PHYSICAL EXAMINATION OF

THE LOWER LIMB

Hip Examination
 SPECIAL TESTS
 Trendelenburg
 Patrick’s Test
 Thomas
 Leg Length
 Trendelenburg’s Test
 Sit pt infront of you, with you sitting in chair
 Place hands on 2 ASIS
 Raise leg off floor
 Pelvis rises –ve
 Pelvis drops +ve
 +ve = Abductor weakness
 Faber (Patrick’s Test)
 Flexion, ABD, ER
 Positive = hip or SI joint
SI Joint Compression and
Distraction Test
 Compression =supine
 Distraction = supine or
side lying
 Evaluation
 Compression
overpressure to ASIS
 Distraction
 Down pressure through
anterior aspect of Ilium
Leg Length Tests

 True Leg Length Discrepancy

 Measure ASIS to medial malleolus
 Positive = 1-1.5 cm
 Apparent (Functional) Leg Length
 Umbilicus to Medial malleolus
Leg Length Discrepancy
Measures
 Thomas Test
 Pt Position = supine with both leg on table
 Evaluation
 One hand under lumbar region
 Passively flex one leg to chest
 Positive = straight leg raises off table
 Increased lordotic curve
Knee Examination

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 Medial and lateral meniscii

C shaped
lateral
meniscus Medial meniscus

Inter-menicscial ligaments
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 ACL and PCL

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 Collateral ligaments
Popliteus
MCL

Arccuate lig.
LCL

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 SPECIAL TESTS
 Patellar apprehension test
 Ligament stability: Lachmans, Valgus/Varus
stress test
 McMurrays
 Sag’s sign
 Anterior drawer test (ACL)
 Posterior drawer test (PCL)

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 Special Tests – Anterior Knee Pain
 Patellar apprehension test*

Starting Push patella

position laterally

 Patellofemoral grind test**

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 Special Tests - Ligaments
 Assess stability Anterior Cruciate
Posterior
Cruciate
of 4 knee
ligaments via
applied
stresses*

Medial Collateral
Lateral Collateral

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 Varus/Valgus Stress
 Knee flexed to 30 °
 Support calf between
hand and torso
 Place other hand
above knee
 Stress the joint
medially + laterally
 Excessive movement
= damage
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 McMurrays Test

 Knee flexed fully

 Ext rot + valgus
stress, extend fully
 Clunk = Medial
meniscal tear
 Int rot + varus stress,
extend fully
 Clunk = Lateral
meniscal tear
 Unreliable

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 Special tests

Lackman’s test for ACL deficiency

Patient is fully relaxed

Knee flexed 20-30º

Tibia is drawn anterior in

relation to the stabilised femur

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 Sag’s sign
 Posterior sagging of the tibia at 90º flexion

 Indicates PCL deficiency

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 Anterior drawer test ( ACL)
 Knee flexed 90º

 Hamstring muscles relaxed

 Tibia is pulled forward

 Foot is stabilised

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 Anterior Drawer Test for ACL
 Physician Position & Movements*
 Patient Position

Note direction of forces

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Posterior Drawer Testing- PCL*

Note direction of forces

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 Varus and valgus stress tests
 Test the MCL and LCL integrity

 Performed at 0º & 30º of flexion

 If +ve at 0º the ACL &/or the PCL are

deficient in addition to the collateral lig.

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 Patellar alignment
 Test the medial and lateral sliding of the patella

 Apprehension test

 Clark’s test for PF pain

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EXAMINATION OF THE
FOOT AND ANKLE
 Thompson test
 Squeeze calf muscle, while foot is extended off
table to test the integrity of the Achilles tendon
 Positive tests results in no movement in the
foot

Thompson Test
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Homan’s test
- Test for deep vein
- With knee extended and foot off table, ankle is moved
into dorsiflexion
- Pain in calf is a positive sign and should be referred.

Homan’s Test
Anterior drawer test
Used to determine damage to anterior talofibular
ligament primarily and other lateral ligament
secondarily
A positive test occurs when foot slides forward
and/or makes a clunking sound as it reaches
the end point