Post on 03-Nov-2015
description
Lower Limb Clinical
ExaminationChrissy Eade BSc(Hons) PGCE MSc
Advanced Practitioner Reporting Radiographer
Ankle/Foot History
Mechanism of injury Time elapsed since the injury Soft-tissue injury Has the patient walked on the ankle? Patients age / bone quality Associated injuries Comorbidities (DM, smoking)
Ankle Movement
Ankle Movement
Lateral Ligamentous Anatomy
Medial Ligamentous Anatomy
Lateral Ankle/Foot anatomy
Physical Exam
Neurovascular exam No NVD Note obvious deformities
Pain over the medial or lateral malleolus Palpation of ligaments about the ankle
Palpation of proximal fibula, lateral process of talus, base of 5th MT
Examine the hindfoot and forefoot
Ottawa ankle rules (1)
Base of 5th fracture
Inversion or Eversion injury?
Metatarsals/Toes MOI-stub, crush, stress.
Look-deformity, bruising.
Feel-Focal tenderness/pain over joints.
Move-minimal!
Common Injuries of foot/ankle
Scenario Out dancing the night before and went over on the
ankle.
Not able to walk at the time.
Presented to ED this am....
..please perform a clinical examination.
Knee -Anatomy
Knee-Physical Exam MOI-Hear a pop??ACL tear (~80% ), meniscal tear (~15%)
Look-swelling, popliteal fossa, muscle bulk.
Alignment-valgus/varus deformity?
! Spontaneous knee pain maybe referred
from the hip..
Tests McMurrays test (menisci)
Patellar Tap (effusion)
Anterior and Posterior draw test (PCL/ACL injury)
Valgus and Varus stress (MCL injury).
Patella Fractures History
RTA , fall onto knee.
Physical Exam
Straight leg raise against gravity (extensor mechanism still intact?)
Pain, swelling, contusions, lacerations and/or abrasions at the site of injury
Palpable defect
Hip Undress, look for scars
Feel-greater trochanter
Move-Check external, internal rotation, flexion.
Pain in the groin=nof/pubic ramus fracture
References1. http://www.bmj.com/content/326/7386/417
2. erthopod.com
3. http://www.ohri.ca/emerg/cdr/knee_rule_flash.html
4. http://www.christuslivewell.org/wp-content/uploads/2013/08/Knee-Anatomy.jpg
5. http://www.advancedfoottexas.com/2010/08/stress-fractures/#/