LE Palpation Flashcards Preview

PHTH 550- Orthopaedic Management > LE Palpation > Flashcards

Flashcards in LE Palpation Deck (32):
1

What movements is the knee joint capable of?

Flexion
Extension
When the knee is flexed, medial and lateral rotation

2

Describe 2 ways to palpate the patella:

1) Partner in supine w/ knee ext. Try gently shifting the patella from side to side.
2) Partner sitting w/ legs hanging off bed. Passively flex and extend the knee as you explore the patella's mvt. (Patella should move from lateral to medial during knee flexion).

3

1. How do you palpate the tibial tuberosity?
2. What action can you use to verify this landmark?

1. Partner seated w/ knee flexed. Locate the patella and slide 3 or 4 in inferior to locate the tibial tuberosity.
2. Ask pt to extend their knee, you will be able to feel the patellar ligament where it attaches to the tibial tuberosity.

4

Head of the Fibula

Partner seated w/ the knee flexed. Locate the tibial tuberosity and slide laterally 3 or 4 in.

Verify this landmark by having partner lie in prone, bend knee 90 and follow the biceps femoris tendon distally to the head of the fibula.

5

1) What muscle attach at the Pes Anserinus site?
2) How do you palpate the Pes Anserinus?

1) Sartorius, Gracilis, Semitendinosus (Say Grace at Tea)
2) Partner seated w/ knee flexed, locate the tibial tuberosity, slide medially one inch and explore its flat surface and any palpable tendons.

6

1) What inserts on the adductor tubercle?
2) How do you palpate the Adductor Tubercle?
3) What action can you use to verify this landmark?

1) Adductor Magnus
2) Partner seated w/ knee flexed. Locate the medial epicondyle of the femur. Slide superiorly along the medial side of the femur to feel the small point of the tubercle.
3) W/ your thumb on the proximal aspect of the tubercle, have your partner adduct his hip.

7

1) Where does the fibular collateral ligament attach?
2) How do you palpate it?

1) Head of the fibula to the lateral epicondyle of the femur.
2) Partner seated w/ knee flexed. Locate the head of fibula and lat epicondyle. Strum horizontally btwn these two landmarks.

8

How do you palpate the tibial collateral ligament?

Partner seated w/ knee flexed. Locate the medial epicondyle Slide distal to the joint space and strum finger horizontally across this space.

9

How do you palpate the medial meniscus?

Partner seated w/ knee flexed. Place thumb on medial tibial plateau in the joint space.
Slowly rotate the knee medially, a gentle pressure against the thumb should be felt.
Try switch between medial and lateral rotation to feel the subtle pressure.

10

How do you palpate the popliteal artery?

Partner supine or prone. Flex the knee and hold the knee so the fingertips of both hands are at the midline of the posterior knee. This pulse may be subtle and hard to find.

11

Knee Flexion Synergists (antagonists on extension)

Biceps Femoris
Semitendinosus
Semimembranosus
Gracilis
Sartorius
Popliteus
Plantaris (weak)

12

Knee Extension Synergists (antagonists on flexion)

Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius

13

Medial Rotation of Flexed Knee

Semitendinosus
Semimembranosus
Gracilis
Sartorius
Popliteus

14

Lateral Rotation of Flexed Knee

Biceps Femoris

15

Ankle: Plantar Flexion Synergists

Gastrocnemius
Soleus
Tibialis posterior
Peroneus longus
Peroneus brevis
Flexor digitorum longus
Flexor hallucis longus
Plantaris

16

Ankle: Dorsiflexion Synergists

Tibialis anterior
Extensor Digitorum Longus
Extensor Hallucis Longus

17

Ankle: Inversion Synergist

Tib Ant
Tib Post
FDL
FHL
EHL

18

Anke: Eversion Synergists

PL
PB
EDL

19

Gastrocnemius
AOI

A: Flex Knee and Plantar Flex Ankle
O: Condyles of the Femur, posterior surface
I: Calcaneus via AT

20

Soleus
AOI

A: Plantar Flex Ankle
O: Soleal Line Tib; posterior aspect of fibula
I: Calcaneus via AT

21

Palpation of Gastroc and Soleus
Position 1
Position 2
Position 3

Position 1- Pt standing on toes posterior leg
Position 2- Pt standing on toes, palpate medial side of the leg
Position 3- Prone: Bend Knee to 90 so the gastric is shortened and ineffectual as a PF. Ask pt to PF against resistance. Isolate soleus from gastroc.

22

Plantaris
1) AOI
2) Palpation

A: Weak PF of ankle and weak flexor of knee
O: Supracondylar line of femur
I: Calcaneus via AT

2) Position: partner prone w/ knee flexed.
Locate head of fib, move thumb medially into popliteal space btwn gastroc heads. Look for an inch wide belly that runs obliquely from lat to med.

23

Popliteus
1) AOI
2) Palpation

A: Medially Rotate Flexed Knee and Flex Knee
O: Lateral condyle of femur
I: Proximal Posterior aspect of tip

-Important for unlocking knee from extended position.
-Very deep, so hard to palpate

2) Position: Prone w/ knee flexed.
Locate tibial tuberosity and slide medially around the posterior shaft tibia.

24

Quadricep Femoris Group
AOI

A:
All: Extend Knee
RF: Flex Hip
O:
RF: AIIS
VM: Medial Lip of the Linea Aspera
VL: Lat lip of linea aspera, gluteal tuberosity and greater trochanter.
VI: Anterior and lateral shaft of femur
I: Tibial tuberosity via the patella and patellar ligament

25

Rectus Femoris Palpation

Position: Supine w/ knee bolstered.
Locate AIIS and Patella. Draw an imaginary line btwn these two points. Strum across the fibers.
Ask pt to flex hip and hold foot off the table.

26

Vastus Medialis Palpation

Position: Supine w/ knee bolstered
Ask pt to fully extend knee.
Palpate medial and proximal to the patella.
Should be a teardrop between rectus femurs and sartorius.

27

Vastus Lateralis Palpation

Position: Pt in side lying.
Place hand on lat side of thigh and have pt extend and relax knee.
Differentiate between vertical fibres of ITB and oblique fibres of lateralis.

28

Hamstring- Common Features

I: Ischial tuberosity
Action:
Flex Knee and Extend Hip

29

Biceps Femoris

A: Flex the knee, laterally rotate the flexed knee,
LH: Extend the hip and laterally rotate the hip
Tilts the pelvis posteriorly.
O: LH: Ischial Tuberosity SH: Lateral line of linea aspera
I: Head of Fibula

30

Semitendinosus

A: Flex knee, medially rotate the flexed knee, extend the hip, help to medially rotate hip. Tilts pelvis posteriorly.
O: Ischial Tuberosity
I: Proximal medial shaft of tibia at Pes Anserinus tendon

31

Semimembranosus

A: Flex the knee, medially rotate the flexed knee, extend the hip, assist to medially rotate the hip, tilt pelvis posteriorly.
O: Ischial Tuberosity.
I: Posterior aspect of the medial condyle of the tibia.

32

How do you palpate the hamstrings?

Hamstring Group
Position: Prone.
Place hand on posterior thigh, ask partner to flex the knee holding the foot off the table. Locate the ischial tuberosity and slide one in distally to find the solid tendon of the hamstrings.

Individual Muscles:
BF: Partner prone w/ knee flexed. Explore lateral half of hamstring, follow the tendon of the BF to the head of the fibula.
SM/ST: Medial half of hamstrings, palpate tendons as they merge onto the tibia.