THE LOWER LIMB PELVIC GIRDLE HIP JOINT KNEE JOINT LOWER LEG ANKLE FOOT TOES.

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Presentation transcript:

THE LOWER LIMB PELVIC GIRDLE HIP JOINT KNEE JOINT LOWER LEG ANKLE FOOT TOES

Examination of the hip and knee Revision of anatomical structures Revision of anatomical movements Clinical relevance of examination

MOVEMENTS OF HIP JOINT FLEXION EXTENSION ROTATION MEDIALLY LATERALLY ILIO-PSAOS RECTUS FEMORIS GLUTEUS MAX HAMSTRINGS AND GRAVITY GLUTEUS MEDIUS AND MINIMUS GLUT MAX PIRIFORMIS OBTURATORS

OTHER MOVEMENTS ABDUCTION - GLUT MAX MIN MED TENSOR LATA SARTORIUS ADDUCTION – ADDUCTORS GRACILIS PECTINEUS QUAD FEMORIS CIRCUMDUCTION COMBINATION OF MOVEMENTS

STEPS IN HIP EXAM Detailed history of injury POSITION PELVIS INSPECTION PALPATOION MEASUREMENT OF LIMB LENGTH EXAM FOR FIXED DEFORMITY GENERAL EXAM MOVEMENTS POWER AGAINST RESITANCE ABNORMAL MOBILITY POSTURAL STABILITY GAIT

PELVIC TILT TRUE LENGTH APPARENT LENGTH NB hip dislocation or # neck of femur

HIP FLEXION

TRENDELENBERG TEST WHEN ONE LEG IS LIFTED THE PELVIS IS TILTED HIGHER ON THAT SIDE NEGATIVE IF PELVIS DROPS ON THAT SIDE TEST IS POSITIVE

THOMAS’S TEST FIXED FLEXION DEFORMIY IS MASKED BY ARCHING BACK REVEALED BY FLEXING SOUND HIP TO CORRECT ARCHING

EXAMINATION OF THE KNEE AND THIGH history of acute injury INSPECTION PALPATION MEASURE THIGH GIRTH MOVEMENTS ACTIVE AND PASSIVE PAIN ON MOVEMENT GENERAL EXAM POWER AGAINST RESISTANCE STABILITY medial lateral,anterior posterior Rotation McMurray torn cartilage STANCE AND GAIT

Knee movements Extension quadriceps femoris(rectus femoris,vastus lateralis medialis and intermedius) Flexion – hamstrings (biceps femoris semi tendenosus membranosus) popliteus gastrocnemius sartorius gracilis Rotation medially popliteus gracilis sartorius laterally biceps femoris

TORN MENISCUS ROTATION ON A FIXED POINT CAUSES THE MENISCUS TO TEAR Locking knee Bucket handle, ant horn,post horn

APLEY’S COMPRESSION TEST Patient lies prone and knee is flexed 90° Compression push on heel so that tibia is forced into femur and rotate tibia on femur Distraction kneel on back of thigh and pull tibia from femur and rotate tibia on femur Positive test indicates meniscal tear

EXAMINATION OF THE KNEE MEDIAL STABILITY

INSTABILTY OF KNEE MEDIALLY

Anterior and posterior draw test Sit on patients foot with knee flexed 90º Anterior Pull on tibia towards you Posterior push tibia into femur Laxity indicates damage to cruciate ligaments

ANTERIOR KNEE TEST

LATERAL STABILITY