Transcript THE LOWER LIMB - University of the Witwatersrand

THE LOWER LIMB
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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
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TENSOR LATA
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SARTORIUS
• ADDUCTION – ADDUCTORS
GRACILIS PECTINEUS QUAD
FEMORIS
• CIRCUMDUCTION COMBINATION OF
MOVEMENTS
STEPS IN HIP EXAM
Detailed history of injury
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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
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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 KNEE
MEDIAL 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