LOWER EXTREMITY EXAM Flashcards
INSPECTION
- evidence of local trauma ⦁ abrasions ⦁ contusions ⦁ lacerations - landmark position - erythema - effusion - atrophy - asymmetry - ambulation / gait - limb length discrepancy
6 ROM PLANES
⦁ flexion ⦁ extension ⦁ abduction ⦁ adduction ⦁ internal rotation ⦁ external rotation
HIP FLEXION MUSCLES
⦁ anterior muscles ⦁ iliopsoas ⦁ rectus femoris ⦁ sartorius ⦁ pectineus
HIP EXTENSION MUSCLES
⦁ posterior muscles
⦁ gluteus maximus
⦁ hamstrings
⦁ adductor magnus
HIP ABDUCTION MUSCLES
⦁ gluteus medius
⦁ gluteus minimus
⦁ tensor fascia lata
HIP ADDUCTION MUSCLES
⦁ adductor longus / brevis / magnus
⦁ gracilis, pectineus, obturator externus
HIP INTERNAL ROTATION MUSCLES
⦁ gluteus medius
⦁ gluteus minimus
⦁ tensor fascia lata
HIP EXTERNAL ROTATION MUSCLES
⦁ obturator externus / internus / superior / inferior ⦁ gemelli ⦁ piriformis ⦁ quadratus femorus ⦁ gluteus maximus
FAdAxL
Labral injury (flex, adduct, axial load)
FAbER
SI joint (flex, abduct, external rotation)
FAIR
Piriformis (flex, add, IR)
FAdIR
FAI (flex, add, IR)
modified Thomas test
supine and pull knee to chest with other leg straight
- tests iliopsoas & quadriceps muscles
ober’s test
IT band
tests for hip flexibility
- Modified Thomas Test = bringing knee to chest while laying supine - tests flexibility of iliopsoas and quadriceps muscles
- Ober’s Test = patient lateral, bend superior leg and raise till knee is downward, leg is up - tests the IT band
Popliteal angle
varus vs valgus
valgus = knock knees (feet apart, knees together) - tests the MCL
varus = bow legged (knees apart, feet together) - tests the LCL
KNEE LIGAMENT ROLES
The medial collateral ligament (MCL) prevents the knee from buckling inwards (valgus injury)
The lateral collateral ligament (LCL) prevents the knee from buckling outwards (varus injury)
The anterior cruciate ligament (ACL) prevents the tibia from sliding forward under the femur
The posterior cruciate ligament (PCL) prevents the tibial from sliding backward under the femur
NEUROVASCULAR ASSESSMENT - 5Ps
⦁ Pain ⦁ Pulse ⦁ Pallor ⦁ Paresthesias ⦁ Paralysis
pedal pulses
- dorsalis pedis
- posterior tibial
- anterior tibial
- peroneal
also remember to evaluate skin color, cap refill, hair growth, temperature
**if you can’t find a pedal pulse = use DOPPLER!!
PERONEAL NERVE (sensation & motor function)
⦁ sensation = palpation of dorsal surface of foot
⦁ motor function = ability to dorsiflex ankle and toes
TIBIAL NERVE (sensation & motor function)
⦁ sensation = plantar surface of foot
⦁ motor function = plantar flexion of ankle and toes
Mulder’s Sign = for
Morton’s Neuroma
Mulder’s Sign = squeeze foot at 1st and 5th metatarsal heads. positive = symptoms or a palpable click
anterior drawer test (ankle) = tests for
ATFL instability - frequently injured during inversion ankle sprain
talar tilt test = tests for
tests the lateral ligaments of the ankle
shifting ankle side to side - testing for deltoid / calcaneofibular and ATFL instability
peroneal tendon instability test
Place downward and medial force on the ankle and have the patient plantarflex/dorsiflex the ankle. Look for/feel for peroneal tendon subluxation over the lateral malleolus.
homan’s test
for DVT; patient supine; hold on to patients thigh. grab foot and firmly/abruptly dorsiflex the foot –> deep calf pain = positive Homan’s sign
Thompson test
for achilles tendon rupture;
pt prone - squeeze gastroc - normal = pt has slight plantar flexion. No response = achilles tendon not intact
