Testing joints of the lower limb and their movement

Question 1

What movements are possible at the hip joint?

Answer 1

Flexion
Extension
Abduction
Adduction
Circumduction

Question 2

What movements are possible at the knee joint?

Answer 2

Flexion
Extension
Limited rotation

Question 3

What movements are possible at the ankle joint?

Answer 3

Dorsiflexion

Plantar flexion

Question 4

What movements are possible at the talo-calcaneo-navicular joints?

Answer 4

Inversion + eversion of the foot.

Question 5

How is flexion of the hip joint tested, and what are the spinal nerve roots involved?

Answer 5

Ask standing patient to raise each leg forward in front of them, keeping it completely straight.
L2 + L3.

Question 6

How is extension of the hip joint tested, and what are the spinal nerve roots involved?

Answer 6

Ask standing patient to raise each leg behind them, keeping it completely straight.
L4 + L5.

Question 7

How is extension at the knee joint tested, and what are the spinal nerve roots involved?

Answer 7

Ask the patient to completely straighten each knee from a flexed (bent) position.
Push down on anterior surface just above ankle
L3 + L4.

Question 8

How is flexion at the knee joint tested, and what are the spinal nerve roots involved?

Answer 8

Patient to lie prone with legs straight + toes hanging over edge of the table, place 1 hand on posterior thigh+ use the other hand to apply resistance to the distal calf downwards as the patient actively flexes their knee
L5 + S1.

Question 9

How is dorsiflexion of the ankle joint tested, and what are the spinal nerve roots involved?

Answer 9

Ask patient to point their toes towards the ceiling.

L4 + L5.

Question 10

How is plantar flexion of the ankle joint tested, and what are the spinal nerve roots involved?

Answer 10

Ask patient to point their toes away from them as if on tip-toes.
If standing, ask to raise heels
S1 + S2.

Question 11

How is abduction of the hip joint tested, and what are the spinal nerve roots involved?

Answer 11

Ask standing patient to raise each leg out to their side while keeping it straight.
L5 + S1.

Question 12

How is adduction of the hip joint tested, and what are the spinal nerve roots involved?

Answer 12

Ask the patient to bring each leg in towards the midline from abduction (out to the side) while keeping it straight.
L1-4.

Question 13

What is circumduction of the lower limb at the hip joint?

Answer 13

A combination of flexion/extension + abduction/adduction so the distal part moves in a circle.

Question 14

What is eversion of the foot at the talo-calcaneo-navicular joints?

Answer 14

Moving the sole of the foot away from the median plane, i.e. facing laterally.

Question 15

What is inversion of the foot at the talo-calcaneo-navicular joints?

Answer 15

Moving the sole of the foot towards the median plane, i.e. facing medially.

Question 16

How would you test circumduction of the hip joint?

Answer 16

Get patient to stand on 1 leg + put other leg out at 45 degrees
Then circle their hip around (demonstrate if necessary)

Question 17

How would you test the limited rotation of the knee joint?

Answer 17

Sit over edge of couch
Stabilise thigh with 1 hand + give downwards + inwards resistance at ankle with other hand, evert foot
Repeat same procedure but for internal rotation: apply downwards + outwards resistance

Question 18

How would you test extension of the 1st metatarsal-phalangeal joint?

Answer 18

Patient to sit with ankle in neutral position
Rest test foot in your lap, stabilise the metatarsal area by contouring hand around plantar surface of foot with thumb curving round base of great toe, provide resistance by placing thumb over MPJ use other hand to stabilise foot at heel, get patient to actively extend MPJ

Question 19

How would you test flexion of the 1st metatarsal-phalangeal joint?

Answer 19

Patient to sit with ankle in neutral position
Rest test foot in your lap, stabilise dorsum of foot just below ankle using 1 hand
Use index finger of other hand to resist beneath proximal phalanx of great toe whilst patient actively flexes great toe