1
Screening Examination of the
Lower Extremities
Melvyn Harrington, MD
Department of Orthopaedic Surgery
& Rehabilitation
Loyola University Medical Center
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• Essentials of
Musculoskeletal Care
• Written for Primary
Care Providers
• Perfect for 3rd & 4th
year med students
going into primary
care
Lower Extremity Screening Exam
•
Inspect, Palpate, and Examine Lower
Extremities (skin, muscles, joints).
•
Test for ROM and muscle strength.
• Observe for specific joint
deformities, tenderness, soft tissue
swelling, joint effusions, bony
enlargement, and synovial
thickening.
2
Lower Extremity Screening Exam
• Skin - Special attention is given to
signs of chronic arterial or venous
insufficiency.
– Nails – inspect for infection, color
– Feet/legs -
– inspect skin for signs of chronic arterial or
venous insufficiency
– inspect for abnormalities of position, varus or
valgus angulation, symmetry of legs and joints
– Note any muscle atrophy, fasciculations, or
involuntary movements
Lower Extremity Screening Exam
•
Inspect for size, length, shape, and
symmetry of the legs and joints. Note any
abnormalities of position, swelling, or
redness.
•
Palpate for bony or muscle abnormalities.
– Knee – patella tendon, patella, medial and
lateral femoral epicondyles, proximal tibia
– Hip - palpate area of greater trochanter, note
any pain
Lower Extremity Screening Exam
•
Test ROM of each joint.
–
Ankle:
•
dorsiflexion (20o)
•
plantarflexion (45o)
•
eversion (20o)
•
inversion (30o)
–
Knee: Note crepitus with ROM
•
flexion (130o)
•
extension (10o)
–
Hip
•
Flexion (120o)
•
Internal Rotation (40o) When the lower leg swings laterally,
the femur rotates internally at the hip joint
•
External Rotation (45o) When the lower leg swings medially,
the femur rotates externally at the hip joint.
3
Lower Extremity Screening Exam
• Manual Motor Testing
• Always grade muscle strength on a scale of 0 to 5:
• 0—No muscular contraction detected
• 1—A barely detectable flicker or trace of contraction
• 2—Ac