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