Lower Limbs Flashcards by Owen Vineall

Test for gluteus maximus

Patient lies prone with knee flexed. Ask to extend thigh at hip joint while applying pressure at distal thigh
At same palpate rounded contour of buttock

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Nerve for gluteus maximus test

Inferior gluteal

L5 S1-2

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Test for gluteus maximus and minimums

Patient lies on side with lower limb fully extended
Ask to abduct at hip joint while applying pressure to distal end of thigh
Palpate just inferior to iliac crest

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Nerve for gluteus medius and minimus

Superior gluteal

L5 S1

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Test for tensor fascia lata

Patient lies on side slightly supine
Ask to extend thigh and abduct
Palpate their tensor fascia lata and ilio-tibial band which can become visible

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Test for hamstrings

Subject lies prone with knee flexed to 30 degrees
Ask to continue to flex while applying resistance just above posterior side of the ankle
Hamstrings tendons will become visible just around popliteal region
Palpable mid posterior thigh

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Nerve for hamstrings test

Tibial division of sciatic L5 S1-2
EXCEPT
Short head of biceps femoris which is common fibulae divisions L5 S1-2

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Purpose of trendelenberg test

Test integrity of abductors in hip joint

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Carrying out trendelenberg test

Stand still on both legs- both sides of hip should be at same level with no tilt
Ask subject to raise one leg whilst feeling their pelvis- if raised legs side drops downwards then is positive

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Features of patient with positive trendelenberg test

Walk with a waddle as a loss or weakness of motor function of gluteus medius and minimus

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Test for quadriceps

Sits on bench with knee flexed 90degrees
Apply resistance at distal end of leg and ask to extend
Quads can be palpated on anterior thigh

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Nerve for quadriceps test

Femoral L2-4

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Movements around hip joint

Flexion
Extension
Adduction
Abduction
Circumduction

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Movements around knee joint

Flexion
Extension
Limited rotation

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Movements around ankle joint

Dorsiflexion

Plantar flexion

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Movements around talo-calcaneo-navicular joints

Inversion

Eversion

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Movements of digits

Flexion
Extension
Abduction
Adduction

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Quadriceps muscle test

Sit on chair with knees flexed at 90 degrees. Ask to try and extend knee against resistance and palpate anterior quadriceps

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Iliopsaos test

Flex thigh against resistance

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Test for hamstrings

Patient lies prone- flex knee for 30 degrees against resitance at ankle palpating posterior thigh

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Testing adductor group of leg

Lie on side supporting upper leg which is abducted- ask to adduct leg against resistance

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Testing for tibialis anterior

Ask to invert foot and up while examiner grasps forefoot to oppose movement

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Where to palpate tibialis anterior tendon during test

Anterior and below the medial malleolus

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Testing for fibular compartment of lower leg

Ask to evert and oppose movement by grabbing forefoot

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Where to palpate fibularis longus and brevis

just below lateral malleolus

How to test for calf muscles

Ask to stand on toes and palpate tendon in calf area on posterior side of ankle

Nervous supply of tensor fascia lata

Superior gluteal

Nerve supply of quads

Femoral

Nerve supply of hamstrings

Tibial division of sciatic

What hamstring muscle isnt supplied by tibial division of sciatic

Short head of biceps femoris

What supplies short head of biceps femoris

Fibular branch of sciatic

Nerve supplying adductor group

Obturator nerve

Nerve supplying fibular compartment

Superficial fibular

Nerve supplying anterior compartment

Deep fibular

Nerve supplying calf muscles

Tibial

Where to palpate femoral artery

Mid inguinal point between ASIS and pubic symphysis- against pubic bone

Where to palpate popliteal artery

Inferior part of popliteal

How to palpate popliteal artery

Lies supine with knee flexed

Palpating dorsalis pedis

Palpate extensor hallucis longus tendon- navicular bone

How to expose hallucis longus tendon

Dorsiflex toes while resistance

Where to palpate tibialis anterior pulse

Palpate just behind medial malleolus- tibia

Route of long saphenous vein

runs upwards 2cm in front of the medial malleolus, along medial side of leg, hands width along the medial side of patella, along medial side of thigh to saphenous opening in inguinal region.

Route of short saphenous vein

passes posteriorly to the lateral malleolus at the ankle, runs superiorly on the posterior leg to drain into the popliteal vein after piercing the fascia over the popliteal fossa

L1 dermatome

Inguinal region

L2 dermatome

Thigh upper lateral

L3 dermatome

Thigh lower lateral

L4 dermatome

Medial leg and big toe

Anterolateral leg Foot 2-4 dorsal

sole lateral margin and heel

Leg and thigh posterior

S3-4

Medial buttock, intergluteal cleft and perineal

Carrying out patellar reflex test

sit with legs dangling. Strike patella tendon, should see brisk extension of the knee joint & should be able to palpate simultaneous contraction of the quadriceps on anterior thigh

Carrying out ankle jerk

sit with legs dangling. Strike the calcaneal tendon while holding the foot slightly dorsiflexed. Should see plantar flexion of ankle joint

Nerve root patellar tendon

Nerve root ankle jerk

Surface mark sciatic nerve

first palpate PSIS, ischial tuberosity, greater trochanter. Nerve leaves the greater sciatic notch, enters gluteal region at midpoint between PSIS and ischial tuberosity. Forms downward curve to pass into thigh around midpoint between greater trochanter and ischial tuberosity before reaching popliteal fossa

Motor test for sciatic

Lie prone knee flexed to 30 degrees and resist further flexion

Motor test for gluteal

Lie on side with leg fully extended and abduct against resistance at distal end

Motor test for femoral

Flex thigh against resistance

Obturator

Lie on side support upper leg up and ask to adduct

Superficial peroneal

Evert foot against resistance

Deep peroneal

Invert foot against resistance

Demonstrate gluteal safe area

Index finger on the ASIS, middle finger on the iliac tubercle – area in between. Superior and lateral quadrant – to minimise risk of damaging sciatic nerve.

Borders of femoral triangle

Inguinal ligament superiorly Adductor longs medially Sartorious laterally

Contents of femoral triangle

Femoral nerve artery and vein

Positions of contents of femoral trianle

Medial to lateral- VAN

Boundaries of popliteal fossa

Superolateral- biceps femoris Superomedially- semimembranous Inferiorly- lateral and medial gastrocnemius Anteriorly- femur

Contents of popliteal fossa

popliteal artery and vein tibial and common peroneal nerve | short saphenous vein popliteal lymph nodes