pediatric muscular exam

Question 1

clavicle exam

Answer 1

• two fingers on the clavicle and palpate while moving the arm superior
• If fracture is present then you will feel crepitus
• If clavicle is normal and decreased tone is present compared to contralateral arm consider brachial nerve palsey

Question 2

tone assessment

Answer 2

• grab the infants arm or leg andpull toward you (assess degree of flexion that returns when you let go)
• Pull test = pick up baby by both arms and see what tone is present, what does head do
• Ventral suspension = place the baby prone on your hand (picture)
• Vertical suspension = hold the baby upright with two hands around the chest and assess flexion
• Hypotonia (image)

Question 3

describe barlows maneuver *

Answer 3

• Grasp the leg with your thumb on the inside of the thigh
• base of the thumb on the knee and your fingers gripping the outer thigh with the ginertips resting on the greater tochanter
• Adduct the thigh and gently apply downward pressure on the femur in an attempt to disengage the femoral head from the acetabulum

**try to push hip out of joint essentially**

• POSITIVE SIGN = CLUNK when the femoral head exits the acetabulum posterioly

Question 4

Ortolani’s maneuer

Answer 4

• Slowly abduct the thigh while maintaing axial pressure
• with the fingertipes on the greater trochanter, exert a LEVER movement in the opposite direction so that your fingertips press the head of the femur back toward the acetabulum with a palpable clunk when pressure is exerted suspect HIP SUBLUXATION OR DISLOCATION

**move back up into socket**

Question 5

describe allis sign

Answer 5

• With the infant supine on the table flex both knees, keeping the feet flat onthe table and femurs aligned with each other
• position yourself at the childs feet and observe the height of the knees
• when one knee appears lower than the other, the allis sign is POSITIVE FOR EITHER a SHORT FEMUR or DISLOCATION

Question 6

Talipes equinovarus

Answer 6

club foot

• can’t move foot back into alignment

Question 7

Metatarsus adductus

Answer 7

• not a worry if you can move midfoot in align

Question 8

Suck reflex

Answer 8

• simply place gloved finger in babies mouth and see if it sucks
• this may be done by observing a feeding or report of good feeding

Question 9

plantar and palmar grasp reflexes

Answer 9

• place a finger in the middle of the hand and assess for a grasp, and a finger touch to sole of foot to assess for a grasp

Question 10

moro reflex

Answer 10

• can be accomplished by releasing the arms after the pull test or placing the baby back on the table after assessing for ventral or vertical tone
• the baby should reach out and grab the air

Question 11

What are the phsyical skills of a toddler

Answer 11

Walks alone
Pulls toys behind when walking
Begins to run
Stands on tiptoe
Kicks a ball

• motor maturation proceedsin a cephalocaudal progression (motor control of head and neck happens first followed by the trunk)