Testing muscle groups of the lower limb Flashcards
How is the tibialis anterior muscle/tendon examined and what is the nerve responsible?
Ask the patient to turn their foot inwards and upwards (inversion) and grasp the forefoot to oppose the movement. The tendon becomes prominent and palpated just below and anterior to the medial malleolus.
Deep fibular nerve, L4 and L5.
How are the extensor hallucis longus and extensor digitorum longus muscles/tendons examined and what is the nerve responsible?
Ask patient to dorsiflex their toes while placing the palm of your hand across the toes to oppose the movement. The tendons of EHL, EDL and tibialis anterior can be seen and palpated.
Deep fibular nerve, L4 and L5.
How are the fibularis longus and fibularis brevis muscles/tendons examined and what are the nerves responsible?
Ask the patient to turn their foot outwards and plantar flex (eversion) while grasping the forefoot to oppose the movement.
The tendons become prominent and palpated just below the lateral malleolus.
Superficial fibular nerve, L5, S1 and S2.
How are the gastrocnemius, soleus m. and calcaneal (Achilles) tendon examined and what are the nerves responsible?
Ask the patient to stand on their toes.
The muscle bellies and the calcaneal tendon can be seen and palpated in the calf area and on the posterior side of the ankle.
Tibial nerve, S1 and S2.
What is the purpose of the Trendelenberg test?
For the integrity of abductors of the hip joint.
To evaluate the motor loss of the abductors (gluteus medius and minimus) of the hip joint.
Patients with a positive Trendelenberg test tend to ‘waddle’ when they walk.
How is the Trendelenberg test performed?
Ask the patient to stand on both legs.
Both right and left side of the pelvis should remain at same level without any tilt.
Stand behind the patient and feel the pelvis.
Ask the patient to raise one leg off the ground.
The pelvis should remain horizontal on one leg.
If the pelvis on the raised leg side drops downwards then the Trendelenberg test is positive.
A positive test indicates a loss or weakness of the motor function of the abductor muscles (gluteus medius and minimus) in the leg the subject is standing on (supported side).
How is the function of the gluteus maximus muscle tested, and what nerves are responsible for its contraction?
Ask the patient to lie prone with their knee flexed.
Ask the patient to extend the thigh at the hip joint while applying resistance at the distal end of the thigh.
Palpate the rounded contour of the buttock for the muscle contraction.
Inferior gluteal nerve, L5, S1 and S2.
How is the function of the gluteus medius and minimus muscles tested, and what nerves are responsible for their contraction?
Ask the patient to lie on their side with the lower limb fully extended.
Ask the patient to abduct the limb at the hip joint while applying resistance at the distal end of the thigh.
Palpate the contraction of the gluteus medius just inferior to the iliac crest.
Superior gluteal nerve, L5 and S1.
How is the function of the tensor fascia late muscle tested, and what nerves are responsible for its contraction?
Ask the patient to lie on their side with the lower limb fully extended. Roll the patient slightly towards supine (not fully) and place your finger tip on the tensor fascia late muscle and ilio-tibial tract (which may become visible).
Ask the patient to abduct the limb at the hip joint while applying resistance at the distal end of the thigh.
Superior gluteal nerve, L5 and S1.
How is the function of the hamstring muscles tested, and what nerves are responsible for their contraction?
Ask the patient to lie prone with their knee flexed to 30 degrees.
Apply an opposing force just above the posterior side of the ankle while the patient attempts to flex their knee further.
The hamstring tendons will be seen around the popliteal region and the muscle contraction is palpable on the posterior side of the mid-thigh.
Tibial division of sciatic nerve, L5, S1 and S2, except for biceps short head, which is common fibular division, L5, S1 and S2.
How is the function of the quadriceps muscles tested, and what nerves are responsible for their contraction?
Ask the patient to sit on the couch with knees bent to 90 degrees over the edge.
Apply pressure at the distal part of the leg while the patient attempts to extend it.
The contracting quadriceps can be palpated on the anterior thigh.
Femoral nerve, L2-4.
