Method Of Exam

• Examine the hip, knee, ankle, midfoot, metatarsophalangeal joints and the interphalangeal joints.
• Examine each joint in weight bearing fashion, as well as lying down.
• For each joint, check for deformity, soft tissue swelling, fluid in the join, focal areas of tenderness and range of motion.
• Palpate the joint with one hand while moving it with the other to feel for crepitation.
• If swollen, distinguish synovial swelling from pitting edema.
  
  
• Hip
  • Inspection
    • Anatomical landmarks
      • Greater Trochanter
    • Muscles around the joint
      • Quadriceps, Hamstrings, Gluteal muscles
  • Palpation
    • Anatomical landmarks
      • Palpate for tenderness
        • in the inguinal region
        • laterally over the trochanteric bursa.
  • Range of motion. Check hip motion with knee flexed:
    • Active
      • Flexion 120^o
      • Extension
      • External rotation 45^o
      • Internal rotation 40^o
      • Abduction
      • Adduction
• Knee
  • Inspection
    • Anatomical landmarks
      • Limb alignment
      • Patellar alignment
    • Muscles around the joint
      • Quadriceps
      • Hamstrings
  • Palpation
    • Anatomical landmarks for
    • Focal areas of tenderness of 
    • Bony prominences and contours for fractures
      • Tibial tubercle
      • Epicondyles of femur
      • Margins of Tibia
    • Musculotendon junctions and tendon insertions for evulsions and tear
    • Joint line for cartilaginous injuries and arthritis
  • Range of motion
    • Flexion (130^o)
    • Extension (0^o) 
    • Look for medial and lateral instability.
    • Suspend legs with patella at equal levels and observe the height of great toes. Uneven height of great toes indicates posterior lag and loss full extension
    • Flex knee to full extent and compare the distance between heel and buttock. Disparity indicates impaired level of flexion
• Ankle
  • Inspection
    • Anatomical landmarks
      • Alignment
      • Distal fibula
      • Lateral malleolus
    • Muscles around the joint
  • Palpation
    • Anatomical landmarks for
      • Talus
      • Peroneal tendon
      • Anterior joint line
      • Medial ligament
      • Sustentaculum tali
  • Range of motion
    • Active
      • Plantar flexion (45^o)
      • Dorsiflexion (20^o)
      • Inversion
      • Eversion

• Foot
  • Inspection standing
    • Anatomical landmarks
      • Look at the integrity of the plantar arch while the patient is standing.
      • Medial process of calcaneal tuberosity
      • Heel foot pad
      • Attachment of plantar fascia
    • Muscles around the joint
  • Palpation
    • Anatomical landmarks 
      • Look for local tenderness of the Achilles tendon
      • The bottom of the foot at the calcaneus.
      • Look for tenderness of the metatarsophalangeal joints and interphalangeal joints^.
  • Range of motion
    • Active
      • Check eversion (20^o) and inversion (30^o) of the midfoot.