Locomotor Examinations

Question 1

How do you begin a GALS assessment?

Answer 1

WIPE
Qs: pain/stiffness, dressing, stairs
Gen insp: crutches/stick/wheelchair
Gait

Question 2

What do you comment on when looking in a GALS assessment?

Answer 2

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

Question 3

What movements do you do in GALS?

Answer 3

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

Question 4

Which muscles does the radial nerve supply?

Answer 4

Wrist extension
Finger extension
Triceps (extend elbows)
Brachioradialis (flex elbows mid pronation)
Supinator
Extend thumb

Question 5

What is the radial nerve dermatome?

Answer 5

1st dorsal web space

Question 6

Which movements are controlled by the median nerve?

Answer 6

Thumb abduction

2 radial lumbricals (MCP resist flexion, IP resist extension)

Question 7

What extra tests are needed for median nerve exam?

Answer 7

Phalen (backs of hands together and press for 60 secs-> numbness/tingling?)
Tinnel (tap over carpal tunnel)

Question 8

What do you look for in a spine exam?

Answer 8

Scars
Pigmentation
Abnormal skin creases/hair growth
Scoliosis
Asymmetry

Question 9

What do you do in a spine exam when the pt is prone?

Answer 9

Femoral nerve stretch test (with knee bent lift knee off bed)
Offer anal tone and perianal sensation

Question 10

What do you do in a spine exam when the pt is supine?

Answer 10

Passive straight leg raise (note ROM)

Sciatic nerve stretch test (dorsiflexion of foot when straight leg raised slightly)

Question 11

Name the muscles of the rotator cuff and function

Answer 11

SITS
Supraspinatus (initiation of abduction)
Infraspinatus (external rotation)
Teres minor (external rotation)
Subscapularis (adduction)

Question 12

What are you feeling for in a shoulder exam?

Answer 12

Temp
Tenderness (acromioclavicular, sternoclavicular)
Effusion (glenohumeral)

Question 13

What other tests do you do after general active and passive movements

Answer 13

Test rotator cuff function (abduction, adduction and external rotation against resistance)
Push against wall (scapula winging)
Function (brush hair, put on coat)

Question 14

What would signify carpal tunnel syndrome?

Answer 14

Wasting of thenar eminence

Phalen & tinel test-> tingling/pain ulnar fingers

Question 15

What would signify ulnar nerve dysfunction?

Answer 15

Claw hand
Hypothenar eminence wasting
Froment sign positive (hold paper between thumb and forefinger, thumb IP joint flexes)

Question 16

What would signify radial nerve dysfunction?

Answer 16

Wrist drop

Decreased sensation over anatomical snuffbox

Question 17

What are the specific tests for hip exam?

Answer 17

Trandelenberg
Real vs apparent leg length
Fixed flexion deformity (Thomas’ test)

Question 18

How do you do Thomas’ test?

Answer 18

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

Question 19

Explain findings of trandelenberg test

Answer 19

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)

Question 20

Where do you measure real and apparent leg length?

Answer 20

Real: ASIS-> medial malleolus
Apparent: Umbilicus-> medial malleolus
Should be symmetrical

Question 21

What do you look for before beginning the examination in a foot & ankle exam?

Answer 21

Shoes and walking aids- pattern of wear

Question 22

What do you look for in a foot and ankle exam?

Answer 22

Deformities, foot arches
Scars, bruising, swelling
Ulcers, calluses, bunions, fungal toenails, ingrowing toenails
Measure calf circumference

Question 23

What do you do after looking in a foot and ankle exam?

Answer 23

Feel malleoli, tarsals, squeeze MTPs
Feeling for tenderness, temp, synovitis, cap refill
Pulses (dorsalis pedis, posterior tibial)
Gross sensation

Question 24

What do you do after feeling in a foot and ankle exam?

Answer 24

Ankle dorsiflexion and plantarfelxion, foot inversion and eversion
Toe flexion, extension, abduction and adduction
Simmond’s test

Question 25

Describe Simmond’s test

Answer 25

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