Lab #3: Osteopathic structural exam

Question 1

step 1: postural analysis

Answer 1

• anteriorly, compare shoulder levels, iliac crests levels, trochanter levels, and palpate as necessary
• from the side, palpate as necessary and check for the line of gravity
• posteriorly, three curves of the back, look for coronal plane curvatures that may indicate scoliosis, leaning, length of arms, hip creases, range of motion and active motion, palpate as necessary

Question 2

step 2: gait analysis

Answer 2

-ask the patient to walk back and forth, look at the arm swing, overall gait, see if they’re limping and how smooth the walk is

Question 3

step 3: dynamic trunk side bending

Answer 3

• look at the patient from behind their back
• ask to bend to right side, and left side, compare movement and smoothness, and see how far their arms go on either side

Question 4

step 4: standing flexion test

Answer 4

-put your thumbs on PSIS on either side, ask them to bend forward, compare the movements on both sides and see if they move symmetrically

Question 5

step 5: stork test

Answer 5

• keep thumb on one PSIS, put other thumb on middle of sacrum, ask them to lift up the leg on that side with their knee bent up
• perform on other side

Question 6

step 6: seated flexion test

Answer 6

• have patient sit on the table facing away from you
• put thumbs on the PSIS
• ask patient to bend forward, and compare PSIS on both sides
• once with arms at sides, then with arms between their legs

Question 7

step 7: screening of upper extremities

Answer 7

• cross arms in front of chest
• arms out to sides with palms down
• arms out to sides with palms up
• put arms above head with palms together
• arms above head, hands together but cross wrists
• bring arms in front of torso in same position
• pull arms in towards chest and up in front of chest
• looking for issues with range of motion or abnormal movements

Question 8

step 8: trunk mobility testing

Answer 8

• stand behind the seated patient, ask them to cross arms in front of chest
• ask them to bend to the right and left
• ask them to rotate to the left and right
• ask them if they have any pain
• put your hands on top of their shoulders, bend them to both sides, turn them to both sides
• palpate their spine

Question 9

step 9: head and neck mobility

Answer 9

• stand behind the seated patient and put your hands on the sides of their shoulder
• ask them to turn their head to both sides, then bend their neck to put ears towards shoulders, bend neck forward and backwards
• test passive range of motion by putting your hands on either side of their skull or on forehead and chin to manually test these motion ranges

Question 10

step 10: quick total body screen palpation/motion testing

Answer 10

• have the patient lie in a supine position
• put hands on ankles and check malleoli for symmetry, palpate ASIS for symmetry, pelvic compression test (press down pelvis)
• lift leg up and bring knee toward chest (flex), bring knee out towards side (abduct), bring knee out towards side (external rotation), back to neutral. Repeat on other side
• straight leg test for tightness on both sides, lift up leg straight
• put hands on countours (lower boundaries) of ribs, medial compression and compare both sides, ask patient to breath in and out, also put hands on sternum, and above breasts

Question 11

Thomas test

Answer 11

• ask the patient to bring one knee to their chest and hold it with the other leg extended
• should have space under the knee, if they don’t, can indicate J sign, tight iliotibial band
• used to measure the flexibility of the hip flexors