Lower Quarter and Extremity Screening Examination Flashcards
what is the basic screening process to get off to a great start?
- patient info- age, gender, c/o
- Medical history/family medical history?
- MOI/trauma? •Signs/symptoms?
- 24-hour presentation?•Aggravating/easing factors?•Red/yellow flags?
what are possible red flags that could come up during the patient interview?
- HX of cancer
- HX of renal or urologic disease ; kidney stones, UTIs
- Trauma/assault (fall, blow, lifting)
- Crohn’s disease, ulcerative colitis, diverticulitis
- Pelvic inflammatory disease (PID)
- Appendicitis
- Recent pregnancy, childbirth, or abortion
- History of alcoholism (e.g. hip osteonecrosis)
- Long-term use of immunosuppressants (e.g. cancer treatment, autoimmune disorder)
- Heart disease (e.g. arterial insufficiency, peripheral vascular disease)
- Receiving anticoagulation therapy (risk factor for hemarthrosis)
- History of hematologic disease such as sickle cell anemia or hemophilia
- Past history of joint replacement
after the patient interview, what are key assessment skills?
- Postural Observation
- Gait
- Palpation
- Balance•AROM/PROM• MMT/Myotomes
- DTR
- Sensation/Dermatomes
- Orthopedic “Special” Tests
what exam skills can you perform in standing?
- Postural observation
- Palpation, soft tissue and bony landmarks
- Neuro screening- Myotome, Dermatome
- Standing squat
- Balance assessment
- AROM of trunk (all directions)
- Functional mobility/skills testing
- Gait
what exam skills can you perform in sitting?
•Postural observation
•Palpation, soft tissue and bony landmarks
•Neuro screening- Myotome, Dermatome?
•AROM of trunk (rotation and overpressure)
(throughout LE)
•DTR (KJ L2-4, AJ S1-2)
•Respiratory excursion
what exam skills can you perform in prone?
•Postural observation •Palpation, soft tissue and bony landmarks -AROM/PROM (overpressure PRN) •Prone press-up - femerial nerve tension test
what exam skills can you perform in supine?
•Postural observation
•Palpation, soft tissue and bony landmarks
•Neuro screening- Myotome, Dermatome?
•Thorax and abdomen (observation and inspection)
•LE palpation, SI tests
•AROM/PROM of LE, trunk (double knee to chest)
•FABER
•SLR (cx flex to duraltension)
(throughout LE)
Babinski’s (PRN)
what cancer related dx can present in the LE
Metastasis
• Bone tumors· Osteoid osteoma, Ewing’s sarcoma (a lump on the ankle)
what vascular related dx can present in the LE
- Arterial insufficiency
- Abdominal aortic aneurysm
- Avascular necrosis
what urogenital related dx can present in the LE
- Kidney (renal) impairment; kidney stones
- Urinary tract infection
- Testicular cancer
what are descriptors of Vascular Claudication?
descrp:Bilateral, no burning
S/Sx:Dec pulses, trophic changes in feet
Location:Calf then move through LE, buttock to feet
Agg: Exertion, stairs, uphill; pain consistent all positions
Ease: Standing still, sitting down, resting 5 min
Age: 40-60+
cause:Atherosclerosis:
what are descriptors of Neurogenic Claudication
descrp: Bilateral or unilateral, burning and dysesthesia in back, buttocks, LEs
S/Sx:Normal pulses, +SLR, sciatica
Location: Low back, buttock, thighs, calves, feet
Agg:Spinal extension, walking, downhill
Ease: Sitting/lying, forward bend, flexion exercises
Age:40-60+
cause:HNP, neoplasm, osteophytes
what are descriptors of Peripheral Neuropathy
descrp:Pain, aching, numb in feet; also motor changes, dec DTRs
S/Sx:Normal pulses, +SLR, sciatica
Location:Feet (and hands) in stocking glove pattern
Agg:Uncontrolled glucose levels, alcoholism
Ease: Pain meds, treat underlying cause
Age:Varies, depending on underlying cause
cause:Depends on cause; DM, RA, SLE, AIDS, cance
what are descriptors of Restless Leg Syndrome
descrp:Variable pain, crawling sensation in LE, involcontractions.
S/Sx: Sleep disturbance, paresthesias
Location:Feet, calves, legs
Agg: Caffeine, pregnancy, iron deficiency
Ease: Eliminate triggers, +iron, walk, mod exercise
Age: variable
cause: unknown
