Lower Limb Clinical

Examination
Chrissy Eade BSc(Hons) PGCE MSc
Advanced Practitioner Reporting Radiographer

Ankle/Foot
History

Mechanism of injury
Time elapsed since the injury
Soft-tissue injury
Has the patient walked on the ankle?
Patients age / bone quality
Associated injuries
Comorbidities (DM, smoking)

Ankle Movement

Ankle Movement

Lateral Ligamentous Anatomy

Medial Ligamentous Anatomy

Lateral Ankle/Foot anatomy

Physical Exam
Neurovascular exam No NVD
Note obvious deformities
Pain over the medial or lateral malleolus
Palpation of ligaments about the ankle
Palpation of proximal fibula, lateral process of talus, base
of 5th MT
Examine the hindfoot and forefoot

Ottawa ankle rules (1)

Base of 5th fracture

Inversion or Eversion injury?

Metatarsals/Toes
MOI-stub, crush, stress.
Look-deformity, bruising.
Feel-Focal tenderness/pain over joints.
Move-minimal!

Common Injuries of foot/ankle

Scenario
Out dancing the night before and went over on the
ankle.
Not able to walk at the time.
Presented to ED this am....

..please perform a clinical examination.

Knee -Anatomy

Knee-Physical Exam
MOI-Hear a pop??ACL tear (~80% ), meniscal tear (~15%)
Look-swelling, popliteal fossa, muscle bulk.
Alignment-valgus/varus deformity?
! Spontaneous knee pain

maybe referred

from the hip..

Tests

McMurrays test (menisci)

Patellar Tap (effusion)
Anterior and Posterior draw test (PCL/ACL injury)
Valgus and Varus stress (MCL injury).

Patella Fractures
History
RTA ,

fall onto knee.

Physical Exam
Straight

leg raise
against gravity
(extensor mechanism
still intact?)
Pain, swelling,
contusions,
lacerations and/or
abrasions at the site
of injury
Palpable defect

Hip
Undress, look for scars
Feel-greater trochanter
Move-Check external,
internal rotation, flexion.
Pain in the groin=nof/pubic
ramus fracture

References
1. http://www.bmj.com/content/326/7386/417
2. erthopod.com
3. http://www.ohri.ca/emerg/cdr/knee_rule_flash.html
4. http://www.christuslivewell.org/wpcontent/uploads/2013/08/Knee-Anatomy.jpg

5. http://www.advancedfoottexas.com/2010/08/stressfractures/#/