Transcript Testing the Muscles of the Lower Extremity

Knee and Ankle
Mazyad Alotaibi
Testing The Muscles of Knee
Knee Extension
ANATOMY:
Prim mover /agonist: Quadriceps
muscle group which consists of 4
muscles
• rectus femoris
• vastus lateralis
• vastus intermedius
• vastus medialis
Synergist / Accessory Muscles:
Tensor Fascia Latae
Range of motion:
135 to 0
Substitution:
when pt in side-lying (grade 2),pt may use hip
internal rotators.
Knee Extension
Effect of weakness and contracture:
effect of weakness : - difficulty in getting up & down from sitting position as
well as on going up & down stairs.
- knee hyperextension.
effect of contracture : - restriction of knee flexion
shortness of the Rectus Femoris, results in a restriction of the knee flexion
when the hip is extended or a restriction of the hip extension when the knee
is flexed.
Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient
ROM
Knee Flexion
ANATOMY:
Prim mover /agonist:
Hamstring muscles Biceps femoris,
Semitendinosus, and Semimembranosus
- Synergist / Accessory Muscles:
Gracilis, TFL, Sartorius, Poplieus,
Gastrocnemius, &Plantaris.
Range of motion: O to 135
Substitution:
- hip flexors.
- Sartorius
- Gracilis
Knee
Flexion
Effect of weakness and contracture:
effect of weakness : - weakness of both med & lat hamstring causes knee
hyperextension.
-weakness of lat. Hamstring causes loss of lateral knee stability.
-weakness of med. Hamstring decrease medial knee stability.
effect of contracture: - knee flexion deformity accompanied by posterior tilting of
the pelvis and flattening of the lumbar curve.
- restriction of knee extension when the hip is flexed
or restriction of the hip flexion when the knee is extended.
Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand,
Direction of Resistance
c- Test
d- Instruction to patient
•
Knee flexion should be measured with the subject supine. This position allows assessment of
the joint range of motion without interference from tightness in the rectus femoris muscle. If
the examiner wishes to assess length of the rectus femoris, have the patient lie prone
Ankle Planter Flexion
ANATOMY:
Prim mover /agonist: Gastrocnemius and
Soleus
Synergist / Accessory Muscles:
Tibialis posterior, plantaris, peroneus longus & brevis,
Flexor digitorum & hallucis longus.
Range of motion:
Substitution:
1.
2.
3.
0 to 45
Flexor hallucis longus and flexor digitorum longus
Peroneus longus and brevis.
Tibialis posterior.
Ankle Planter Flexion
Effect of weakness and contracture:
effect of weakness : - result in an hyperextension of the knee as well as in a non-weight bearing
position as in standing.
- during walking the inability to rise on toes.
effect of contracture: result in an equnus position of the foot and flexion of the knee.
- also a restriction of the ankle dorsiflexion when the knee is extended and a restriction of the
knee extension when the ankle is dorsiflexed.
Procedures:
WB test and Non WB test
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient
Foot Dorsiflexion and Inversion.
ANATOMY:
Prime mover/agonist: Tibialis Anterior
Synergist/ Accessory muscles:
peroneus tertius, extensor digitorum and hallucis
longus.
Range of motion: 0 – 20
Substitution:
By the extensor digitorum and
extensor hallucis longus muscles
results in toes extension
Foot Dorsiflexion and Inversion.
Effect of weakness/contracture/shortening:
effect of weakness: decrease the ability to dorsiflex the ankle joint (droop foot).
effect of contracture: in ability to plantarflex the ankle.
Foot Dorsiflexion and Inversion.
Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand,
Outer hand, Direction of Resistance
c- Test
d- Instruction to patient
•
•
•
•
Patient Position:
·
Sitting, with the patient’s heel resting on the
thigh of the therapist. Patient's foot should be
dorsiflexed and inverted.
Therapist and Patient Instructions:
·
Therapist is sitting on stool beside the limb
being tested. The heel of the patient can be
resting on the therapist’s thigh. The resistance
hand should be placed around the dorsum and
medial aspect of the foot. Resistance is given
down and out toward eversion. The stabilizing
hand is around the posterior leg just above the
ROM
Foot Inversion From Planter Flexion
ANATOMY:
Prime mover/agonist: Tibialis posterior
peroneus tertius (with Dorsiflexion), extensor digitorum
and hallucis longus.
Range of motion: 0 – 35
Substitution:
the flexors digitorum and hallucis longus muscles results in toes
flexion
Foot Inversion From Planter Flexion
Effect of weakness/contracture/shortening:
effect of weakness: may dropping in medial arch of the foot. ( flat foot).
effect of contracture: in ability to plantarflex & evert the ankle.
Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient
ROM
Foot Eversion From Plantar Flexion
ANATOMY:
-
Prime mover/agonist:
Peroneus longus and Peroneus brevis
-
Synergist/ Accessory muscles:
Extensor digitorum longus and Peroneus Tertius.
- Range of motion: 0- 35
- Substitution:
No substitution.
Synergist/ Accessory muscles: Extensor digitorum longus
and Peroneus Tertius.
Foot Eversion fromPlantar Flexion
Effect of weakness/contracture/shortening:
effect of weakness: may results in:
- Decrease the strength of eversion of the foot & planter flexion of the ankle jt.
- Decrease lateral stability of the foot.
effect of contracture: results in an everted or valgus position of the foot.
Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient
ROM
Test for Lower limb discrepancy
Definition:
Lower limb discrepancy is a condition of unequal long or round
measurements of the lower limbs. Long measurements or Leg
length discrepancy (LLD) may comes from difference in length of
the femur, or tibia, or both. In some conditions, the whole side is
affected, including the upper limbs. Round measurement or Leg
circumference discrepancy may comes from difference in lower
limbs size due to muscle atrophy or swelling.
Leg length discrepancy : Many people walk around with LLD’s of up
to 2 cm. and not even know it. However, discrepancies above 2 cm.
becomes more noticeable, and a slight limp is present. But even up
to 3 cm. a small lift compensates very well. Beyond 3 cm. however,
the limp is quite pronounced, and medical care is often sought at
that point. Walking with a short leg gait is not only unsightly, but
increases energy expenditure during ambulation. It could also put
more stress on the long leg, and causes functional scoliosis.
Test for Leg Length Discrepancy
A- True leg length Discrepancy
Measure from A.S.I.S to inferior border of medial
malleolus Fix point to fix point
• Patient lies supine on a table with trunk, pelvis,
and legs in straight alignment and legs close
together. The distance from ASIS to the medial
malleolus is measured on right and left.
• To determine the reason of shorted leg whether
in the tibia or in the femur :
Ask the patient lies in crock lying position by
support his feet on the surface of table with
knees and hips flexed. Make good observation
on the knees level. (tibia and femur bone). If
one knee project further anteriorly than the
other, the femur of that extremity is longer. If
one knee appears higher than the other, the
tibia of that extremity is longer.
Gross Leg Length Discrepancy
Magee 4th Edition – pg. 628
B- Apparent leg length discrepancy
In apparent shortening, the limb is
not altered in length, but appears
shortened. This may be as a result
of an adduction contracture of the
hip joint, which has to be
compensated for by tilting of the
pelvis, or SIJ pathology causing
pelvic rotation.
Non-Fix point to fix point
-Measure from tip of xiphoid process
to inferior border of medial
malleolus.
- Measure from the umbilicus to the
medial malleolus
Leg Length Measurements
Eyeball method
Measurement method
Prone Knee Flexion Test for Tibial Shortening
Measurement of circumference of the
knee
Swelling around the knee joint
1.
2.
3.
- at middle of patella
-below the patella 5cm
-above the patella 5cm
Muscle atrophy:
1.
2.
3.
4.
Above the patella 10cm
Above the patella 15cm
Above the patella 20cm
Above the patella 25cm