Lower Limb Palpation and Muscle Testing Flashcards
What is the normal torsion angle?
10-15 degrees is considered “normal anteversion”
Coxa Norma is considered ___ degrees between the femoral neck and the medial side of te femoral shaft
125 degrees
140 degress is considered coxa ___
vara
valga
What structures pass above the piriformis?
The superior gluteal vessels and nerve
What structures pass below the piriformis (7)?
- sciatic nerve
- posterior femoral cutaneous nerve
- inferior gluteal vessels and nerve
- nerve to obturator internus (and superior gemellus)
- nerve to quadratus femoris (and inferior gemellus)
- pudendal nerve
- internal pudendal vessels
The femoral triangle is bounded by the _______ superiorly, the _______ medially and the _______ laterally.
- the inguinal ligament
- the medial border of the adductor longus muscle
- the medial border of the sartorius muscle
What forms the floor of the femoral triangle?
The pectineus and adductor longus muscles medially and iliopsoas muscle laterally
What forms the roof of the femoral triangle?
The fascia lata, except at the saphenous opening where it is formed by the cribriform fascia
What are the 3 components of the femoral sheath?
- Femoral Artery
- Femoral Veins
- Femoral Canal
What are the 2 superficial veins of the lower limb?
great and small saphenous veins
What does the great saphenous vein drain?
the dorsal venous arch of the foot
Describe the path of the great saphenous vein
It ascends anterior to the medial malleolus along the medial side of the leg in relation with the saphenous nerve and continues upward running posterior to the medial condyles of the tibia and femur and then along the medial aspect of the thigh where it terminates with the femral vein
Where is the best place to palpate the great saphenous vein?
anterior to the medial malleolus
When are handheld dynometers more effective at sensing change in muscle strength than MMT?
for MMT grades 3.5 and above
If a patient performed a gastrocnemius and soleus MMT grade of 3 what were they able to do?
Maintaining the heel off the floor through one to two repetitions only with subsequent attempts resulting in decreased range
If a patient performed a gastrocnemius and soleus MMT grade of 4 what were they able to do?
Maintaining the heel fully off the floor through three to five repetitions with subsequent attempts resulting in decreased range
If a patient performed a gastrocnemius and soleus MMT grade of 5 what were they able to do?
Maintaining the heel fully off the floor through more than six repetitions
What is the Thomas test used to measure the flexibility of what 4 muscles/muscle groups?
- Iliopsoas muscle group
- Rectus Femoris
- Tensor Fascia Latae/Iliotibial Tract
- Sartorius
What reflects a negative Thomas test result?
The lower back and sacrum remain on the table.
The hip can make a 10° posterior tilt or a 10° hip extension.
The knee must be able to make 90° flexion.
What reflects a positive Thomas test result?
The patient is not able to maintain their lower back and sacrum against the table.
The hip has a large posterior tilt
The hip is not able to reach neutral position
The knee is not able to meet flexion of 80° or more
When should hamstring length be assessed?
In patients who display altered hip extension or increased muscle bulk in the distal two thirds of the hamstrings on postural assessment
What is the normal length of the hamstrings?
80° of hip flexion with the contralateral leg extended, and 90° with the contralateral leg flexed
When should adductor length be assessed?
When an adductor notch is noted during the postural assessment or when a patient stands with excessive hip adduction with or without excessive medial femoral rotation
What is the normal length of the adductors?
hip abduction to 45° without lateral movement of the pelvis
How can you differentiatie between the one- and two-joint hip adductors?
Passively flex the knee to 15° (plases the two-joint hip adductors on slack)
- An increase in the range of hip abduction when the knee is flexed indicates that the shortness is in the two-joint hip adductors (adductor longus, gracilis, and medial hamstrings). - If the hip abduction remains unchanged, the one-joint hip adductors are likely short
Triceps surae tightness can be a hidden cause of what pathology?
LBP
What is the normal length of the triceps surae?
0° of foot dorsiflexion
When the gluteus mediaus and minimus are weak which muscles become the primary hip abductors?
the tensor fascia lata or quadratus lumborum
How do you test for quadratus lumborum muscle length?
Have the patient sidebend to each side and observe the smoothness of the spinal curves
What indicates a shortened quadratus lumborum?
the lumbar spine appears straight when the patient bends to the opposite side, and a fulcrum is seen above L4-L5
How do you test for piriformis muscle length?
stands beside the leg being tested with the patient in supine
place that leg into hip flexion just less than 60° (45 to 55 degrees)
Adduct and medially rotate the hip
Where can you palpate the pririformis?
2-3 inches lateral to a line drawn between the PSIS and the apex of the sacrum along a line drawn from the middle of this line to the greater trochanter
Trendelenburg sign is assocaited with hip drop to the ____ side of the affected muscles
opposite
How does someone with Trendelenburg Gait compensate?
by leaning the torso toward the involved side during stance phase on the affected extremity
What does Ober’s test evaluate?
evaluates a tight, contracted or inflamed tensor fasciae latae and iliotibial band
How do you perform Ober’s test?
With the patient sidelying, extend the hip, adduct through the use of gravity, and externally rotate the hip
What is the purpose of the Noble compression test?
: To assess for iliotibial band friction syndrome
What represents a positive Noble compression test?
Pain produced over the distal IT band, where the pressure is being applied, before 30 degrees short of knee extension is a positive test
What is the purpose of Craig’s test?
To determine the anteversion of the femur
How is the Craig’s test performed?
The patient is prone and the tested knee is placed in 90 degrees of flexion. The examiner then begins to rotates the hip medially and laterally, while palpating the greater trochanter area, until the outward most point is found in the lateral aspect of the hip (the greater trochanter is parallel to the table at this point). The angle is then measured to determine the patient’s amount of anteversion
What is normal hip anteversion?
8-15 degrees
Where can you palpate the adductor canal?
in the middle third of the thigh between the anterior and medial compartments of the thigh
Where can you palpate the popliteal artery?
In the popliteal fossa (more medial than lateral)
Where can you palpate the great saphenous vein?
Just anterior to the medial malleolus
