Lower Limb Palpation and Muscle Testing

Question 1

What is the normal torsion angle?

Answer 1

10-15 degrees is considered “normal anteversion”

Question 2

Coxa Norma is considered ___ degrees between the femoral neck and the medial side of te femoral shaft

Answer 2

125 degrees

Question 3

140 degress is considered coxa ___

Answer 3

vara

valga

Question 4

What structures pass above the piriformis?

Answer 4

The superior gluteal vessels and nerve

Question 5

What structures pass below the piriformis (7)?

Answer 5

• sciatic nerve
• posterior femoral cutaneous nerve
• inferior gluteal vessels and nerve
• nerve to obturator internus (and superior gemellus)
• nerve to quadratus femoris (and inferior gemellus)
• pudendal nerve
• internal pudendal vessels

Question 6

The femoral triangle is bounded by the _______ superiorly, the _______ medially and the _______ laterally.

Answer 6

• the inguinal ligament
• the medial border of the adductor longus muscle
• the medial border of the sartorius muscle

Question 7

What forms the floor of the femoral triangle?

Answer 7

The pectineus and adductor longus muscles medially and iliopsoas muscle laterally

Question 8

What forms the roof of the femoral triangle?

Answer 8

The fascia lata, except at the saphenous opening where it is formed by the cribriform fascia

Question 9

What are the 3 components of the femoral sheath?

Answer 9

• Femoral Artery
• Femoral Veins
• Femoral Canal

Question 10

What are the 2 superficial veins of the lower limb?

Answer 10

great and small saphenous veins

Question 11

What does the great saphenous vein drain?

Answer 11

the dorsal venous arch of the foot

Question 12

Describe the path of the great saphenous vein

Answer 12

It ascends anterior to the medial malleolus along the medial side of the leg in relation with the saphenous nerve and continues upward running posterior to the medial condyles of the tibia and femur and then along the medial aspect of the thigh where it terminates with the femral vein

Question 13

Where is the best place to palpate the great saphenous vein?

Answer 13

anterior to the medial malleolus

Question 14

When are handheld dynometers more effective at sensing change in muscle strength than MMT?

Answer 14

for MMT grades 3.5 and above

Question 15

If a patient performed a gastrocnemius and soleus MMT grade of 3 what were they able to do?

Answer 15

Maintaining the heel off the floor through one to two repetitions only with subsequent attempts resulting in decreased range

Question 16

If a patient performed a gastrocnemius and soleus MMT grade of 4 what were they able to do?

Answer 16

Maintaining the heel fully off the floor through three to five repetitions with subsequent attempts resulting in decreased range

Question 17

If a patient performed a gastrocnemius and soleus MMT grade of 5 what were they able to do?

Answer 17

Maintaining the heel fully off the floor through more than six repetitions

Question 18

What is the Thomas test used to measure the flexibility of what 4 muscles/muscle groups?

Answer 18

• Iliopsoas muscle group
• Rectus Femoris
• Tensor Fascia Latae/Iliotibial Tract
• Sartorius

Question 19

What reflects a negative Thomas test result?

Answer 19

The lower back and sacrum remain on the table.
The hip can make a 10° posterior tilt or a 10° hip extension.
The knee must be able to make 90° flexion.

Question 20

What reflects a positive Thomas test result?

Answer 20

The patient is not able to maintain their lower back and sacrum against the table.
The hip has a large posterior tilt
The hip is not able to reach neutral position
The knee is not able to meet flexion of 80° or more

Question 21

When should hamstring length be assessed?

Answer 21

In patients who display altered hip extension or increased muscle bulk in the distal two thirds of the hamstrings on postural assessment

Question 22

What is the normal length of the hamstrings?

Answer 22

80° of hip flexion with the contralateral leg extended, and 90° with the contralateral leg flexed

Question 23

When should adductor length be assessed?

Answer 23

When an adductor notch is noted during the postural assessment or when a patient stands with excessive hip adduction with or without excessive medial femoral rotation

Question 24

What is the normal length of the adductors?

Answer 24

hip abduction to 45° without lateral movement of the pelvis

Question 25

How can you differentiatie between the one- and two-joint hip adductors?

Answer 25

Passively flex the knee to 15° (plases the two-joint hip adductors on slack)

 - An increase in the range of hip abduction when the knee is flexed indicates that the shortness is in the two-joint hip adductors (adductor longus, gracilis, and medial hamstrings). 
 - If the hip abduction remains unchanged, the one-joint hip adductors are likely short

Question 26

Triceps surae tightness can be a hidden cause of what pathology?

Answer 26

LBP

Question 27

What is the normal length of the triceps surae?

Answer 27

0° of foot dorsiflexion

Question 28

When the gluteus mediaus and minimus are weak which muscles become the primary hip abductors?

Answer 28

the tensor fascia lata or quadratus lumborum

Question 29

How do you test for quadratus lumborum muscle length?

Answer 29

Have the patient sidebend to each side and observe the smoothness of the spinal curves

Question 30

What indicates a shortened quadratus lumborum?

Answer 30

the lumbar spine appears straight when the patient bends to the opposite side, and a fulcrum is seen above L4-L5

Question 31

How do you test for piriformis muscle length?

Answer 31

stands beside the leg being tested with the patient in supine
place that leg into hip flexion just less than 60° (45 to 55 degrees)
Adduct and medially rotate the hip

Question 32

Where can you palpate the pririformis?

Answer 32

2-3 inches lateral to a line drawn between the PSIS and the apex of the sacrum along a line drawn from the middle of this line to the greater trochanter

Question 33

Trendelenburg sign is assocaited with hip drop to the ____ side of the affected muscles

Answer 33

opposite

Question 34

How does someone with Trendelenburg Gait compensate?

Answer 34

by leaning the torso toward the involved side during stance phase on the affected extremity

Question 35

What does Ober’s test evaluate?

Answer 35

evaluates a tight, contracted or inflamed tensor fasciae latae and iliotibial band

Question 36

How do you perform Ober’s test?

Answer 36

With the patient sidelying, extend the hip, adduct through the use of gravity, and externally rotate the hip

Question 37

What is the purpose of the Noble compression test?

Answer 37

: To assess for iliotibial band friction syndrome

Question 38

What represents a positive Noble compression test?

Answer 38

Pain produced over the distal IT band, where the pressure is being applied, before 30 degrees short of knee extension is a positive test

Question 39

What is the purpose of Craig’s test?

Answer 39

To determine the anteversion of the femur

Question 40

How is the Craig’s test performed?

Answer 40

The patient is prone and the tested knee is placed in 90 degrees of flexion. The examiner then begins to rotates the hip medially and laterally, while palpating the greater trochanter area, until the outward most point is found in the lateral aspect of the hip (the greater trochanter is parallel to the table at this point). The angle is then measured to determine the patient’s amount of anteversion

Question 41

What is normal hip anteversion?

Answer 41

8-15 degrees

Question 42

Where can you palpate the adductor canal?

Answer 42

in the middle third of the thigh between the anterior and medial compartments of the thigh

Question 43

Where can you palpate the popliteal artery?

Answer 43

In the popliteal fossa (more medial than lateral)

Question 44

Where can you palpate the great saphenous vein?

Answer 44

Just anterior to the medial malleolus