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

THE LOWER LIMB PELVIC GIRDLE HIP JOINT KNEE JOINT LOWER LEG ANKLE FOOT TOES

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Page 1: THE LOWER LIMB PELVIC GIRDLE HIP JOINT KNEE JOINT LOWER LEG ANKLE FOOT TOES

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

Page 9: THE LOWER LIMB PELVIC GIRDLE HIP JOINT KNEE JOINT LOWER LEG ANKLE FOOT TOES

HIP FLEXION

Page 10: THE LOWER LIMB PELVIC GIRDLE HIP JOINT KNEE JOINT LOWER LEG ANKLE FOOT TOES

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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THOMAS’S 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 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

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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

Page 15: THE LOWER LIMB PELVIC GIRDLE HIP JOINT KNEE JOINT LOWER LEG ANKLE FOOT TOES

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

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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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