Locomotor Examinations Flashcards
How do you begin a GALS assessment?
WIPE
Qs: pain/stiffness, dressing, stairs
Gen insp: crutches/stick/wheelchair
Gait
What do you comment on when looking in a GALS assessment?
From behind: Shoulders Spinal alignment Level of iliac crests Hamstring bulk Popliteal swelling Calf muscles Achiles and hindfoot swelling From side: thoracic kyphosis, lumbar lordosis From front: Deltoid bulk and symmetry Knee alignment Foot arches and deformity When lying: Soles & calluses Arms & hands
What movements do you do in GALS?
Touch toes (measuring change in length between spinous processes)
Tip head sideways and chin to chest and extension
Jaw side to side
Sunbathing posture (elbows behind head)
Finger grip and dexterity
Hip and knee flexion
Which muscles does the radial nerve supply?
Wrist extension Finger extension Triceps (extend elbows) Brachioradialis (flex elbows mid pronation) Supinator Extend thumb
What is the radial nerve dermatome?
1st dorsal web space
Which movements are controlled by the median nerve?
Thumb abduction
2 radial lumbricals (MCP resist flexion, IP resist extension)
What extra tests are needed for median nerve exam?
Phalen (backs of hands together and press for 60 secs-> numbness/tingling?)
Tinnel (tap over carpal tunnel)
What do you look for in a spine exam?
Scars Pigmentation Abnormal skin creases/hair growth Scoliosis Asymmetry
What do you do in a spine exam when the pt is prone?
Femoral nerve stretch test (with knee bent lift knee off bed)
Offer anal tone and perianal sensation
What do you do in a spine exam when the pt is supine?
Passive straight leg raise (note ROM)
Sciatic nerve stretch test (dorsiflexion of foot when straight leg raised slightly)
Name the muscles of the rotator cuff and function
SITS Supraspinatus (initiation of abduction) Infraspinatus (external rotation) Teres minor (external rotation) Subscapularis (adduction)
What are you feeling for in a shoulder exam?
Temp
Tenderness (acromioclavicular, sternoclavicular)
Effusion (glenohumeral)
What other tests do you do after general active and passive movements
Test rotator cuff function (abduction, adduction and external rotation against resistance)
Push against wall (scapula winging)
Function (brush hair, put on coat)
What would signify carpal tunnel syndrome?
Wasting of thenar eminence
Phalen & tinel test-> tingling/pain ulnar fingers
What would signify ulnar nerve dysfunction?
Claw hand
Hypothenar eminence wasting
Froment sign positive (hold paper between thumb and forefinger, thumb IP joint flexes)
What would signify radial nerve dysfunction?
Wrist drop
Decreased sensation over anatomical snuffbox
What are the specific tests for hip exam?
Trandelenberg
Real vs apparent leg length
Fixed flexion deformity (Thomas’ test)
How do you do Thomas’ test?
Tests for fixed flexion deformity
Lie on back, bring one knee close to abdomen
Other leg should remain relaxed on floor
If other leg raises then fixed flexion defomity present
Explain findings of trandelenberg test
If when lift R foot up, hips stay level= normal
If when lift R foot up, hips dip to R, shows weakness of L abductors (eg gluteus medius)
Where do you measure real and apparent leg length?
Real: ASIS-> medial malleolus
Apparent: Umbilicus-> medial malleolus
Should be symmetrical
What do you look for before beginning the examination in a foot & ankle exam?
Shoes and walking aids- pattern of wear
What do you look for in a foot and ankle exam?
Deformities, foot arches
Scars, bruising, swelling
Ulcers, calluses, bunions, fungal toenails, ingrowing toenails
Measure calf circumference
What do you do after looking in a foot and ankle exam?
Feel malleoli, tarsals, squeeze MTPs
Feeling for tenderness, temp, synovitis, cap refill
Pulses (dorsalis pedis, posterior tibial)
Gross sensation
What do you do after feeling in a foot and ankle exam?
Ankle dorsiflexion and plantarfelxion, foot inversion and eversion
Toe flexion, extension, abduction and adduction
Simmond’s test
Describe Simmond’s test
Triad to detect achilles tendon rupture
Pt prone w/feet hanging off the bed
1) angle of dangle (rupture= more dorsiflexed)
2) Squeeze calf bringing muscle off tibia (normal, plantar flexion will occur, absence=rupture)
3) Look/feel for gap in tendon
