THE LOWER LIMB
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Transcript of THE LOWER LIMB
THE LOWER LIMB
• PELVIC GIRDLE• HIP JOINT• KNEE JOINT• LOWER LEG• ANKLE• FOOT • TOES
Examination of the hip and knee
Revision of anatomical structuresRevision of anatomical movementsClinical 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