MSK EXAMINATION: LOWER LIMB Flashcards
Order of Examining LL
- Hip
- Knee
- Ankle & Foot
INTRO
LOOK
FEEL
MOVE
+Function
Hip Examination - Look:
Patient lying flat & stood up
- deformity, symmetry, scars swellings, wasting
- leg length discrepancy
Hip Examination - Feel
*Greater trochanter tenderness
APPARENT LEG LENGTH
*Measure leg length from xiphisternum/umbilicus to medial malleolus using tape measure
TRUE LEG LENGTH
*Measure from ASIS to medial malleolus
- Fixed flexion deformity (commonly d/t arth.)
Hip Examination - Move
FLEXION
- knee flexed at 90º
- normal @ 120º
ROTATION
- internal and external rotation
ABDUCTION
- secure contralateral ASIS
~45º
ADDUCTION
- secure ipsilateral ASIS
*can do both abduction and adduction
• THOMAS’ TEST = fixed flexion deformity @ hip
1. fully flex patient normal hip until you feel lumbar lordosis flatten on hand
= (+) hip examining is being raised up thus relying on lumbar spine movement to get hip flat
alt. 2. flex both hips until lumbar spine flattens on hand
thenextend one leg at a time
• TRENDELENBURG TEST = abductor function
assessment of hip and proximal gluteal strength of the side patient standing on
1. Stand patient infront of you and facing mirror.
2. Place hand on iliac crests
3. flex knee and bring leg off ground
= (+) pelvis dips on the side of the non-weight bearing leg
= normal (-) pelvis remains level or may rise
NoFemur Sign
Short leg and externally rotated
Tenderness around lateral aspect of thigh
(Great) trochanteric bursitis
Hip Examination - Function:
Gaits
Antalgic = painful
Trendelenburg dip = weak abd. giving waddling gait
Ataxic = wide, clumsy
High stepping = foot drop
Examination of the Knee:
LOOK
FEEL
MOVE
FUNCTION
Examination of the Knee - Look:
standing and lying
- symmetry, alignement
- VARUS = bow legged
- VALGUS = medial deviation
- fixed flexion of knee
- rashes, wounds, scars, swellings
- quads wasting
- swelling: housemaids knee
Examination of the Knee - Feel:
- Temperature difference: mid-thigh, knee to shin (both)
- Tenderness along patella border, extensor mechanism, and medial and lateral joint lines
- Feel for bakers cyst = popliteal cysts
- PATELLAR TAP, if none, then BULGE TEST
Examination of the Knee - Move:
?pain
- Full flexion
- Full extension
-Fixed flexion deformity = Squash hand onto couch = limited extension? (ligament tear or OArth)
- Straight leg raise = check extensor mechanism
- Extensor lag
- Passive extension
- Passive flexion
- LIGAMENTS
*Flex knee at 20-30º
MCL: valgus stress = inwards
LCL: varus = outwards
make a tent with knees, feet flat, assess from side
*PCL: posterior sag (+)
ACL: pull tibia forward whilst stabilising shin
Examination of the Knee - Function:
Walking
Examination of the Foot & Ankle
LOOK
* lying and standing
FEEL
MOVE
FUNCTION
Examination of the Foot & Ankle - Look:
- nail, skin, rashes
- scards, wounds, calluses (MTarsal Heads)
- swelling or wasting of calves
toes:
- clawing: dorsiflexion
- hammer toes
- mallet toes
- joint swelling
- hallux valgus
- hallux rigidus
*check shoes
STAND UP: * arch = look medially, and from back - high arch? = pes cavus - flat arch? = pes planus - Hindfoot alignment = too many toes Vs Normal slight valgus
*mobile arch = tip toes = arch will reappear
- Achilles tendon: thickening, swelling
- Calf: muscle bulk or wasting
Examination of the Foot & Ankle - Feel:
- Temperature: shins, ankles, midfoot, forefoot
- Palpate for tenderness
- fibular head
- malleoli
- talus
- calcaneus
- navicular
- metatarsals
- phalanges
- Ankle Joint
- Subtalar joint
- Midfoot joint
- Squeeze
- Forefoot joint
- Dorsalis pedis
- Posterior tibial
- Capillary refill time
