LOWER LIMB Flashcards
test the movement of the hip joint
Ask patient to stand lift knee up - flex down again - ex adduction abduction circumduction
assess the movement of the knee joint
ask patient to bend knee back and then bring it back to normal position (flex and exts), foot planted on ground turning knee L and R (limited rotation)
Test movement of the ankle joint
ask patient to raise the toes (dorsiflexion)
and point toes (planter flexion)
Test the movement of the talo-calcaneal joints
ask patient to turn sole of foot inwards (inversion) and outwards (eversion)
Test movement of the metatarsal phalangeal joints
ask the patient to flex and extend their toes
Test the function of the gluteus medius muscle
ask the patient to lie on their side on the couch and abduct their leg upwards against resistance - palpate the muscle
Trendelenburg test - ask patient to stand up straight and lift one leg - observe level of iliac crest (drooping will occur on opposite side if gluteus medius and minimus are paralysed)
innervation of gluteus medius
superior gluteal nerve
innervation of gluteus maximus
inferior gluteal nerve
innervation of iliopsoas
femoral nerve
action of iliopsoas
flexion and lateral rotation of the thigh
innervation of quadriceps
femoral nerve
what muscles make up the quadriceps group
vastus medialis + intermedius + lateralis + rectus femoris
test the function of the qauds
ask patient to sit on the edge of the bed and extend their leg against resistance while you palpate the muscles of the thigh
innervation of the adductors of the thigh
obturator nerve
test the function of the adductors of the thigh
ask patient to lie down on their side - lift their leg to abducted position and ask them to adduct against resistance while you palpate their inner thigh
innervation of the hamstrings
sciatic nerve
test the function of the hamstrings
ask patient to lie on their front - ask them to bend their leg at the knee against resistance while you palpate the back of the thigh
innervation of tibialis anterior
deep peroneal nerve
test the function of the anterior leg compartment muscles
ask subject to dorsiflex the foot (lift toes up) as you resist and stabilise the ankle joint
what is the action of the fibular compartment muscles?
eversion of the foot (sole outwards)
innervation of the fibular compatment of the leg
peroneal nerve
innervation of the muscles of the posterior compartment of the leg
tibial nerve
test the function of the calf muscles
ask patient to plantar flex the foot (point toes) while sitting or lying down while you resist and palpate bellies of gastrocnemius
nerve roots of sciatic nerve
L4 L5 S1 S2 S3
surface mark the sciatic nerve
curve between midpoint of PSIS and ischial tuberosity –> travels down half way between ischial tuberosity and greater trochanter –> then travels in straight line to popliteal fossa
test the motor function of the sciatic nerve
ask patient to flex the knee against resistance
test the motor function of the gluteal nerve
ask patient to abduct their thigh against resistance
test the motor function of the femoral nerve
ask patient to extend knee against resistance
femoral nerve roots
L2 L3 L4
test the motor function of the obturator nerve
ask patient to adduct thighs against resistance
obturator nerve roots
L2 L3 L4
test the motor function of the superficial peroneal nerve
ask patient to evert their foot (soles out)
test the motor funtion of the deep peroneal nerve
ask patient to dorsiflex the foot
demonstrate the dermatomes of the lower limb
L1 groin, L2 mid thigh, L3 knee, L4 inner leg to floor, L5 outer leg to mid foot, S1 outer foot and ankle, S2 calf and back of thigh
test the patellar tendon reflex
ask patient to sit on edge of the bed - strike their patellar tendon with the hammer
nerve root responsible for patellar reflex
L4
test the achilles tendon reflex
ask patient to lie on their front and completely relax their legs - dorsiflex the patients foot slightly and strike the achilles tendon
nerve root responsible for achilles tendon reflex
S1
where would you feel the femoral pulse?
tips of finger feel at midway between ASIS and pupic symphysis
where would you feel the popliteal pulse?
midline in the inferior part of the popliteal fossa while knee is flexed to relax hamstring
palpate the dorsalis pedis pulse
dorsum of foot in first intermetatarsal space just lateral to extensor digitorum hallucis tendon
palpate the posterior tibial artery pulse
behind and below the medial malleolus
surface mark the long saphenous vein
the vein extends up the medial side of the lower limb, passing anteriorly to medial malleolus - drains into femoral vein at the femoral triangle immediately inferior to the inguinal ligament
surface mark the short saphenous vein
passes posteriorly to the lateral mallelous and along lateral border of calcaneal tendon –> passes up to popliteal fossa where it drains into the popliteal vein
define the gluteal safe area
superior lateral region of gluteal space - heel of hand at greater trochanter of femur - index finger at ASIS andrest of fingers along iliac crest
boundaries of the popliteal fossa
(diamond shape) superomedially: semimembranosus Superolaterally: biceps femoris Inferomedilly: gostrocnemius (med head) Inferolaterally: gastrocnemius (lat head)
