SPINE & LOWER

LIMB
EXAMINATION
DR THIT LWIN

FACULTY OF MEDICINE & HEALTH SCIENCES

UMS

Objectives
-to perform a systematic examination of each
region of the musculoskeletal system.

INTRODUCTION

GALS screen
Screening for the lower limb.
Examination of vertebral column.
Examination of lower limbs and vertebral column is closely
interrelated and never complete without examination of the
pelvis

SCREENING
Gait

Walk. Normal cycle

1.Heel strike, 2.stance phase
3. Toe off, 4.swing phase

Arm

Both hands behind the head

Leg

Passive hip internal Rotation

FABER Test

Spine

Spine curvature

Trendelenburg
antalgic
high stepping

Kyphosis,Scoliosis,
Lordosis

EXAMINATION OF THE SPINE

LOOK

FEEL

MOVE

Scoliosis, rib hump, asymmetry

Body list, loss of normal L
lordosis,Shoulder level,,hair
tuft,Paravertebral muscle
spasm ;Caf Au Lait Spots,
gibbus
Vertebra prominens
All spinous process
Paravertebral tenderness
Step-off in spinous process
Forward bending (40-60)
Lateral bending (40-60)
Rotation (3-18)

Spinal
excursion
test
(schobers)

Look: cervical spine-lordosis

wry neck(torticollis)
:thoracic spine (scoliosis)
asymmetry of rib cage
:rib hump

scoliosis

GIBBUS=ANGULAR
KYPHOSIS

Lumbar spine:Look lordosis

body list
Caf Au Lait Spots
hairy tufts
gibbus

Feel: spinous process

vetebral prominens
:paravertebral muscle spasm
:
step-off in spinousprocess
Move: forward flexion
lateral bending
rotation-Patient must sit on examination bed/

EXAMINATION OF HIP
LOOK
4S2AD

Scars, Sinus, Swelling, Shorting

Wasting(Atrophy)
Limb posture(Attitude), FFD,

FEEL
2T,2P

Temp, Tenderness-at GT, anterior hip

tenderness, inner side of thigh
Bony Piont-ASIS, pubic symphysis,Pulses

MOVE

Active fallowed by Passive

Flexion(0-120), Extension 0-20 Abduction(0-45)
Adduction(0-25)
Rotation- with Hip and Knee joints flexed
External rotation(0-60)
Internal rotation(0-30)

Thomas Test
Trendelenburg Test

EXTERNAL ROTATION DEFORMITY

ABDUCTION OF
HIP

ADDUCTION OF
HIP

APPARENT LENGTH

REAL LENGTH

measure from ASIS to tip of medial malleolus

and compare with the other side

TRENDELENBURG,S TEST(5S)
Trendelenburgs

test- Ask the subject to stand

on one leg and then on the other.
Observe pelvis tilt on the non weight bearing
side.
Positive result:
Key: 3S: Sound Side Sinks

NORMAL LEFT HIP

HIP MUSCLES

WEAK ABDUCTORS
OF LEFT HIP

STANDING ON BOTH LEGS

TRENDELENBERG
TEST- NEGATIVE
Means the right Hip
joint & the abductor
muscles are normal
so the pelvis tilts to
right side to lift the
left foot of the ground

TRENDELENBERG
TEST- POSITIVE
Means the right
hip abductors are
weak, so the pelvis
droops to left side

THOMAS TEST
Step 1: the patient lies supine on the
examination table. The clinician passes the palm
of his hand beneath the patients spine to identify
lumbar lordosis.
Step 2: The "normal " hip is flexed till the thigh
just touches the abdomen to obliterate the
lumbar lordosis.
Step 3: measure the angle between the affected
thigh and the table

EXAMINATION OF KNEE
LOOK

Scar, sinus ,swelling,wasting (Atrophy)

(quardriceps),deformity
Genu varus/valgus/recurvatum
FFD

FEEL

Temp , tenderness, bony pointsTibial tuberosity/patella tendon/inferior pole

of patella/collateral ligaments/quardricep
tendon

MOVE

Flexion (0-135)
Extension (0-10)

Patella tap
Collateral stress
test
Lachmanns test
Anterior drawer
Posterior drawer

THE KNEE JOINT

Look: for Genu valgum, Genu
varum: fixed flexion or
recurvatum
Quadriceps muscle wasting
Dont forget to look the popliteal
fossa
Feel : Tenderness
Temperature changes
Swelling

1.

PATELLAR TAP

1.
2.

Indication- To know about the presence of excessive

fluid in the knee joint like serous effusion, blood or pus.
Position: Patient lying down, with knee extended.
Procedure:
Empty the supra patellar pouch by gradual application of
pressure from above towards the knee joint & hold the
hand to prevent possible return flow.
Tap the patella down with the finger of the other hand

Result- If the Patella returns after touching the Femoral

condyles,
Patellar tap is positive & so some fluid is present in the knee
joint.
Patellar tap is negative in normal subjects, as there is no
excessive fluid in the knee joint.

A patellar tap

NORMAL SPINAL ANATOMY

Normal spinal
curvature to allow

springiness

to absorb excess
compressive force
Total-33

vertebrae

MOVEMENTS OF THE VERTEBRAL

COLUMN
Cervical vertebrae: Seven (7) in number
Nodding occurs at atlanto-occipital joint.
Rotational movements at atlanto axial joint
Flexion, extension & lateral flexion occur at the mid-cervical
level.
Thoracic vertebrae: Twelve (12) in number
Least mobile area, movement is mainly rotational, with
minimal flexion & extension

SPINAL MOVEMENTS- CONTINUED

Lumbar vertebrae: Five (5) in number
Flexion, Extension, Bending to right and Lt
Sacral vertebrae: Five (5) in number
All the vertebrae are fused together, so no movement is
possible
Coccyx: contains four(4) fused vertebrae

SPINAL CORD
The spinal cord extends from the foramen magnum to the
lower border of L1 vertebra in adults and L3 in children.
The posterior and anterior nerve roots at each spinal level join
one another and exit through the inter vertebral foramina
forming spinal nerves.
Spinal nerves are 31pairs in total.
8-cervical
12-thoracic
5-lumbar
5 sacral
1-coccygeal

A. NEUTRAL POSITION-NERVE ROOT IS SLACK

B. STRAIGHT LEG RAISING LIMITED BY PAIN
DUE
TO TENSION OF ROOT OVER PROLAPSED DISC.

C. TENSION INCREASED BY DORSIFLEXION

OF FOOT.
D. ROOT TENSION RELIEVED BY FLEXION

LOOK PATIENT
FACE AS WELL
AS RANGE OF
SLR

EXAMINATION OF ANKLE & FOOT

LOOK

Deformity:Flat foot (Pes planus)High arch (Pes

Cavus),bunion, tophi, claw toes, hammer toe
CTEV,

FEEL

Temp,Bony prominences,
Pulsations-anterior tibial,dorsalis pedis,peroneal,
Archilles tendon- Tenderness,palpable gap

MOVE

Ankle joint-dorsiflexion,planter flexion

Sub-talr joint- inversion,eversion
Mid-tarsal joint- Addtion, abduction

Thompso
m Test

PALPABLE GAP

THOMPSOMS TEST

THANK

YOU