THE LOWER LIMB

• PELVIC GIRDLE

• HIP JOINT

• KNEE JOINT

• LOWER LEG

• ANKLE

• FOOT

• TOES

Examination of the hip and knee

Revision of anatomical structures

Revision of anatomical movements

Clinical relevance of examination

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

OTHER MOVEMENTS

• ABDUCTION - GLUT MAX MIN MED• TENSOR LATA • SARTORIUS• ADDUCTION – ADDUCTORS

GRACILIS PECTINEUS QUAD FEMORIS

• CIRCUMDUCTION COMBINATION OF MOVEMENTS

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

PELVIC TILT

• TRUE LENGTH

• APPARENT LENGTH

• NB hip dislocation or # neck of femur

HIP FLEXION

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

THOMAS’S TEST

• FIXED FLEXION DEFORMIY IS MASKED BY ARCHING BACK

• REVEALED BY FLEXING SOUND HIP TO CORRECT ARCHING

EXAMINATION OF THE KNEE AND THIGH

history 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

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

TORN MENISCUS

• ROTATION ON A FIXED POINT CAUSES THE MENISCUS TO TEAR

• Locking knee• Bucket handle, ant

horn ,post horn

APLEY’S 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

EXAMINATION OF THE KNEEMEDIAL STABILITY

INSTABILTY OF KNEE MEDIALLY

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

ANTERIOR KNEE TEST

LATERAL STABILITY