ALS Lecture 4 - Examination of the Limbs DONE Flashcards
gait cycle
1 foot contacts ground -> same foot contracts ground
2 phases of gait cycle
stance, swing
stance phase
foot in contact with ground
swing phase
foot not in contact with ground
stance phase constitutes what percent of gate cycle?
60
5 movements in stance phase
heel strike, foot flat (loading response), mid stance, terminal stance (push off), toe off (pre-swing)
heel strike
heel is first bone to touch ground
foot flat (loading response)
weight onto reference leg
foot flat (loading response) is important for
weight-bearing, shock absorption, forward progression
mid stance
alignment (leg below body), balance body weight on reference foot
terminal stance (push off)
heel of reference foot rises while toe still on ground
toe off (pre-swing)
toe of reference foot rises, swings int air, beginning of swing phase of gait cycle
swing phase constitutes what percent of gate cycle?
40
3 parts to swing phase
initial swing, mid swing, terminal swing
pathological disorders of gait (4)
antalgic, slapping foot, foot drop, trendelenburg
antalgic gait
pain in any limb, pt walks with limp so foot on painful side on ground less
slapping foot gait
weakness in dorsiflexors, in heel strike foot can’t come up
foot drop gait
completely weak dorsiflexors, in swing foot dangles, toes strike floor and higher step
trendelenburg gait
weakness of hip abductors gluteus medius and minimus, on side pt is standing on, lean over to shift centre of mass to other side so they don’t fall
orthopaedic exam
look, feel, move, x-ray
look in orthopaedic exam
deformity, muscle wasting, scars, gait abnormalities
move in orthopaedic exam
range of movements, resisted movement for muscle power
GALS screening examination
gait, arms, legs, spine
shoulder joint type
ball and socket
shoulder range of movement
large
should be able to abduct arthritis up away from body ______ degrees
180
shoulder abduction test
stand behind patient, feel bottom of scapula, feel scapula move as arm abducts
what degree of shoulder abduction is by scapulothoracic joint?
60-180
what degree of shoulder abduction is by glenohumeral joint?
120-180
shoulder external rotation and abduction test (1)
abducted position, humerus is externally rotated, uncomfortable if previous anterior dislocation
shoulder external rotation and abduction test (2)
apley scracth test, see how far pt can reach over shoulder
shoulder internal rotation and abduction test
see how far pt can get hand up back, measured as level on thoracic spine
also bring arm across to shoulder (at front)
shoulder flexor power test
stabilise joint, resist arm move forwards
shoulder extensor power test
stabilise joint, resist arm move backwards
shoulder adductor power test
stabilise joint, resist arm move down towards body
shoulder abductor power test
stabilise joint, resist arm move up away from body
shoulder elevation power test
put hands on shoulders and resist shoulders shrugging
test for shoulder sensation (which nerve and where)
axillary, sergeant’s stripe
elbow joint type
hinge
elbow flexion power test
support elbow, test flexion against resistance
elbow extension power test
support elbow, test extension against resistance
elbow supinator power test
support elbow, test forearm supination against resistance
elbow pronation power test
support elbow, test forearm pronation against resistance
wrist dorsiflexion is ___degrees
70
wrist palmar flexion is ___degrees
80
demonstrate ulnar and radial deviation of wrist
done
metacarpophalangeal flexion is ___degrees
90
metacarpophalangeal extension is ___degrees
30-45
proximal interphalangeal joint flexion is ___degrees
0-100
distal interphalangeal joint flexion is ___degrees
90
distal interphalangeal joint flexion is ___degrees
10
test for long extensor power
movement of metacarpophalangeal joints against resistance
test for finger flexor power
grip patient’s fingers and pull up while asking them to resist
test for finger abductor power
spanning hand, move fingers away from midline, ask them to resist adduction movement and keep fingers open
test for finger adductor power
use a paper or banknotes the patient holds between their fingers and try to pull the note
pinch grip
picking up small objects
power grip
hand makes space for item being held, flexing all joints in the hand
thomas test for fixed flexion deformity of hip (3 steps)
- lie patient on flat, firm couch
- place hand under lumbar lordosis
- flexion of hip should eliminate lumbar lordosis
test hip extension
lie patient on front, lift leg, should be 20-30 degrees
test hip abduction (2 steps)
- feel anterior superior iliac spine on leg being tested.
2. abduct hip, feel with other hand
test hip adduction
on back, push leg over other leg
test hip external rotation
use foot to rotate hip out
test hip internal rotation
use foot to rotate hip in
femoral neck anteversion ____degrees
10-15
trendelenburg test (3 steps)
- pt stand on leg with problem
- put fingers on anterior superior iliac spines
- feel dip on opposite side
knee joint type
hinge type synovial
hyperextension of knee is ___degrees
-10
flexion of knee is ___degrees
130-140
knee deformities (3)
genu varum, genu valgum, genu recurvatum
genu varum
bowed legs, common arthritis
genu valgum
knock knees, arthritis on outside of knee, away from midline
genu recurvatum
back knee, hyperextension of knee
test medial collateral ligament stability
push knee into valgum position (inwards), stabilise knee with one hand and stretch ligament
test lateral collateral ligament stability
push knee into varus position (outwards)
Drawer test use
assess suspected rupture cruciate ligament in knee
Drawer test method for ACL
- pt lay back, feet flat, knees up
- stabilise feet, pull tibia forward
- if CAN be pulled forwards = positive drawer test = ACL rupture
Drawer test method for PCL
- pt lay back, feet flat, knees up
- stabilise feet, push tibia backwards
- if CAN be pushed backwards = positive drawer test = PCL rupture
test for quadriceps muscle power
resist leg extension
test for hamstring muscle power
resist leg flexion
schober test is for
lumbar spine flexion and extension
schober test (2 steps)
- compare fixed point on spine about 10cm apart using 2 fingers
- ask pt to bend forwards to touch toes, 10cm should go to 15cm, then lean back
- ask pt to run hand down each thigh
true leg length
affected limb is physically shorter than other
apparent leg length discrepancy
pelvis tilted up on one side, e.g. scoliosis, one leg seems shorter
measure leg length from
umbilicus to medial malleolus of ankle
if one leg is definitely shorter, check if tibia or femur is shorter by
position hip at 45, knee at 90, if tibia shorter knee not as high from front, if femur shorter knee further back than side
rotator cuff is an important
shoulder joint stabiliser
rotator cuff is a (what type of thing?)
tendon
rotator cuff attaches to
greater tuberosity of humerus
muscles of the rotator cuff
supraspinatus, infrapsinatus, teres minor, subscapularis
drop arm test is for
rotator cuff function
drop arm test
- hold patient arm out at side
- release hand, ask pt to keep arm in place
- if major rotator cuff tear arm will drop a bit
L4 lesion motor loss
tibialis anterior, resisted dorsiflexion of foot
L4 lesion reflex loss
missing knee jerk reflex, definite L4 problem
L4 lesion sensation loss
L4 dermatome on medial part of lower leg/foot
L5 lesion motor loss
extensor hallucis longus, extension of big toe
L5 lesion reflex loss
none
L5 lesion sensation loss
L5 dermatome on dorsum of foot
S1 lesion motor loss
peroneus longus and brevis, eversion of foot
S1 lesion reflex loss
very specific to ankle jerk reflex
S1 lesion sensation loss
S1 dermatome on lateral part of lower leg/foot
