Lower Limb Clinical

ExaminationChrissy 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

References1. 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/wp-content/uploads/2013/08/Knee-Anatomy.jpg

5. http://www.advancedfoottexas.com/2010/08/stress-fractures/#/