND THIGHhistory of
acute injury

• INSPECTION
• PALPATION
• MEASURE THIGH GIRTH
• MOVEMENTS ACTIVE AND PASSIVE
• PAIN ON MOVEMENT
• GENERAL EXAM

• POWER AGAINST RESISTANCE
• STABILITY medial lateral,anterior posterior
• Rotation McMurray torn cartilage
• STANCE AND GAIT

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Knee movements

• Extension quadriceps femoris(rectus
  femoris,vastus lateralis medialis and
  intermedius)
• Flexion hamstrings (biceps femoris semi
  tendenosus membranosus) popliteus gastrocnemius
  sartorius gracilis
• Rotation medially popliteus gracilis sartorius
• laterally biceps femoris

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TORN MENISCUS

• ROTATION ON A FIXED POINT CAUSES THE MENISCUS TO
  TEAR
• Locking knee
• Bucket handle, ant horn ,post horn

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APLEYS COMPRESSION TEST

• Patient lies prone and knee is flexed 90
• Compression push on heel so that tibia is forced
  into femur and rotate tibia on femur
• Distraction kneel on back of thigh and pull
  tibia from femur and rotate tibia on femur
• Positive test indicates meniscal tear

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EXAMINATION OF THE
KNEEMEDIAL STABILITY
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INSTABILTY OF KNEE MEDIALLY
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Anterior and posterior draw test

• Sit on patients foot with knee flexed 90º
• Anterior Pull on tibia towards you
• Posterior push tibia into femur
• Laxity indicates damage to cruciate ligaments

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ANTERIOR KNEE TEST
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LATERAL STABILITY
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