Examination of Lower Limb

Dr Raj
 Inspection
Skin- color changes, edema, scars, tattoo,
naevus etc
Symmetry between the two lower limbs
Swellings or edema
Resting state
Superficial veins (remove vein)
Bone landmarks and contours
 palpation- any pain?
Confirm the bone landmarks
Look for tenderness in the area of these
landmarks and joint spaces
Palpate for the lymph nodes
Femoral pulse Mid inguinal ligament: b/w
ASIS & pubic ramus, Dorsalis pedis (midpoint
b/w malleoli, or near wall of 1st metatarsal)
and posterior tibial pulse
 Range of movements

Active movements
Passive movements
Active resistance
 ALLENS TEST
Indications: surgery, harvest an artery,
catheterization
Ensures both arteries are functional otherwise
there is ischaemia
Press firmly while patient makes fist
Remove pressure and open fist
If one artery blocked, when pressure removed
there is the pallor in half the hand
 Tenills Sign
- Tapping over course of median nerve
- If patient feels pain over any point in forearm
supplied by median nerve
- For carpal tunnel syndrome
Phalens test
Pain on dorsiflexion (prayer position)
Test for carpal tunnel syndrome/median
nerve entrapment
Hold hand together in flexed position 30
sec
Positive sign for carpal tunnel is tingling
in the median nerve territory
palmar surface digits 2-4.
 Strength of the Muscles

No contraction
some contraction
With gravity eliminated (lie down, less power)
Against gravity
Against resistance
 Steps of Examination
Inspection

Palpation

Range of movements

Special tests
In children, Obterator artery supplies head of femur via LIGAMENTUM TERES

Orthopaedics: patient with fracture of femur head, head implant

Q ANGLE INCREASES- knock knees

Q ANGLE DECREASES- valgum
 CTEV

pes planus- flat feet

pes cavus- arched feet

Genu verum- rickets

genu- knee
coxa- hip
 HAMMER TOE- Flexion at proximal IP join

Claw toe: FLEXION at proximal and distal PIP joints

 mallet toe

MALLETS TOE: FLEXION of distal IP joint

-Big toe or other four toes
Big toe only has 2 phalanx
 https://www.youtube.com/watch?v=c6biKrtw
oY0
 Palpation
Confirm Inspection findings.

Bony landmarks.

Joint and muscle tenderness.

 Range of Movement
Active movement.

Passive movement.

Active resisted movement.

 Special Tests
Trendelenberg sign

Anterior drawer test

Posterior drawer test