Motor System examination Part-9 I Lower Limb muscles power assessment I Knee, Ankle & Toes movements — Transcript

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1. 0:00Hello everyone. This is my ninth video
2. 0:02on motor system examination.
3. 0:05For the lower limb muscle power
4. 0:07assessment, we have to assess the
5. 0:08movements at the hip, knee, ankle, and
6. 0:11the toes. So, I have already covered the
7. 0:14hip movements. Today, I will perform the
8. 0:17knee, ankle, and the toes movement. In
9. 0:20knee joint, we have to assess the knee
10. 0:21flexor and knee extensor. So, in knee
11. 0:24flexor, child should be in the prone
12. 0:26position, and we have to tell the child
13. 0:28to flex the knee. And for against
14. 0:30resistance, we have to give the downward
15. 0:32pressure on the leg.
16. 0:35And muscles for the knee flexion are
17. 0:37mainly hamstring muscle group, in which
18. 0:40biceps femoris, semimembranosus, and
19. 0:42semitendinosus muscle.
20. 0:45There are two heads of the biceps
21. 0:46femoris, long head and short head. Long
22. 0:49head supplied by the tibial division of
23. 0:51the sciatic nerve, and short head by the
24. 0:53peroneal division of the sciatic nerve,
25. 0:56L5 S1 S2.
26. 0:58And the semimembranosus and
27. 1:00semitendinosus supplied by the
28. 1:02L5 S1 S2 sciatic nerve branch.
29. 1:06And other muscles which are also
30. 1:08involved for the knee flexion are
31. 1:10popliteus, sartorius, gracilis, and
32. 1:12gastrocnemius. Now, for the knee
33. 1:14extensor, child should be in the supine
34. 1:17or sitting position. We have to tell the
35. 1:19child to extend the knee. And for
36. 1:21against resistance, we will
37. 1:24give the pressure toward the flexion of
38. 1:26knee, and child will try to extend. And
39. 1:29the muscle for the knee extension are
40. 1:32quadriceps femoris muscle.
41. 1:35It is composed of large four muscles,
42. 1:38rectus femoris and vastus lateralis,
43. 1:40medialis, and intermedius.
44. 1:43Quadriceps femoris supplied by the
45. 1:46femoral nerve, L2 L4. Whenever child is
46. 1:49having quadriceps muscle weakness, child
47. 1:51will have the difficulty in climbing a
48. 1:53stairs, walking forward, and in sitting
49. 1:56position, when you will tell the child
50. 1:58to extend the knee, child will lean
51. 2:00backward
52. 2:02because of the quadriceps muscle
53. 2:04weakness. Now, at the ankle joint, we
54. 2:06have to assess the ankle plantar flexor,
55. 2:09dorsiflexor, inversion, and eversion
56. 2:11movements.
57. 2:12In plantar flexor, child should be in
58. 2:15supine or sitting position, and we have
59. 2:17to tell the child to plantar flex the
60. 2:19foot at ankle joint, and for against
61. 2:22resistance, we will keep our hand over
62. 2:24the
63. 2:25sole of the foot, and we will give the
64. 2:27dorsiflexion force. We can also assess
65. 2:30the plantar flexor by telling the child
66. 2:33to stand on the tiptoe, hop on one foot,
67. 2:36and muscle for the ankle plantar flexion
68. 2:39are gastrocnemius and soleus muscle
69. 2:42supplied by the tibial nerve S1 S2. Now,
70. 2:45for the ankle dorsiflexion, child should
71. 2:47be either in the sitting or supine
72. 2:49position.
73. 2:50We will tell the child to do the foot up
74. 2:53position. And for against resistance, we
75. 2:56will keep our hand over the foot, and we
76. 2:58will give the downward pressure.
77. 3:01Even we can assess when the child is in
78. 3:03a standing or walking, we will tell the
79. 3:06child to stand or walk on heel. So, we
80. 3:09can assess the dorsiflexor. Main muscle
81. 3:12for the ankle dorsiflexion is tibialis
82. 3:15anterior supplied by the deep peroneal
83. 3:17nerve L4 L5.
84. 3:19Other muscle which also contribute are
85. 3:21the extensor digitorum longus and
86. 3:23extensor hallucis longus. In ankle
87. 3:26dorsiflexor weakness or tibialis
88. 3:28anterior muscle weakness, child will
89. 3:30have the foot drop. It is seen in the L5
90. 3:33radiculopathy.
91. 3:34When child will walk, child will have
92. 3:36the steppage or high stepping gait.
93. 3:39In this, child will raise the affected
94. 3:42leg higher than the
95. 3:44ground by exaggerated flexion at the hip
96. 3:46and the knee joint to compensate the
97. 3:49ankle dorsiflexion. Normally, when child
98. 3:53walk,
99. 3:54heel is strike first. While in the ankle
100. 3:57dorsiflexor weakness, in foot drop, toes
101. 4:00is strike first followed by the heel.
102. 4:03So, there will be a audible double slip
103. 4:06sound
104. 4:07present whenever there is a
105. 4:09high stepping gate.
106. 4:11Now, for the ankle inversion, we have to
107. 4:13tell the child to invert the foot or to
108. 4:16turn the sole medially. In this video,
109. 4:18you can see how to perform the ankle
110. 4:20inversion. And the muscle for the ankle
111. 4:23inversion are tibialis posterior when
112. 4:25the foot in the plantar flexion
113. 4:27position. And tibialis anterior when the
114. 4:31foot in the ankle dorsiflexion position.
115. 4:34Tibialis posterior is supplied by the
116. 4:36tibial nerve L5 S1 and tibialis anterior
117. 4:38is supplied by deep peroneal
118. 4:41nerve L4 to L5.
119. 4:43Now, for the ankle eversion, we have to
120. 4:45tell the child to raise the outer border
121. 4:48of foot or to turn the sole laterally.
122. 4:51And the muscles for the ankle eversion
123. 4:53are
124. 4:53peroneus longus, brevis, and tertius.
125. 4:56Peroneus longus and brevis supplied by
126. 4:59the superficial peroneal nerve.
127. 5:01It is also helpful for the plantar
128. 5:04flexion.
129. 5:05And peroneus tertius supplied by the
130. 5:08deep peroneal nerve
131. 5:10L4 to L5 S1.
132. 5:13And also extensor digitorum longus help
133. 5:15for the ankle eversion.
134. 5:17Now, after that, we have to perform the
135. 5:20dorsiflexion and the plantar flexion of
136. 5:23the
137. 5:24toes movement.
138. 5:25So, in the dorsiflexion of the toes, we
139. 5:27have to tell the child to extend the
140. 5:29toes.
141. 5:31Against the resistance, we have to keep
142. 5:33our finger over the toes. And the
143. 5:35muscles for the dorsiflexion of toes or
144. 5:38extension of the toes, we can say, are
145. 5:41extensor digitorum longus, extensor
146. 5:43digitorum brevis, and extensor hallucis
147. 5:47longus.
148. 5:48Now, after that we have to perform the
149. 5:50flexion of the toes. In this, we have to
150. 5:53tell the child to flex the toes and for
151. 5:56against resistance, we will keep our
152. 5:58finger over the plantar surface of the
153. 6:01toes and we will tell the child to flex
154. 6:03the toes. And muscles for the flexion of
155. 6:07toes are
156. 6:08flexor digitorum hallucis longus and
157. 6:11brevis and for the great toe, calf
158. 6:12muscle. So, this is all about the lower
159. 6:15limb muscle power assessment. Thank you
160. 6:18so much.