Objective - Observation + Palpation

Question 1

Objective Routine

Answer 1

> Observation (ABCD)
> Palpation
> Effusion 
> Active + Passive RoM
> Resisted testing 
> Accessory testing (joint stability)
> Ligament testing 
> Functional tests e.g lunge/step up etc.
> Palpation (confirmation of painful structure - only adds to picture as pain does not mean damage)

Question 2

Observation

- Alignment

Answer 2

> Limb position/shape/deformity

• are the feet pronated/supinated (look at medial arch and achilles curve + toes visible from posterior)
• knees valgus/varus
• base of support
• shoulders: pronated/elevated etc.

Question 3

Observation

- Bulk of muscles

Answer 3

> Atrophy - muscle wasting due to disuse or neuro interruption
Hypertrophy - muscle bulk on one side vs. other (may be due to compensation

Question 4

Observation

- Colour

Answer 4

> Bruising
Necrosis - lack of blood supply - check pulse + signs of skin decay
Cellulitis - skin infection

Question 5

Observation

- Deformity

Answer 5

> Dislocation (tenting of skin or sulcus)
Flat feet (collapse of medial arch - possibly due to tib post disruption)
Haglund’s deformity (bony growth on calcaneus - either rubbing of shoes on calcaneus or tight achilles causing stress)

Question 6

Palpation

Answer 6

> Swelling (joint = hot + puffy)
- deep joints or those where gravity will move swelling are difficult to locate swelling
Temp
Atrophy

Question 7

Effusion Testing for knee

Answer 7

> If knee = damaged

• Intracapsular structures - quick swelling within capsule
• Extracapsular - slower and not contained

> Patella tap test - tap patella - soft end feel = swelling
(fix superior pole with 1st finger and thumb of one hand)
(other hand taps patella and searches for swelling)

> Sweep test
- Medial first - inferior to superior
- Lateral - superior to inferior
(look for medial bulge)