clinical exam for ortho Flashcards
what to look at on the foot
callouses big toe lesser toe asymmetry skin changes obvious deformity nails mid/hind foot deformity plantar arch
what to feel for on the foot
ask if any tenderness
pulses: dorsalis pedis, posterior tibial pulses
temperature
deformities
squeeze MTPJ, mid tarsal, anterior joint line, subtalar joint (individual toe if deformity)
palpate achilles tendon
movements of the foot
active then passive
1. inversion and eversion
2.big toe dorsiflexion and plantar flexion
3. ankle dorsi and plantar flexion
4. passive only twist midtarsal joint and
subtalar hold at heel and twist foot
normal inversion and eversion angle
30 and 20
normal big toe dorsi and plantar
70 and 45
normal ankle dorsi and plantar
20 and 40
patient standing look front on
deformities in forefoot on weightbearing
patient standing look side on
arches
ask patient to stand on tiptoes
patient standing look from back
achilles tendon thickening and valgus or varus
ask patient to stand on tiptoes to see if normal varus
special tests for the foot
-gait
patient standing knee look
- general health
- walking aids, orthosis
- alignment of knees v/v
- quad muscles wasting
- ertythema of knee
- large effusions/ haemarthrosis
patient standing side knee
- fixed flexion deformity
- scars
- baker cyst from OA
patient standing back knee
- muscle wasting
- scars
- alignment of legs
patient standing special tests for knee
-gait
patient lying look knees
- trunk 45 degrees
- scars on knee(midantline)
- patella effusion
patient lying feel knees
ask if any pain
-erythema
-feel for heat
-patellar tap
-sweep test/ cross fluctulence- look other side for bulge
-palpate the knee structures with knee 90degrees
patella tendon, patella, quad tendon, medial and lateral femoral condyle, medial and lateral collateral lig, joint line tibia plateau and condyle
(look at face)
patient lying movement tests knee
- straight leg raise: look for discomfort
bend knee and rotate for pain- both knees - flexion and extension of knee active and passively
flexion and extension of knee norm
140 and -10
collateral ligament knee test
medial and lateral
for medial hold ankle medially and knee laterally and push against each other
then vice versa
cruciate knee test
anterior and posterior drawer (check for sac post) anterior: -flex knees -sit on their foot -feel in the joint line -pull the tibia towards
posterior: push the tibia in
meniscal knee test
McMURRAY provcation test
- trying to provoke pain by trapping meniscus
- grab the foot and flex and extend the knee when applying twisting force
special tests for knee
- collateral ligaments
- anterior and posterior drawer
- meniscal mcmurray
hip exam look patient standing from front
- general health
- walking aids
- posture
- quads wasting
- surgical scar
hip patient standing from side
spine alignment
flexion of knee
contractures at ankle
scars on hip
hip patient standing from back
spine, shoulders level straight spine pelvis level-feel iliac crest atrophy of buttocks scars muscle wasting leg malalignment
special test standing for hip
- tredelenburg gait- get to stand on one leg and feel iliac crest, fatigue - sit infront of patient
- gait
patient lying look hip
as pain anywhere
- feel iliac crest
- feel hand bredth below IC for GC and palpate
patient lying move
- straight leg raise and flex knee for spinal pathology
- Thomas’s test: flex unaffected knee and put hand on lumbar spine and then flex that hip right up and straighten out affected
- hip flexion active then passive
- external and internal rotation with knee flexed
- abduction and adduction: put hand on pelvis and with straight leg move out/in over other leg
- hip extension: lies face down and put hand on pelvis and lift each leg
functional/ special tests for the hip
- leg length
true=ASIS to medial mall
apparent=umbilical to medial mall-for both legs
2.
apparent leg length difference causes
due to pelvic tilt or in the spine scoliosis
true leg length differences causes
hip dysplasia or previous fracture
normal hip flexion and extension
125 and 20
normal hip abd and adduction
45 and 30
normal internal and external hip rotation
40 and 45
thomas test positive result
affected knee can’t extend or can’t keep back on table or can’t flex knee >80
patient sitting looking hands with pillow
- general health
- look at elbows for nodules
- look at hands for…
- palm asymmetry, deformity, muscle wasting, thickenings Dupytren, erythema
- dorsal: muscle wasting- guttering and 1st dorsal space, pitting, splinter haemorrhages, nodules, synovitis
- specific RA disease and OA disease
- scars: mcpj RAsurgery
feel hand exam
ask if pain
feel pulses radial and ulnar compare both
thickening of palm
temperature over joints
wasting of eminences
squeeze:MCPJx2, dip and pip joints each, wrist squeeze
movements hand
1. wrist flexion and extension: prayer sign passive then active hold wrist and move 2. radial deviation and ulnar deviation 3.spread fingers wide 4. make a fist 5. can assess finger individually passive 6.thumb/ finger flexion and extension 7. thumb/ finger add and abd
special tests for hand nerve tests
- median nerve motor: to thenar look for wasting and ask patient to bring thumb up to ceiling against resistance
- sensation median on tip of index finger
- motor ulnar at hypothenar wasting, push little finger out against resistance
- sensation ulnar tip of little finger
- motor radial nerve push fingers up against resistance and wrist up
- sensation radial nerve over 1st dorsal space
specific tests for median nerve hand
- phalen’s test: flex the wrist up with elbow and hold for 30s to see if numbness
- tinel’s test: tap over carpal tunnel to produce numbness
function test for hand
- grip on your finger
- fine pinch grip stop pulling finger out
- hold a pen
shoulder exam look from front
- general health
- muscle wasting
- erythema
- scars-delopectoral scar
- clavicle prominences medial from dislocation or fracture
shoulder look from side standing
- posture
- asymmetry in height
- lateral scar, arthroscopy
- prominences of clavicle
- prominence of deltoid
shoulder back look
- asymmetry in height
- fullness in fossa
- no spine
- muscle wasting
- scars
feel shoulder
ask if pain
- temperature on sternoclavicular, acromioclavicular front rotator cuff and back
- tenderness over sternoclavciular joint out along clavicle to acriomioclavicular and spine of scapula
- extend the arm back to feel ant rotator cuff for tender
- glenohumeral joint and -subacromial spaces and
- greater tuberosity
move the shoulder
-neck up/down, left and right, ear on shoulder
-hands behind head
-hands behind back (IR)
-abduction: passive and active to the top if poss
-extension: bring arm back as far as poss
-flexion bring arm forward as far as poss
active and passive
-external rotation bring arm out far as possible with tucked in
active and passive
normal internal rotation level shoulder
t5
normal flexion and extension of shoulder
150 and 40
external rotation shoulder normal and internal rotation
45-60
and 90
special test shoulder rotator cuff tests
Jobe’s test=supraspinatous
external rotation: infraspinatous and teres minor
subscapularis: gerber’s lift off and belly press test
