LE Palpation

Question 1

What movements is the knee joint capable of?

Answer 1

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

Question 2

Describe 2 ways to palpate the patella:

Answer 2

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).

Question 3

1. How do you palpate the tibial tuberosity?

2. What action can you use to verify this landmark?

Answer 3

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.

Question 4

Head of the Fibula

Answer 4

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.

Question 5

1) What muscle attach at the Pes Anserinus site?

2) How do you palpate the Pes Anserinus?

Answer 5

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.

Question 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?

Answer 6

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.

Question 7

1) Where does the fibular collateral ligament attach?

2) How do you palpate it?

Answer 7

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.

Question 8

How do you palpate the tibial collateral ligament?

Answer 8

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

Question 9

How do you palpate the medial meniscus?

Answer 9

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.

Question 10

How do you palpate the popliteal artery?

Answer 10

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.

Question 11

Knee Flexion Synergists (antagonists on extension)

Answer 11

Biceps Femoris 
Semitendinosus 
Semimembranosus
Gracilis 
Sartorius 
Popliteus 
Plantaris (weak)

Question 12

Knee Extension Synergists (antagonists on flexion)

Answer 12

Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius

Question 13

Medial Rotation of Flexed Knee

Answer 13

Semitendinosus 
Semimembranosus
Gracilis 
Sartorius 
Popliteus

Question 14

Lateral Rotation of Flexed Knee

Answer 14

Biceps Femoris

Question 15

Ankle: Plantar Flexion Synergists

Answer 15

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

Question 16

Ankle: Dorsiflexion Synergists

Answer 16

Tibialis anterior
Extensor Digitorum Longus
Extensor Hallucis Longus

Question 17

Ankle: Inversion Synergist

Answer 17

Tib Ant 
Tib Post 
FDL
FHL 
EHL

Question 18

Anke: Eversion Synergists

Answer 18

PL
PB
EDL

Question 19

Gastrocnemius

AOI

Answer 19

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

Question 20

Soleus

AOI

Answer 20

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

Question 21

Palpation of Gastroc and Soleus
Position 1
Position 2
Position 3

Answer 21

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.

Question 22

Plantaris

1) AOI
2) Palpation

Answer 22

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.

Question 23

Popliteus

1) AOI
2) Palpation

Answer 23

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.

Question 24

Quadricep Femoris Group

AOI

Answer 24

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

Question 25

Rectus Femoris Palpation

Answer 25

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.

Question 26

Vastus Medialis Palpation

Answer 26

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.

Question 27

Vastus Lateralis Palpation

Answer 27

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.

Question 28

Hamstring- Common Features

Answer 28

I: Ischial tuberosity
Action:
Flex Knee and Extend Hip

Question 29

Biceps Femoris

Answer 29

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

Question 30

Semitendinosus

Answer 30

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

Question 31

Semimembranosus

Answer 31

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.

Question 32

How do you palpate the hamstrings?

Answer 32

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.