Lower Limb 1.2 Flashcards
What are the joint movements permitted at a particular joint determined by?
- shapes of the reciprocal articular surfaces of the bones
- surrounding ligaments
- muscle tone
What are general rules for examination of joints?
1) Look – visual inspection
2) Feel - palpation
3) Move – range of passive movements
4) Measure – measure the degrees of movement
5) Compare with the opposite limb
How do you assess the passive movements and tone of joints in the lower limb?
- After inspection and palpation ask the patient to consciously relax the limb and trunk muscles
- hold the part of the limb and move the joint gently
- Notice and record any abnormalities during the passive movement of the joint
What are you looking for when you hold the part of the limb and move the joint gently
- stability of the joint
- abnormal movements
- joint crepitus
- rigidity
- spasticity
- pain
- Range of movements
What do you compare the joint of one limb with?
the other limb
What is the passive range of movement?
When the examiner moves the joint through a range of motion, with no effort from the patient
What is the range of movement of a joint determined by?
- joint structure
- ligaments
- tendons
- muscles
- skin
- tissue injury
- fat tissue
- body temperature
- activity level
- age
- sex
What can these factors affect?
- passive movement of a joint
- result in hyper mobility or hypo mobility of. joint
What else affects joints other than physical factors?
neuromuscular activity in the muscles responsible for voluntary movement at a joint usually causes few muscle fibres within a muscle being in a state of contraction all the time
What is this contraction responsible for?
skeletal muscle tone
How do you test degrees of loss or increase of tone?
- passively moving the joints 2. comparing the resistance to the movements by the muscles on the two sides of the body
What do you feel when you test for passive movement of a joint?
some residual resistance even though the patient was not consciously contracting that muscle
What is this residual resistance?
muscle tone
What is responsible for the muscle tone?
reflex control from the afferent nerve endings situated in the muscle itself
What underlies muscle tone?
integrity of the spinal segmental reflex arc
What happens if there is a breach in the spinal segmental reflex arc where the simple spinal reflexes are not functioning?
- that muscle will be without any tone
- muscle will remain fully relaxed or floppy
What happens if you test for passive movement of the joint where. break in spinal segmental reflex arc?
experience hypermobility
What does the anterior root of the spinal nerve do? What are these motor neurones referred to as?
- it is part of spinal segmental reflex arc
- sends motor neurons to the muscle
- these motor neurons are referred to as the lower motor neurons
What are the lower motor neurons of the spinal segmental neurons are influenced by?
nerve impulses received from the cerebral cortex, midbrain, pons and medulla
What are these supra spinal neurons called?
upper motor nuerons
What sort of effect do impulses from the upper motor neurones have on lower motor neurons?
an inhibitory effect on the lower motor neurons
What happens if there is an upper motor neurone lesion?
- If the higher cerebral control is interrupted, as in an upper motor neuron lesion
- this inhibitory influence will be lost which results in an exaggeration of the muscle tone
What happens if you test for passive movement at a joint with upper motor neuron lesion?
rigidity or hypomobilty
How do you asses muscular power of muscles of hip and knee joints?
- will resist the movement by applying an opposing force and estimate the power of the contracting muscle/s.
- If possible, you will also palpate or visually observe the contracting muscle.
- Please note that all of the muscles may not be palpated or seen especially if they are located deep
What is a prime mover?
main muscle responsible for producing a specific movement of the body part
What muscles does flexion at the hip joint test?
- Psoas major
2. iliacus (Sartorius, rectus femoris, pectineus)
What muscles does extension at the hip joint test?
Gluteus maximus
What does abduction at the hip joint test?
- Gluteus medius
2. Gluteus minimus
What does adduction at the hip joint test?
- Adductor longus
- adductor brevis
- adductor magnus (pectineus, gracilis)
What is involved in cirumduction?
All above muscles
What does internal (medial) rotation at the hip joint test?
Obturator externus, (all adductors, semitendinosus and semimembranosus)
What does external (lateral) rotation at the hip joint test?
- Piriformis
- obturator internus
- gemellus superior & inferior
- quadratus femoris (biceps femoris) tree
What does flexion at the knee joint test?
- Biceps femoris
- semitendinosus
- semimembranosus
- (gracilis)
What does extension at knee joint test?
Quadriceps femoris
What is the purpose of the Trendelenberg test?
- test the strength of the hip abductors
- gluteus medius and minimus
What happens if these muscles are weak in Trendelenberg test?
they become unable to give the supportive effect on the pelvis
What happens when the foot is raise on the normal side?
pelvis falls towards that side
What happens if the hip adductors are normal?
the pelvis will stay in position, or slightly tilt upwards
What happens if the hip adductors are weak on one side?
the pelvis will tilt downwards towards the normal side when the foot on the normal side is raised
What happens when there is weight bearing on the affected leg?
pelvis droops
What is the method of the Trendelenberg test?
- With consent, position your hands on the patient’s iliac crests
- Ask the patient to lift each foot in turn off the floor
- When the right foot is raised, the left hip abductors are being tested
- When the left foot is raised, the right hip abductors are being tested
- The abductors should be strong enough to support the pelvis and keep it level on a one-legged stance.
- They may even contract sufficiently that you feel a slight upwards tilt in the pelvis - this is normal (see diagram A and C below) - If there is weakness in the abductors, they will be unable to stabilise the hip on the weight bearing femur, so the pelvis will sag towards the unsupported side (see diagram B and D below).
What muscles are in the anterior compartment of the leg?
dorsiflexor and inverter group of muscles of the foo
What muscles are in the posterior/fibular compartment of the leg?
plantarflexor and evertor group of muscles of the foot
What are the muscles involved in plantarfelxion of the foot at the ankle joint?
- Gastrocnemius
2. Soleus (tibialis posterior, fibularis longus)
What are the muscles involved in dorsifelxion of the foot at the ankle joint?
- Tibialis anterior
- extensor hallucis longus
- extensor digitorum longus
- fibularis tertius
Where does inversion and eversion of the foot occur?
subtalar joints
What muscles are involved in inversion of the foot?
- Tibialis posterior
2. Tibialis anterior
What are the muscles involved in eversion of the foot?
Fibularis longus, brevis & tertius
