LL measurement PDF

Measurements for lower limb Dr Faten Elnozahi  Hip Flexion (115° to 125°) Patient position : Supine, allow knee to flex Other leg straight Fulcrum: greater trochanter Stationary arm: Greater Trochanter & lat...

Measurements for lower limb Dr Faten Elnozahi  Hip Flexion (115° to 125°) Patient position : Supine, allow knee to flex Other leg straight Fulcrum: greater trochanter Stationary arm: Greater Trochanter & lateral superior crest of ilium Movable arm: Lateral mid-line of femur toward condyle  Hip extension (0-10°-15°) Position fulcrum Stationar Movabl of patient y arm e arm (1) Prone, opposite (1) Same (1) Same (1) Same as lower extremity over as flex ion as the table to stabilize flex ion flexion the pelvis. (2) Prone, anterior Same superior spines must Same Same be in contact with table.  Hip abduction (0-45°) Patient position: supine Fulcrum: Inferior to anterior superior spine Stationary arm: On a line between the anterior superior spines Movable arm : Dorsal mid-line of thigh toward the patella  Hip adduction to midline (45°-0) Adduction beyond mid line(0-20°-30°) Patient position : Same as above, other leg passively or actively abducted out of the way. Fulcrum: same Stationary arm: same Movable arm: same  Hip internal and external rotation (0- 45°) Patient position : Sitting, knee flexed to 90 degrees Fulcrum: Patella Stationary arm: Perpendicular or parallel to table Movable arm: Tibial crest to mid malleoli  Knee flexion and extension (0-120°- 130°) Patient position : Sitting or prone , thigh supported knee free over edge or prone Fulcrum: Lateral condyle Stationary arm: Femoral lateral midline trochanter & condyle Movable arm: Lateral mid fibula toward malleolus  Ankle dorsiflexion(0-20°) and plantarflexion (0-40°-45°) Patient position: Supine lying position. Fulcrum : Posterior to base of fifth metatarsal Stationary arm: On a line between fibular head and malleolus Movable arm: Lateral mid line of th 5 metatarsal  Subtalar inversion(0-35°) and eversion(0-35°). Patient position: Sitting, knee in flexion foot in neutral position Fulcrum: In between both malleoli Stationary arm: Parallel to leg Movable arm: Ly along heads of metatarsals pivot Cervical ROM Cervical side bending(Lateral flexion) Trunk ROM Extension 20°-30° Lateral flexion 30° Flexion75-90° average(80°) Rotation 45°  1-One is able to record motion of the thoracic spine, by taping from the spinous process of C7 to T12. Likewise, motion of the lumbar spine can be measured from the spinous process of T12 to S1. Usually, if the total spine in flexion is 4 inches the examiner will find that 1 inch occurs in the dorsal spine, and 3 inches occurs in the lumbar spine. 2-Using the fingertip-to-floor method, the distance from the third fingertip to the floor is measured, first with the patient standing erect, and then after the subject laterally flexes the spine. The change in distance from erect standing to lateral flexion is considered the range of lateral flexion.  3-The knee joint may be used as fixed point. Record distance of finger tips from the knee joint on lateral bending (see Figure B).  LongitudinalM and e around s u r e ments A. Longitudinal M ea su re m e n ts l) Material needed Tape measure 2) Patient Position Supine lying with legs relaxed in extension. 3) Method The examiner holds one end of the tape measure on the umbilicus and the other end on the medial malleolus. From anterior superior iliac spine to the medial malleolus True Leg Length Discrepancy: To determine true leg length, first place the patient's legs in precisely comparable positions and measure the distance from the anterior superior iliac spines to the medial malleoli of both ankles (from one fixed bony point to another). Begin measurement at just below the anterior superior iliac spine. Unequal distances between these fixed points verify that one lower extremity is shorter than the other.  To determine where the discrepancy lies (whether in the tibia or in the femur), ask the patient to lie supine, with his knees flexed to 90° and his feet flat on the table. If one knee appears higher than the other, the tibia of that extremity is longer. If one knee projects furthers anteriorly than the other, the femur of that extremity is longer. A true shortening may be the result of poliomyelitis, or of a fracture that crossed the epiphyseal plate during childhood.  B. Femoral length discrepancy. A. Tibial length discrepancy. Apparent Leg Length Discrepancy: Establish that there is no true leg length discrepancy before testing for an apparent discrepancy, in which there is no true bony inequality. Apparent shortening may stem from pelvic obliquity or from adduction or flexion deformity in the hip joint. During inspection, pelvic obliquity manifests itself as uneven anterior or posterior superior iliac spines while the patient is standing.  Have the patient lie supine with his legs in as neutral position as is possible, and take a measurement from the umbilicus (or xiphisternal juncture) to the medial malleoli of the ankle (from a nonfixed point to a fixed bony point). Unequal distances signify an apparent leg length discrepancy, particularly if the true leg length measurements are equal. An apparent leg length discrepancy associated with pelvic obliquity B- segmental leg length measurements: Goal: to determine site of occurrence of shortening 1. Highest point of iliac crest to greater trochanter: to determine changes in neck shaft angle 2. Greater trochanter to lateral knee joint line: to determine femoral shaft length 3. Medial knee joint line to medial malleolus : to determine tibial length  Circular Measurements These measurements are performed to evaluate the degree of muscle wasting or the degree of edema. l) Material needed Skin marker Tape measure 2) Patient Position The patient must always be in a comfortable relaxed position. The supine lying position is most often the best one to ensure relaxation of any parts of the limbs. 3) Methods The measurements always have to be taken at the same place for comparison. The "skin marker" will be used to mark on the skin the precise area. For example: Quadriceps wasting must be measured at 15 cm over the superior border of the patella. For measurement of edema a precise area must be determined and measure from a bony prominences near the area. When recording results, these must include the exact distance from which the circumference measurements have been taken. Thank You