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Lower limb examination undergrads
1.
Lower limb examination
An introductory lecture
2.
STANDARD APPROACH LOOK
FEEL MOVE SPECIAL TESTS
3.
Regional approach •
Hip • Knee • Foot (diabetic)
4.
HIP LOOK
5.
• Gait… In
hip: short limb gait trendelenburg gait antalgic gait • Scars, sinuses, skin changes, deformities
6.
• Trendelenburg test
Standing on affected leg: pelvis falls to unaffected side, body swerves to affected side to compensate
7.
FEEL
8.
• Temperature •
Joint palpation (tenderness) –GT –ASIS – Joint line – Pubic symphisis
9.
MOVE
10.
• Flexion: 0
– 140 – Thomas test 100 Right Thomas test positive
11.
• Abduction: 0
– 45 • Adduction: 0 – 30 • Internal rotate: 0 – 40 • External rotate: 0 – 50
12.
SPECIAL TESTS
13.
Limb length measurement
• To determine site of shortening • Start with galeazzi test
14.
• Then proceed
with Bryant’ triangle
15.
• Measure apparent
length: –Umbilicus to medial malleolus • Measure true length: –ASIS to medial malleolus
16.
Summary hip +
Trendelenburg test • Look • Feel • Move • Special test + Thomas test + LLD measurement
17.
KNEE LOOK
18.
• Gait patterns:
antalgic, lateral thrust • Front, side, back: – Deformities, swellings, wasting, sinus, scars, skin changes
19.
• Sit at
side of table: – Assess patella tracking (inverted J) – Measure Q – angle • ♂ - 14 ♀ - 17
20.
FEEL
21.
• Temperature •
Effusion assessment – Cross fluctuation – large – Patella tap – medium – Bulge test – little – Hollow test – minimal
22.
• Joint line
tenderness – may suggest meniscus involvement
23.
MOVE
24.
• Flexion: active,
passive • Extension: active, passive
25.
SPECIAL TESTS
26.
Aims • To
determine internal knee structures integrity • To assess patellofemoral joint stability
27.
Knee integrity •
Posterior sagging sign – PCL
28.
• Drawer’s test
– anterior and posterior • Lachman’s test – ACL
29.
• Varus and
valgus test – MCL, LCL • McMurray test – ? Done in 0 and 30 degrees
30.
PFJ assessment •
Palpate the patella and its undersurface – tenderness • Patella apprehension test
31.
Summary knee •
Look • Feel • Move • Special test + patella tracking, Q angle + effusion assessment + internal knee integrity + PFJ assessment
32.
FOOT (DIABETIC) •
Vasculopathy • Immunopathy • Neuropathy – Motor – Sensory – Autonomic
33.
LOOK
34.
• Wounds, ulcer,
gangrene • Deformities
35.
• Immunopathy –
cellulitis features • Vasculopathy – loss of hair • Neuropathy – Motor – claw toes, callosities – Autonomic – dry skin
36.
FEEL
37.
• Immunopathy –
warmth, tender • Vasculopathy – pulses, cold peripheries, CRT
38.
MOVE
39.
• Ankle –
active and passive • Tightness of tendon Achilles – Due to glycolisation products deposition
40.
SPECIAL TESTS
41.
• Neuropathy –
Sensory – glove and stocking – Monofilament – assess protective sensation • Ankle-brachio systolic index (ABSI) – 0.8 – 1.0 ratio
42.
King’s classification •
Stage 1 – normal foot • Stage 2 – foot at risk • Stage 3 – ulcerated foot • Stage 4 – infected foot • Stage 5 – necrotic foot • Stage 6 – major amputation
43.
Summary foot (diabetic)
• Aim to detect features of: – Vasculopathy –Immunopathy – Neuropathy • Classify the foot (King’s)
44.
THANK YOU
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