{"id":1210,"date":"2010-12-04T14:50:08","date_gmt":"2010-12-04T14:50:08","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/inspection-8\/"},"modified":"2024-01-08T14:13:09","modified_gmt":"2024-01-08T14:13:09","slug":"inspection-8","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-lower-extremities\/the-knee\/inspection-8\/","title":{"rendered":"Inspection"},"content":{"rendered":"<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Ask the patient to expose the <span style=\"color: #33cccc;\"><strong>reference points<\/strong><\/span> of the <span style=\"color: #33cccc;\"><strong>pelvis<\/strong><\/span> (<em>anterior superior iliac spine and poster superior iliac spine<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Ask the patient to stand up straight and, from a distance of about 2 to 3 metres, inspect the <span style=\"color: #33cccc;\"><strong>ventral side<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>dorsal side<\/strong><\/span> and both <span style=\"color: #33cccc;\"><strong>lateral sides<\/strong><\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Preferably, inspect in a cranial to caudal sequence.<\/span><\/li>\n<li><span style=\"color: #003366;\">Palpate when necessary, to localise the position of a certain structure with greater accuracy.<\/span><\/li>\n<li><span style=\"color: #003366;\">Assess the <span style=\"color: #33cccc;\"><strong>spontaneous posture<\/strong><\/span> (\u2018<em>individual baseline position<\/em>\u2019) and ask the patient to stretch the knees and place the feet together.<\/span><\/li>\n<li><span style=\"color: #003366;\">Assess the <span style=\"color: #33cccc;\"><strong>bony structures<\/strong><\/span> for <span style=\"color: #33cccc;\"><strong>shape<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>position<\/strong><\/span> (<em>position and relative position of the separate bone structures and joints<\/em>), comparing left and right during this process.<\/span><\/li>\n<li><span style=\"color: #003366;\">The specific inspection follows when the patient is lying down.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong>Ventral Side<\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">Stand in front of the patient and inspect the shape and position of the following structures <em><strong>[Figure 50]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-738\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-50.jpg\" width=\"400\" height=\"293\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-50.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-50-300x220.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 50<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Bones and Joints<\/em><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Pelvis<\/strong><\/span> (<em>asymmetry<\/em>): Determine by palpating reference points on both sides; iliac crest, anterior superior iliac spine <em><strong>[Figure 51]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Legs<\/strong><\/span>: Tibias are normally <span style=\"text-decoration: underline;\">exorotated<\/span>, with respect to the femurs (<em>rotation abnormalities of upper and lower leg based on the position of the patella<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Q-angle<\/strong> <\/span><em><strong>[Figure 50]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Knees<\/strong><\/span>: Genu valgum, genu varum; position of the patellas: patella alta = abnormally high patella.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Feet<\/strong><\/span>: Pes planovalgus, pes cavus.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1203\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-51.jpg\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-51.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-51-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 51<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Soft Tissues<\/em><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Skin.<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscle contours of the <\/span><span style=\"color: #003366;\">quadriceps femoris muscle + <\/span><span style=\"color: #003366;\">adductors.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong>Dorsal Side<\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">Ask the patient to make a 180\u00b0 turn, or stand behind the patient and inspect the shape and position of the following structures on the posterior side <em><strong>[Figure 52]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1204\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-52.jpg\" width=\"400\" height=\"311\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-52.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-52-300x233.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 52<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Bones and Joints<\/em><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Pelvis<\/strong><\/span>: Palpate reference points on both sides; iliac crest, posterior superior iliac spine; palpate the latter at the height of the \u2018<em>dimples<\/em>\u2019 <em><strong>[Figure 53]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Knees<\/strong><\/span>: Genu valgum, genu varum; knee fold height.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Feet<\/strong><\/span>: Calcaneus: valgus\/varus position.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1205\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-53.jpg\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-53.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-53-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 53<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Soft Tissue<\/em><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Skin<\/strong><\/span>: In particular, in the back of the knee (<em>Baker\u2019s cyst<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscle contours of the <\/span><span style=\"color: #003366;\">hamstrings + <\/span><span style=\"color: #003366;\">triceps surae muscle.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong>Lateral Side<\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">Ask the patient to make a 90\u00b0 turn followed by a 180\u00b0 turn, and assess the shape and position of the following structures <em><strong>[Figure 54]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1206\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-54.jpg\" width=\"300\" height=\"372\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-54.jpg 300w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-54-242x300.jpg 242w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 54<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Bones and Joints<\/em><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Lumbar vertebrae<\/strong><\/span>: Increased lordosis.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Pelvis<\/strong><\/span> (<em>forwards and backwards tilt<\/em>): Palpate the <span style=\"text-decoration: underline;\">anterior superior iliac spine<\/span> and the <span style=\"text-decoration: underline;\">posterior superior iliac spine<\/span> on the side concerned. Normally, the pelvis may tilt forwards by about <span style=\"color: #33cccc;\"><strong>10\u00b0 in men<\/strong><\/span> and about <span style=\"color: #33cccc;\"><strong>25\u00b0 in women<\/strong><\/span> <em><strong>[Figures 55a, 55b]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Lower extremities<\/strong><\/span> (<em>genu recurvatum, flexion contracture in knee and hip joint<\/em>): Greater trochanter, fibular head and lateral malleolus should lie along a single imaginary vertical line<em><strong> [Figures 55a, 55b]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1207\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-55a.jpg\" width=\"250\" height=\"464\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-55a.jpg 250w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-55a-162x300.jpg 162w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><strong><span style=\"width: 250px; display: block;\">Figure 55a<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1208\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-55b.jpg\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-55b.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-55b-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 55b<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Soft Tissue<\/em><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Skin (<em>fluid accumulation, Baker\u2019s cyst<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscle contours of the <\/span><span style=\"color: #003366;\">tensor fascia latae muscle &amp; iliotibial band.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Gait Pattern<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">Next, ask the patient to walk and note:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Symmetry (<em>torso rotation<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Stride length.<\/span><\/li>\n<li><span style=\"color: #003366;\">Load left and right leg.<\/span><\/li>\n<li><span style=\"color: #003366;\">Flexion contractures of the knee.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong>Specific Inspection In Lying Position<\/strong> <\/span><\/p>\n<p><span style=\"color: #003366;\">Ask the patient to lie flat on the examination table in the supine position with extended knees and hips <em><strong>[Figure 56]<\/strong><\/em>. <\/span><span style=\"color: #003366;\">Assess if this is possible (<em>Bonnet\u2019s position, flexion contracture<\/em>), and then assess the shape of the following structures:<\/span><\/p>\n<p><span style=\"color: #003366;\"><strong><em>Bones<\/em><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Contours of femoral condyles and epicondyles.<\/span><\/li>\n<li><span style=\"color: #003366;\">Patella.<\/span><\/li>\n<li><span style=\"color: #003366;\">Contours of tibial condyles.<\/span><\/li>\n<li><span style=\"color: #003366;\">Tibial tuberosities.<\/span><\/li>\n<li><span style=\"color: #003366;\">Head of the fibula.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Soft Tissue<\/em><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Skin (<em>especially in the knee region<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscle contours of the:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Quadriceps femoris muscle (<em>especially vastus medialis and vastus lateralis muscles as these atrophies first<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Patellar ligament.<\/span><\/li>\n<li><span style=\"color: #003366;\">Hoffa\u2019s fat pad.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1209\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-56.jpg\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-56.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-56-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 56<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Procedure Ask the patient to expose the reference points of the pelvis (anterior superior iliac spine and poster superior iliac spine). Ask the patient to stand up straight and, from a distance of about 2 to 3 metres, inspect the ventral side, dorsal side and both lateral sides. Preferably, inspect in a cranial to caudal [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[70],"tags":[144],"class_list":["post-1210","post","type-post","status-publish","format-standard","hentry","category-the-knee","tag-the-examination-of-the-lower-extremities"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Inspection - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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