Extremities

Question 1

Extremities, rubric

Answer 1

Extremities - 24
Upper extremities – palpate all bones, joints, ROM
Arms (3)
Wrists (3)
Hands/fingers (3)
Lower extremities – palpate all bones, joints, ROM
Legs (3)
Ankles (3)
Feet (3)
Pulses – brachial, femoral, and brachial/femoral together (3)
Hips – Ortolani and Barlow for hip displacement (2)
Knee Height (1)

Question 2

Upper extremities, video

Answer 2

• -Upper extremities – palpate all bones, palpate all the joints, and do ROM in all joints.
• -Palpate the hand, every single joint, confirm lack of 6th digit, may need to pry hand open. Look at the creases. Palpate and rotate every shingle joint.
• -Wrist, elbow, shoulders
• -Assess brachial pulses.

–Assess the femoral pulses.

–Compare the brachial pulse to the femoral pulses simultaneously, they should be equal.

Question 3

Lower extremities, video

Answer 3

(Done after chest/abdomen)
Next we are going to look at the lower extremities … These are assessed the same way as the upper extremities:

Feel all the bones and all the joints. This includes each toe. ROM includes toes as well and then on back up to the knee.

Assess the plantar grab by placing finger at base of toes.

And, the Babinski. With infants the toes should flare.

Then assess the palmar grasp.

Hips: assess for symmetry in knee height. Have feet parallel. Knees should be the same height.

Then two maneuvers:

Finger on greater trochanter, the other fingers surround the leg.

Barlow’s: Bring the knees up and the adduct them (knees together).

Barlow’s attempts to dislocate a hip.

Ortolani Maneuver: represents an attempt to reduce the hip joint. Lift the knees up and then abduct at the hip (bring them out.) If hip is displaced, this should reduce it. Often seen in breech babies, also a familial trait