the lower limb pelvic girdle hip joint knee joint lower leg ankle foot toes
TRANSCRIPT
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