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THE LOWER LIMB

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. FLEXION EXTENSION ROTATION MEDIALLY LATERALLY.

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THE LOWER LIMB

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

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

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

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

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

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

  7. HIP FLEXION

  8. 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

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

  10. 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 EXAMINATION OF THE KNEE AND THIGHhistory of acute injury

  11. 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

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

  13. 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

  14. EXAMINATION OF THE KNEEMEDIAL STABILITY

  15. INSTABILTY OF KNEE MEDIALLY

  16. 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

  17. ANTERIOR KNEE TEST

  18. LATERAL STABILITY

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