OSPE LL Flashcards
How would you test Gluteus Maximus?
Which nerve is it supplied by?
It is supplied by the inferior gluteal (L5-S2)
For test:
- Subject lies prone with knee flexed
- Subject should extend the thigh at the hip joint
- Examiner should resist the movment at the distal end of the thigh and palpates glut max
What is the Trendelenberg test?
Test for Hip abductors:
- Subject stands upright on both feet
- Examiner stands behind.
- Note the level of both iliac crests.
- Subject is asked to stand on one leg. A drop in the level of iliac crest on the unsupported side indicates weakness of the hip abductors on the stance (contralateral) side.
How woul you test the force of the hip abductors?
By perfoming hte Trendelenberg Test
Test Gluteus Medius
Which Nerve would you test with that?
Testing the Superior Gluteal Nerve (L5+S1)
- Subject lies on side with lower limb fully extended
- Ask to abduct the limb at the hip joint
- resist at the distal end of the thigh
- palpate gluteus medius just inferior to iliac crest
How do you test the quadriceps muscles?
Which nerve do you test when doing so?
They are supplied by the femoral nerve (L2-4)
- Subjects sits on couch with leg flexed at 90°
- Asked to extend against resistance (supplied at distal end of leg)
How do you test the hamstring muscles of the thigh?
Which nerve do you test when doing so?
Sciatic nerve –> L5,S1,S2 (tibial devision except short head of biceps is fibular devision)
- subject lies prone with knee flexed to 30°
- Examiner applies pressure at distal end of led and ask the patient to flex the knee further
- Tendons should be seen at the palpateal fossa+ muscles can be felt
How would you palpate the femoral artery?
Mid-inguinal point
- between asis and pubic symphisis
How would you palpate the polpiteal artery?
Subject lies prone with knee flexed
palpate in the inferior part of the palpiteal fossa in relation to the tibia
How would you test the function of tibialis anterior?
Which nerve do you test when doing so?
Deep Fibular Nerve L4,5
- Subject is asked to invert (–> turn foot inwards and upwards)
- Examiner should resist the movement at the forefoot
- Tendons can be seen+ palpated below + anterior to medial malleolus
How would you test the function of the fibular compartment of the leg?
Which nerve do you test when doing so?
Superificial Peroneal nerve: L5,S1,S2
- Subject should evert (outside and upwards movment) the food
- Examiner resists movement
- See+palpate tendons just posterior to lateral malleolsu
How would you test the posterior compartment of the leg?
Which nerve do you test when doing so?
Tibial Nerve (S1+2)
- Ask subject to stand on toes
- Tendon+ muscles can be palpated
Where would you palpate the dorsalis pedis pulse?
Just lateral to extensor hallucis longus tendon
Palpate the tibialis posterior pulse
Palpate just behind the medial malleolus
Explain the route of the long saphenous vein (and its relationship to the malleolus)
Runs upwards 2cm infront of medial malleolus
Along medial side of leg
Hands-with medially to patella
Along medial side of thigh to saphenous opening in inguinal region
Explain the route of the short saphenous vein
What is its relation to the malleoli?
Runs from lateral side of foot inferior and posterior to lateral malleolus
Runs posterior and joins the polpiteal vein at the polpiteal fossa
Test the patellar tendon
Explain its nerve supply
Palpate the patella tendon and hammer it with patient sitting onto couch relaxed, knee 90° flexed
See response and palpate contraction of quadriceps
It tests L4
Recall the route of the patellar reflex
Sensory afferent goes to spinal chord and synapses onto anterior horn with motor effernt to quadriceps
Test the ankle jerk reflex
Which Nerve does it test?
S1-2
- Patient sits on couch with feet dangling relaxed from couch
- Stike the calcaneal tendon with the reflex hammer while holding feet slightly dorsiflexed with other hand
- If it works: plantarflexion
How would you test the adductor group of the hip joint?
Which nerve do you test by doing so?
Testing the obturator nerve (L2-4)
Situation
- Patient: Lies supine with both limbs fully extended.)
- Examiner: Stands on one side of the subject with the test leg passively abducted to 45 degrees.
Ask the patient to adduct forcefully
Examiner: applies force to resist the adduction of the thigh. With the other hand examiner palpates the medial aspect of the thigh for contraction of the adductors.
How do you test iliopsoas muscle?
Which nerve do you test when doing so?
Nerve: Iliacus - femoral nerve, L3,4; Psoas - L1,2,3
- Patient: Supine. Knee may be flexed to 90 degrees
- Examiner: Stand in front or side
- Ask the subject flex the thigh at the hip joint.
- Examiner: applies pressure at the distal end of anterior thigh to resist the flexion while the other hand holds down the pelvis.
- Muscles are not accessible for palpation
Outline the borders of the polpiteal fossa
- Superior Borders
- Lateral
- Biceps Femoris
- Medial
- Semimembranosus
- Lateral
- Inferior Borders
- Lateral head of gastrocnemius
- Medial head of gastrocnemius
- Skin and fascia (anterior)
- Femur (posteriorl)
Which structures run through the polpiteal fossa?
- Popliteal artery and vein
- Tibial Nerve and Common Peroneal Nerve
- Short saphenous vein
- Popliteal lymph nodes
What are the borders of the femoral triangle?
- Superiorly – the inguinal ligament
- Medially – adductor longus
- Laterally - sartorius
What are the contents of the femoral triangle?
How are they organised?
From lateral to medial:
- Femoral nerve
- Femoral artery
- Femoral vein
How can you idenfity the gluteal safe area?
Whay do you need it?
t is the area wher IM injections can be performed without hitting the sciatic nerve
Position the index finger on the ASIS and the middle finger on the iliac tubercle –> safe area is the area in between!
Map and test the dermatomes of the lower limb
- touch the subject on a normal area of skin with both devices you will use for testing
- Ask the subject to close the eyes
- Examine the dermatomes systematically
- Ask the patient if they can feel touch normal, dull or not at all
- Repeat on the opposide limb and compare the coressponding dermatomes
- Alway test fine touch (with cotton wool)
- and coarse touch (wich pin etc) to test both spinal sensory pathways
Test the motor component of the sciatic nerve
Any movement in foot
Knee flexion
Test the motor compartment of the gluteal nerves
Trendelbergs test
Test with subject abducting the hip and extend the hip
Test the motor component of the femoral nerve
Knee extention
Test the motor component of the obturator nerve
Hip adduction (against resistance)
Test the motor comonent of the deep peroneal nerve
Where might damage occur?
- Damage might occur at fractures of the head of fibula
look for foot drop
- –> test dorsiflexion of foot
Test the motor comparment of the superficial peroneal nerve
Eversion of foot
Surface mark the sciatic nerve
The nerve leaves the greater sciatic notch and enters the gluteal region at the midpoint between the PSIS and the ischial tubersoity.
It forms a downward curve to pass into the thigh around the midpoint between the greater trochanter and the ischial tubersoity before reaching the popliteal fossa (behind the knee).
