Joint Examinations Flashcards
What do you look for when observing gait?
- Gait cycle
- Symmetry
- Assess turning
- Any signs of discomfort
Observe hips: what you looking for (from front)?
- Scars
- Pelvic tilt
- Quadricep wasting
- Joint deformity
Observe hips: what you looking for (from side)?
- Lumbar lordosis
- Knee flexion
- Foot arches
Observe hips: what you looking for (from back)?
- Scoliosis
- Iliac crest alignment
- Gluteal muscle bulk
When palpating hip, what you looking for?
- Tenderness
- Warmth
What could tenderness of hip suggest
Trochanteric bursitis
Describe Thomas’s test
- Place hand under the spine
- Passively fee the unaffected leg as far as possible
- Your hand should detect the lumbar lordosis flattening
- With unaffected leg flexed, the contralateral leg should be flat on the bed
What are the Special tests for a hip exam
- Thomas’s test
- Trendelenberg’s test
How do you measure actually leg length?
ASIS -> medial malleolus
How to you measure apparent leg length?
umbilicus -> medial malleolus
What do you do to complete hip exam?
Examine spine, knees, neuromuscular exam of lower limbs and view any available imaging
What do you look for in exam of hands (inspection)
- Skin
- Scars
- Muscle wasting
- Deformity
On palmar surface of hand: what 2 things to you particularly look for?
- Dupuytren contracture
- Thenar and hypothenar wasting
Where can you touch on palmar surface of hand to test median nerve?
Thenar bulk
Where can you touch on palmar surface of hand to test ulnar nerve?
little finger
Where can you touch on hand to test radial nerve?
dorsal surface mear thumb
What does tenderness in anatomical snuffbox indicate?
scaphoid fracture
How should patient be positioned and dressed for shoulder exam?
standing
top off
Shoulder inspection: what do you look for?
- head and neck posture
- Symmetry of shoulders
- Deltoid wasting
- Scars
(skin, scars, muscle wasting, deformity)
Shoulder test; What does empty can test test for? and how is it done?
Assess for weakness of supraspinatus
arms out stretched and as if emptying can of beans
Hands exam: What are the 4 look things?
- Skin: colour
- Scars: trauma
- Muscle wasting: thenar muscles
- Deformity: RA, dextrupens contracture
- Symmetry: differences between the hands
Hands exam: what are the 4 feel things?
- Palpate: every joint + wrist (lumps or tenderness)
- Temprate: compare temps
- Neurate: palmar and dorsal surfaces
- Vascular: cap refill, pulse
Hands exam: What are the 4 move things?
- Test actions: fist, back out, spread out fingers, all the thumb ones
- Power grip
- Hold a pen
- Buttons
Hand exam: what are the 4 special tests?
- Sensory: ulnar, medien, radial
- Motor:
- Tinnels
- Phalens
Hand exam special tests: what special tests to check motor function?
- Ulnar: crossed fingers, grip paper, abduct against resistance
- Median: Palmar abduction (thumb)
- Radial: wrist and finger dorsiflexion
Knee exam: what do you inspect form the front?
- Valgus, varus deformity
- knee swelling
- quadricep bulk
Knee exam: what do you inspect form the side?
- knee hyperextension?
- foot arches
- toe deformity
Knee exam: what do you inspect form behind?
- gluteal muscle bulk
- popliteal swellings
- hindfoot abnormalities
Knee exam: what does patella tap test for?
Allows for detection of large joint effusions
knee exam: what does swipe test test for?
allows detection of small joint effusions
What would you do to complete knee examination?
- examine hip
- examine ankle
- perform neurovascular examination of both lower limbs
What do you look for in general inspection in foot exam? (not on foot)
- uneven footwear
- foreign objects in shoes
- bandages
- dressings
What do you look for in inspection of foot exam?
- skin, scars, muscle wasting, deformity
-ulcers
-oedema - joint deformity
Foot exam: What hidden spaces do you need to check in inspection?
- Between the toes
- back of the heel
What pulses do you check in foot exam? find it on yoself
- Posterior tibial pulse
(located posterior and inferior to the medial malleolus) - Dorsalis pedis pulse
(located lateral to the extensor hallucinate longus tendon)
Foot exam: explain how you would test vibration
- check they know what it feels like (sternum)
- hit tuning fork and ask patient to say when they can feel it vibrating and when stopped
- place on ball of foot
what tuning forking should be used to check vibration in foot exam
128 Hz
Foot exam: explain how to test reflex
- Ankle jerk reflex
- leg bent slightly to side
- tap back of the ankle
What would you do to complete diabetic foot exam?
- peripheral vascular exam
What exposure is required for GALS examination?
Remove shirt, wear shorts
What initial questions do you ask in GALS examination?
- Do you have any pain or stiffness in your joints, muscles or back?
- Do you have any difficulty getting dressed?
- Do you have have any difficulty going up and down the stairs?
GALS exam: what do you look for on inspection from the front?
- Shoulder symmetry + muscle bulk
- Elbow extension
- Quadriceps bulk
- Knee swelling and deformity
- Foot deformity
GALS exam: what do you look for inspection from the side?
- Spine
- Knee flexion (/hyperextension)
- Foot arches
- Toe deformity
GALS exam: what do you look for on inspection from the back?
- Shoulder symmetry
- Spinal alignment
- Iliac crest alignment
- Gluteal muscle bulk
- Popliteal swellings
- Hind-foot abnormalities
What do you do for arms bit of GALS?
- Shoulder: arms behind head
- Hands and wrists:
- look: supinate
- feel: tenderness over MCP joint
- move: fist, grip strength, piano fingers
What do you do for Legs bit of GALS?
- Passive movement
- Joint effusion (patellar tap)
- Feet: look, feel (MTP joint)
What passive movement do you do for legs of GALS?
- with patient lying down: flex knee and hip
- internal and external rotation of hip joint (with hip and knee flexed to (90))
What do you do for spine of GALS
- lumbar flexion: measure expansion
- cervical spine lateral flexion (45)
what would you do to complete GALS screening examination?
- focused examination of joints with suspected pathology
- further imaging if indicated
Spinal exam: what do you feel for when palpating spinal processes?
- Alignment
- Irregularities
- Tenderness
Spinal exam: What do you feel for when palpating paraspinal muscles?
Any areas of tenderness or spasm
Explain how to test thoracic rotation
Ask patient to cross arms and then rotate as much as possible
What are the two points on the back for schooners test?
10ch above and 5cm below posterior superior iliac spine (PSIS)
Schober’s test: how big should the distance be between the two points once the patient has bent over?
Greater than 20cm
