Lower Extremity Assessment and Procedures

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Lower Extremity Assessment and Procedures

• PRA 635

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Osseous Anatomy of Hip Joint
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LAE Hip

• There is no palpable joint play that can give
  examiner specific palpatory awareness of loss of
  joint play in LAE, but..
• Patient Supine with leg in neutral abduction and
  neutral external rotation
• Examiner Contacts patients calcaneus and dorsum
  of foot
• Action Impulse and body weight inferiorly
• Do not internally rotate leg as doing so may jam
  femoral head into acetabulum

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LAE Hip
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Hip Flexion-Adduction Arc Test

• Patient Supine with knee in flexion
• Examiner Stands perpendicular to patient
• Fingers interlocked over patients knee and
  snugly against chest/sternum
• Action Downward pressure through femur shaft
  into hip joint
• Move hip joint through an arc from 90 of hip
  flexion to full adduction and then from 140 of
  hip flexion to full adduction
• May feel a sticking point within this arc

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Hip Flexion-Adduction Arc Test
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Osseous Anatomy of Knee Joint
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Patellar Superior-Inferior Glide

• Patient Supine with 5 knee flexion and support
• Examiner Holds superior and inferior aspects of
  patella with thumbs/index fingers of both hands
• Action Push patella superior to inferior without
  downward pressure
• Normal glide is 1-2 inches
• Mobilize by several stretching type pushes inot
  fixation

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Patellar Superior-Inferior Glide
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Patellofemoral AP Rock

• Patient Supine with 5 knee flexion and support
• Examiner Holds one thumb on superior aspect of
  patella and other thumb on inferior aspect of
  patella
• Action Push AP on superior aspect of patella and
  then on inferior aspect of patella

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Patellofemoral AP Rock
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Patellofemoral ML and LM Excursion

• Patient Supine with 5 knee flexion and support
• Examiner Holds medial and lateral aspects of
  patella with thumbs/index fingers of both hands
• Action Push ML or LM, gliding patella on femur
• Fixation is though to be fibrotic restriction

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Patellofemoral ML and LM Excursion
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Tibiofemoral Varus Tilt

• Patient Supine with legs extended
• Examiner Stands facing medial aspect of LE
• Superior hand is placed on medial femoral
  condyles
• Inferior hand grasps ankle
• Action Bring knee just-off lock and tilt ML
• Manipulation uses HVLA directed ML

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Tibiofemoral Varus Tilt
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Tibiofemoral Valgus Tilt

• Patient Supine with legs extended
• Examiner Stands facing lateral aspect of LE
• Superior hand is placed on lateral femoral
  condyles
• Inferior hand grasps ankle
• Action Bring knee just-off lock and tilt LM
• Manipulation uses HVLA directed LM

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Tibiofemoral Valgus Tilt
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Tibiofemoral AP Glide

• Patient Supine with knee flexed 90
• Examiner Seated facing distal aspect of
  patients foot for stabilization
• Grasp posterior aspect of proximal tibia with
  fingers
• Thumbs placed on either side of tibial tuberosity
• Action Short thrust delivered PA then AP

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Tibiofemoral AP Glide
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Tibiofemoral LAE

• There is no palpable joint play that can give
  examiner specific palpatory awareness of loss of
  joint play in LAE, but..
• Patient Supine with leg abducted 45 and off
  table
• Examiner Stabilizes patients tibia with inner
  thighs
• Contact both hands on either side of and just
  proximal to femoral condyles
• Action Both knees extend while simultaneously
  pushing cephalad with both hands

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Tibiofemoral LAE
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Tibiofemoral Rotational Mobilization

• Patient Supine with hip and knee flexed
• Examiner Standing beside patient grasping
  proximal aspect of tibia just inferior to
  tibiofemoral joint
• Assess rotational joint play in medial and
  lateral rotation
• Action Examiner meets physiological barrier of
  motion, either medial or lateral, and holds this
  end-range
• While holding end play, rotate entire knee joint
  further into range mobilizing fixation

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Tibiofemoral Rotational Mobilization
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Superior Tibiofibular AP Shear

• Patient Supine with knee flexed at 90
• Examiner Contacts superior fibular head with
  thumb on anterior surface and index finger bent
  at 45 on posterior surface
• Action AP and PA shear

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Superior Tibiofibular AP Shear
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Osseous Anatomy of the Foot
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Mortise Joint LAE

• Patient Supine with knee and hip flexed at 90
• Examiner Seated with back against patients
  posterior upper leg
• Examiner cradles ankle with both hands
• Lateral hand contacts dorsal surface of foot at
  talus
• Indifferent (medial) thumb contacts posterior
  aspect of ankle joint just above Achilles
  insertion
• Foot should be everted to lock subtalar joint

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Mortise Joint LAE

• Action Examiner pushes away from body while
  producing slight counterpressure against
  patients upper leg

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Mortise Joint LAE
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Mortise Joint AP Glide

• Patient Supine with knee and ankle flexed at 90
• Examiner Contact hand grasps above mortise
• Stabilizing hand holds plantar surface of foot
  until ankle is flexed at 90
• Action Examiner uses push-pull mobilization

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Mortise Joint AP Glide
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Subtalar Rock

• Patient Supine with knee and ankle flexed at 90
• Examiner Contacts navicular on dorsal surface
  with thumb web and just above insertion of
  Achilles tendon with indifferent thumb web
• Action Joint distraction then thumb web
  contacting calcaneus pushes with slight wrist
  flexion
• Other thumb web contact pushes in reverse
  direction with same force rocks calcaneus on
  talus

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Subtalar Rock
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Subtalar Joint Medial/Lateral Tilt

• Patient Supine with knee and ankle flexed at 90
• Examiner Contacts navicular on dorsal surface
  with thumb web and just above insertion of
  Achilles tendon with indifferent thumb web
• Action Examiner uses LAE to cause medial/lateral
  tilt of joint
• Foot should not be everted

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Subtalar Joint Medial Tilt
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AP Glide Metatarsals on Cuneiforms

• Patient Supine with knee flexed at 90
• Examiner Stands laterally to patient and finds
  base of first metatarsal bone
• Examiners superior hand is over cuneiform and
  inferior hand is over first metatarsal
• Action Inferior hand moves such that index
  fingers and knuckles of both hands rub on one
  another as metatarsals are moved in AP glide on
  cuneiforms

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AP Glide Metatarsals on Cuneiforms
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Metatarsal-tarsal Mobilization

• Patient Supine position
• Examiner Stabilizes dorsal aspect of cuneiforms
  and cuboid with index finger and thumb web
• Mobilizing hand makes contact with metatarsal
  hand with index finger
• Action Metatarsal heads are lifted slightly, and
  a clockwise force and then a counterclockwise
  mobilizing force are applied

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Metatarsal-tarsal Mobilization
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Intermetatarsal Mobilization

• Patient Supine position
• Examiner Seated at foot of patient
• Contacts shaft of fourth and fifth metatarsals
• Index finger is on dorsal aspect and thumb on
  plantar aspect of forefoot proximal to metatarsal
  heads
• Action Mobilize fifth metatarsal while
  stabilizing fourth metatarsal in AP plane
• Progress in same manner for assessment other
  digits/articulations

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Intermetatarsal Mobilization
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MTP LAE

• Patient Supine position
• Examiner Contacts the phalanx with platform
  contact
• Platform is a fully flexed index finger acting as
  a platform with thumb holding phalanx
• Action While stabilizing metatarsal head,
  examiner contacts proximal base of phalanx and
  pulls

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MTP LAE
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Cuboid AP Glide

• Patient Supine position
• Examiner Contacts dorsal and plantar surfaces of
  cuboid with index and thumb, respectively
• Indifferent hand makes contact on dorsal,
  proximal aspect of fifth metatarsal shaft
• Action Joint play in PD or DP directions
• Manipulation action approximates
  wringing-out-towel action, with both hands moving
  in rotational direction

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Cuboid AP Glide
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Cuboid AP Glide