Lower Limbs Flashcards
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
Nerve for gluteus maximus test
Inferior gluteal
L5 S1-2
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
Nerve for gluteus medius and minimus
Superior gluteal
L5 S1
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
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
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
Purpose of trendelenberg test
Test integrity of abductors in hip joint
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
Features of patient with positive trendelenberg test
Walk with a waddle as a loss or weakness of motor function of gluteus medius and minimus
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
Nerve for quadriceps test
Femoral L2-4
Movements around hip joint
Flexion Extension Adduction Abduction Circumduction
Movements around knee joint
Flexion
Extension
Limited rotation
Movements around ankle joint
Dorsiflexion
Plantar flexion
Movements around talo-calcaneo-navicular joints
Inversion
Eversion
Movements of digits
Flexion
Extension
Abduction
Adduction
Quadriceps muscle test
Sit on chair with knees flexed at 90 degrees. Ask to try and extend knee against resistance and palpate anterior quadriceps
Iliopsaos test
Flex thigh against resistance
Test for hamstrings
Patient lies prone- flex knee for 30 degrees against resitance at ankle palpating posterior thigh
Testing adductor group of leg
Lie on side supporting upper leg which is abducted- ask to adduct leg against resistance
Testing for tibialis anterior
Ask to invert foot and up while examiner grasps forefoot to oppose movement
Where to palpate tibialis anterior tendon during test
Anterior and below the medial malleolus
Testing for fibular compartment of lower leg
Ask to evert and oppose movement by grabbing forefoot
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
L5
Anterolateral leg
Foot
2-4 dorsal
S1
sole lateral margin and heel
S2
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
L4
Nerve root ankle jerk
S1
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
