physical examination Flashcards
what is liver flap suggestive of
opiate overdose hepatic encephalopathy cirrhosis acute liver failure wilsons disease
leukonychia
- what does it look like
- what causes it
white marks on nails
trauma / hitting nails
hypoalbuminaemia
liver cirrhosis
chemo
xanthelasma is suggestive of
liver cirrhosis
what are some signs found on examination that may suggest chronic liver disease
bruising ascites (rare( clubbing dupuytrens contracture hepatomegaly asterexis liver flap spider naevi palmar erythemia wasting jaundice (Rare)
murphys sign
- examination technique
- what does this suggest
hand in RUQ
pain during inspiration (‘breath catches’)
no pain LUQ
cholecystitis, ascending cholangitis
kaiser fleischer rings
dark ring in iris
copper - Wilsons
non cardiac chest pain
GORD peptic ulcer pulmonary MSK (eg arthritis in small rib joint) pscyhosomatic, anxiety, stress
what does it indicate if chest pain is relieved by
a) position
b) rest
a) fluid
b) ischaemia
ankle swelling that goes at night (postural)
not pathological
below what age for MI/stroke etc stuff of family history
60
Central sternotomy
Midline vertical quite long
Midline of tummy, goes around umbilicus
aortic surgery scar
aortic surgery scar
Midline of tummy, goes around umbilicus
Pacemaker insertion
L, upper chest, above axilla, under clavicle, mid clavicular line
L, upper chest, above axilla, under clavicle, mid clavicular line
Pacemaker insertion
Midline vertical quite long
central sternotomy
how many splinter haemorrhages is fine
0-1
capillary refill time
Pressure for 5s
Normal refill within 2s
radiofemoral delay=
indicates
See if femoral pulse comes in after and weaker, than the radial pulse
Coarctation of aorta (congenital narrowing of aorta)
where do you feel for femoral artery
Femoral is in mid-inguinal point (halfway between pelvis and midline) (kinda in groin)
what do you palpate the brachial artery for
what does this indicate
Feel for a collapsing pulse aka water hammer! (Rapidly increasing and rapidly collapsing) - arm raised above heart
Aortic valve regurgitation
slow rising pulse in carotid =
aortic stenosis
JVP moves
tamponade
JVP high (and raised?)
HF (Rside?)
JVP low
dehydration
normal JVP
how to make it more visible
3cm above sternal angle
press RUQ
high arched palate
marfans
displaced apex beat
HF
locating apex beat
hand in L 5th intercostal space midclavicular.
roll onto L to increase prominince
1st heart sound =
2nd heart sound =
1 mitral and tricuspid valve closing
2 aortic and pulmonary valve closing
fixed splitting of 2nd heart sound
atrial septal defect
normal = pulmonary valve closure delay on inspiration so delayed (= this splitting is normal)
added heart sounds =
HF
where to auscultate:
mitral valve
tricuspid valve
pulmonary valve
aortic valve
which uses bell
mitral - L 5th intercostal space midclavicular
tricuspid- L 4th intercostal space next to sternum
aortic - R 2nd intercostal space next to sternum
pulmonary - L 2nd intercostal space next to sternum
mitral uses bell
where do the murmurs radiate:
- aortic
- mitral
carotids
axilla
sacral oedema examination
palpate lower back - are there any indents left
where to palpate the aorta
where to palpate renal arteries
bit above umbilicus
few cm either side of umbilicus
Palpate popliteal pulses
posterior knee at knee crease, knees flexed 30degree
Thumbs at front, fingers in crease feeling
this is deep so hard to feel .
Obvious may indicate aneurysm
Palpate dorsalis pedis pulses
First metatarsal web space (lateral to extensor tensor hallucis tendon) - top of foot
Palpate posterior tibial pulses
Posterior and just inferior to medial malleolus (ankle bone)
Burgers test
Raise leg straight to 45 degrees (passive) for 2 -3 mins
Look for pallor, or superficial vein emptying/ guttering
The sit up with legs hanging over pain
Reactive hyperaemia / spreading redness - significant PAD
tandem walking
one foot in front of another
tests balance
parkinsons gait
Apraxic gait Stoop gait - Festinant Small shuffling steps - stride decrease Elbow and wrist flex May lose balance when turning Unilateral loss of arm swing Increasingly rapid steps to maintain upright posture
Hemiplegic gait
one sided weakness
Dragging one of their legs, swing it round, foot scrapes on ground
Arm hanging on same side as leg weakness
Lurches
Shoulder adducted, elbow flexed, wrist flexed
Hip adducted, knee extended, ankle plantar flexion
Scissoring gait
in spasticity, increased tone - so can’t move legs freely
Small steps
Legs straight
Knees locked and knock together
spastic gait
increased tone - so can’t move legs freely
Small steps
Legs straight
Knees locked and knock together
= scissoring gait
Steppage
weakness/paralysis of dorsiflexion (can’t lift foot up).
Unilateral = common peroneal nerve palsy, foot drop, spinal lesion
Bilateral = generlaised polyneuropathy
So they avoid normal steps as they would trip on the toes that would flop down → exaggerated walk with high lift to pull feet above ground, high knees
Loud slapping noise as foot hits the ground
waddling gait
proximal weakness
sensory ataxia gait
unsteady
Cerebellar ataxia gait
Unsteady, patient sways side to side when walking
Wide based
Difficulty turning
Cannot stand steadily with feet close together / eyes closed
Walking heel to toe exaggerates this
pinhole visual test
problem if they see better through pinhole
Test for inattention/ visual extinction
Hold up both hands between you and patient, at periphery
Move fingers on each side then both together and ask patient which is moving
If there is visual inattention/ extinction, the patient will be able to detect unilateral movement but will ignore one side when both stimuli are presented simultaneously
pupil reflex - light in one eye
both should restrict
3rd nerve palsy eyes
one eye closed, when lid opened - eye points down and out
bells palsy = which cranial nerve
UMN/LMN
7th - facial
LMN
forehead spared from facial nerve pathology when
UMN lesion
Rinne’s test
Put on mastoid and near ear – to compare bone and air conduction
Ideally equal / air conduction slightly better
Conductive deafness = bone conduction is better than air (louder)
Unterberger test
Walk with eyes closed. Watch for rotation to side of lesion
bovine cough indicates
vagal palsy
where is bicep vs tricep vs brachioradialis reflex
inc nerve roots
bicep reflex hit the hard bit in the elbow-pit
C5 C6
tricep hits the back of the elbow, slightly above the tip
C6 C7
brachioradialis hits the bit above the bony prominence thumb side
C5 C6
how to test (Dys)diadochokinesia
rapidly alternate placeing hand face up and down into your other hand
neural examination power scale
5 full strength 4 - weaker than normal 3 - can move against gravity, but not against resistance 2- twitch - contraction 1 - nothing
spastic tone
type of high tone
First increase, then decrease in tone
Tone depends on speed (higher tone/ resistance with higher speed)
Tone is different for different muscles (abduct/adduct)
UMN eg stroke
rigid tone
type of high tone
Increased tone over joint radius, and in both directions (eg abduct and adduct)
Tone high for slow and high speeds - irrespective
Parkinsons
pronator drift
- Ask patients to copy you and put hands out in position like carrying a stack of books, but arm fully extended.
- Then ask them to close their eyes and observe the position of the arms
- if one of their arms drifts down and pronates. (pronators are the ones spared of weakness in UMN problem)
Contralateral pyramidal tract lesion - UMN lesion
plantar/dorsi flexion
plantar flexion = they push foot towards ground against hand on ball of feet
Dorisflexion = they raise toes/ foot towards their face whilst doctor hand resist on superior of foot
inversion/eversion of foot
Inversion - lateral malleolus facing down (pic). Doctor tries to pull foot flat (pull lateral side up) whilst patient maintains inversion
Eversion - foot flat. Doctor tries to invert it by pulling lateral side down to curled position while patient maintains eversion
selective weakness =
indicates?
abductor vs adductor
indicates UMN
pyramidal weakness =
indicates?
Extensor > flexor in arms
Flexor > extensor in legs
UMN
Proximal muscle weakness (but distal is strong) — indicates?
muscle disease
distal muscle weakness (but proximal strong)– indicates?
nerve disease
one sided weakness – indicates
problem in brain eg stroke
weakness at a certain level indicates
spinal cord problem
Knee jerk/ Patella reflex
Ankle jerk
plantar reflex
inc nerve roots
Knee jerk/ Patella reflex- lift knee slightly and tap hammer below knee
L3 L4
Ankle jerk- Patients leg is semiflexed with knee pointing out to side. Pull toes (dorsiflex) to stretch tendon. Hammer on achilles tendon
S1
plantar reflex- (Socks off). Start at lateral border of the bottom of the foot towards the big toe
Observe toes:
- Normal : flexion of big toe (goes down)
- Pathological : big toe goes up and other toes fan out
This reflex is present in babies/infants <2y but is pathological in adults
ankle clonus =
seen in what pathology
= repeated rhythmic jerking
support ankle and force dorsiflexion on foot (toes point up)
UMN lesions
zig zagged lines when doing heel to shin
ataxia
what Hz from vibration sense
128 hz tuning fork
Stereognosis
Graphesthesia
3D object placed in hands (Eyes closed)- work out eg key, coin
Eyes closed work out what is ‘drawn’ in skin (eg 8 shape)
koilonychia
iron def anaemia
spoon shaped nails
what causes clubbing
lung cancer pulmonary fibrosis IBD liver disease heart problems idiopathic bronchiectasis
palmar erythema
Raised oestrogen - pregnancy
Liver disease
liver flap asterix
- how long held
- indicates
30s
encephalopathy
respiratory failure - CO2 retention
corneal arcus
light ring is iris
phospholipid/cholesterol
apthous ulcer
ulcer on inside of mouths/lips
when might you see breast atrophy in women
liver disease
where is c section scar
pant line
where is kidney transplant scar
angled line in iliac fossa
pitting oedema examinatino
5 seconds press over bony prominence
bi/unilateral
how far proximally does it extend
virchows node
- where
- indicates
in L supraclavicular
associated with abdominal cancer especially ovarian, kidney, gastric and testicular
which side should patient roll to if you palpate spleen and want to feel it again
R
rovsing sign
indicates what
palpate L iliac fossa and the R side hurts
Appendicitis
percussion
- dull/ tympanic
dull = solid stuff, liquid (organs, bones, poo, fluid collections) tympanic = air/ gas (lungs, empty bowel)
shifting dullness
Start at umbilicus, go out away from you
Resonant (bowel gas) → dull (stool, ascitic fluid). Keep finger here as a mark
Roll towards you
Wait 20-30 seconds
Tap again
If resonant now, likely to ascitic fluid rather than stool (stays dull)
fluid thrill
if ascites present
Place hand flat on L side of abdomen
Ask patient to place hand ulnar (pinky) side on the midline - to stop skin transmission of fluid
tap/ flick on R side
Feel if thrill felt by flat L hand
high pitched tinkling bowel sounds
bowel obstruction
absent bowel sounds
- how long til you can be like yeah g theyre absent
- what might cause absent bowel sounds
2mins
Peritonitis
Constipation
Electrolyte abnormalities
Recent surgery
scrotal transillumination =
possible pathologies for each case
torch . light seen?
Normal testis can be identified No transillumination - Spermatocele - Epididymitis - Epididymal tumors Yes transillumination - Epididymal Cyst - Cyst of the cord - Lax hydrocele
Not normal testis No transillumination - Testicular Tumour - Haematocele (smooth surface, history of trauma) - Orchitis (tender) Yes transillumination - Hydrocele
‘getting above’ scrotal swelling
No
- Hernia
- Infantile hydrocele
Yes = true swelling
tender scrotal swelling differential diagnosis
Testicular torsion
Infection/ inflammation
Trauma
Strangulation
how to assess anal tone during DRE
ask them to squeeze
asthma worse when (in the day)
night
intermittent - some days fine
MRC dyspnoea breathless scale
1 - only SOB during exercise
2 - SOB when hurrying or walking uphill
3 - walks slower than average, stops walking 1-2 km
4- stops walking 100m or few mins
5 - SOB at rest, too breathless to leave the house, breathless dressing/undressing
inspiratory/ expiratory wheeze
Expiratory = intrathoracic obstruction Inspiratory = extrathoracic obstruction
purulent sputum suggests (2)
suggests lung abscess or bronchiectasis
what does childhood bronchitis often lead on to as an adult
asthma
what infections can lead to bronchiectasis
pneumonia
whooping cough
measles
paroxysmal nocturnal dyspnoea associated with what condition
pulmonary oedema
orthopnea indicates
how is it gauged
pulmonary oedema
obesity
severe pneumonia
pleural effusion
number of pillows - eg 2, 3
beta blockers resp s/e
wheeze
stridor =
inspiratory wheeze
SVC obstruction may present how
face/neck swelling
Chemosis=
swollen conjunctival oedema (underlid) due to exudate
horners syndrome
Ptosis (top eyelid droop)
Enopthalmous (Sunken eye)
pupil constriction
fine tremor may indicate
adrenergic (Adrenaline) stimulation – beta 2 agonists eg salbutamol
warm hands (Resp)
CO2 retention - T2RF
causes of bounding, hyperdynamic pulse
CO2 retention, respiratory failure
Pulsus paradoxus
indicates
Normally BP decreases during inspiration, compared to expiration. Here this decrease is exaggerated. It is a paradox as you can detect beats at heart but not at distal radial pulse due to decrease in BP peripherally
Severe obstructive airway disease eg severe asthma and cardiac tamponade
different chest shapes (3)
barrel chest- hyperinflated, COPD
pigeon chest - bit sticks out -Pectus carinatum
funnel chest - bit goes in - pectus excavatum
ankylosing spond effect on chest wall
reduced chest wall mvmt
what do intercostal and subcostal recession indicate
respiratory distress
how far should tracheal notch be from cricoid
3/4cm/ fingers
normal chest expansion
3-5cm
tactile vocal fremitus
vibration feeling
“99”
consolidation= more vibration
effusion/pneumothorax = less vibration (particles further apart)
lung lobes
R - upper, middle, lower
L- upper, lower
whispering pectoriloquy
if you suspect consolidation, do this
Patient Whisper “1, 2, 3” or “99”
Listen for dramatic increase in volume around consolidated lung
Crepitations vs rhonchi
Rhonchi = low pitched rattling lung sound (obstruction/secretions in larger airways) Crepitations = crackling/rattling
vocal resonance
Breath in, breath out,“Say 99 each time i make contact with the stethoscope”
Consolidated lung sounds louder (sound travels quicker through solid than air)
Quiter in effusion / pneumothorax – lung separated from wall
where would an inguinal hernia be (roughly)
groin/ base of penis/ pubic bone
inguinoscrotal hernia :direct vs oblique hernia
- shape
- reducibility
Globular (sphere shape) = direct hernia
Pyriform (pear, long shape) = oblique hernia
Direct = backwards Oblique = up, backwards, laterally
enterocele charachteristics
enterocele - small bowel hernia (rather than ommentum) soft visible peristalsis gurgling sensation tympanic resonance audible sounds
strangulated hernia charechteristics
hot to touch
tender
tense
scrotal neck test
Hold neck of scrotum between fingers, both hands
Tell if swelling is scrotal / inguinal / inguinoscrotal
omentocele charachterisitc
dough-y
varicocele characteritics
bag of worms
omentocele vs enterocele reducibility
Omentocele = easy at first, difficult later Enterocele = difficult first, easy later
3 fingers test aka Ziemans test
Cough Feel impulse On the finger of the : Deep inguinal ring = indirect hernia Superficial ring = direct hernia Saphenous opening = femoral hernia
proper names for high/ low arch foot
Flat foot = pes planus
High arch = pes cavus
lingual/ thyroglossal/ pyramidal/ retrosternal thyroid lump
location and other examination features
lingual - migrates up neck, seems kinda at back of thraot/oral cavity (Rare!) - may be able to see when mouth opened
thyroglossal - midilne, adams apple kinda level
- moves up when tongue poked out
pyramidal - just adding a bit on top of where normal thyroid is
retrosternal - gone now, partially/fully behind sternum
- unable to get below it on palpation
- dull upper sternal percussion
appetite in hypo/hyperthryoidism
hyper- increased appetite (despite weight loss!) – this occasionally acc causes weight gain
hypo- decreased appetite (Despite weight gain!)
voice changes with thyroid problems
hypo - hoarse - slow - low (if extreme)
diar/const hyper/hypothyroidism
diar = hyper const = hypo
concentration levels hypo/hyperthyroidism
both decrease in concentration
clubbing hyper/hypothyroidism
hyper - in the poptarts! – graves
periods hyper/hypo thryoidism
- fertility
lesss periods in hyper
more periods in hypo
fertility problems in both
does goitre cause swallowing problems
no, rarely, even when large
hyper/hypothyroidism speed of onset
slow - hypo
quicker - hyper
does amiodarone/lithium cause hypo/hyperthyroidism
hypo mainly for both
tremor - hypo/hyperthryoidism
hyper
thyroid examination swallowing
only thyroid swellings move with swallowing
thyroid swelling bruit indicates
hyper - graves
graves eye disease
exophthalmos = bulging eyes graves lid lag diplopia bloodshot - conjunctival oedema lid retration -(can see white above circles) - all types of hyper visual acuity
hyper/hypothyroidism reflexes
hyper = increased hypo= decreased
where is great saphenous vein
drains into what
medial leg
drains into femoral vein via saphenofemoral junction (groin) (4cm lateral and inferior to pubic tubercle)
where is small saphenous vein
drains into what
posterior calf
Drains into popliteal vein via saphenopopliteal junction (knee popliteal fossa)
venous insufficency / venous HTN effects
Oedema
Pigmentation
Fibrosis
Ulceration
how long is warfarin prescribed for after DVT
6m
what are perforator veins
connect superficial to deep veins
varicose veins
2 causes
Deformed wall + valves→ dilated veins, thin walls
Bulging
perforator vein incompetence
saphenofemoral incompetence
varicose veins
- gender
- occupation
- pain charachter
- worse when
- associated symptoms
- females
- standing up
- dull ache
- worse at end of day/laying down
- skin pigmentiation, ulcer (lower 1/3, medial leg), swelling/oedema, constipation, DVT, eczema, venous stars, gangrene, hot
cough impulse venous insufficiency
if you feel thrill at saphenofemoral junction (aka saphenous opening) (4cm lateral and inferior to pubic tubercle) then it is saphenofemoral (aka saphenous) incompetence
Lipodermatosclerosis =
seen in ?
Hardening of skin, around ankles
varicose veins / venous insufficiency
Schwartz test / percussion/ tap test
tap at saphenofemoral junction (aka saphenous opening) (4cm lateral and inferior to pubic tubercle)
if impulse felt in varicosites down the leg, then is it SFJ incompetence
modified perthe’s test
Checks for deep vein function , DVT
Tourniquet tied in standing position (full veins) below saphenous opening, thigh
Patient walks 3-5mins/ exercise / foot raises to tip toe 10 times
observing vein distension
Secondary varicose veins distend more than primary - If superficial veins are empty, deep veins are patent (primary)
(unmodified: pain and vein distension = secondary. no pain, collapsed veins = primary)
leg raising test to distinguish primary/secondary varicose veins
Legs raised, veins empty. Quick evacuation indicates primary varicose veins. Slow evacuation – delay/obstruction = secondary varicose veins
Trendelenburg test
where is the incompetence? Perforator or saphenofemoral junction or communicating system
1. veins empty by stroking ankle to thigh
2. tonriquet below SFJ
3 If varieties fill → perforator incompetence (problem is more distal to SF junction). If they don’t fill quickly, then problem with SF junction
4. Then if they don’t refill - tie on mid-thigh perforators, saphenopopliteal junction and the mid-calf perforators
5. If is already distended, then distends more on tourniquet removal – both perforator and saphenofemoral incompetence!
varicose vein investigation beyond examination
doppler US aka duplex
first line treatment for intermittent claudication
and next steps
compared to critical ischaemia
exercise
risk factor modification
statin, anti-platelet
angioplasty
critical ischaemia Can not treat conservatively, needs revascularization
- Amputation
- Stent
- Angioplasty
- Bypass
Varicose Veins TREATMENT
compression stockings
sicca
dry eyes / mouth
GALS 3 questions
“Do you have any pain or stiffness in your muscles, joints or back?”
“Can you dress without difficulty?”
“Can you walk up and down stairs without difficulty?”
how to test thoracic spine rotation
“turn side to side”
Put your hands on their hips to stop them moving
Temporomandibular joints tested how
open mouth wide / swing jaw L /R
Normal limit of flexion at hip =
120 deg
Normal limit of flexion at knee =
140 deg
normal range of hip rotation (knee above hip lying flat, knee and hip flexed 90 deg, move lower leg around)
45 deg each way
Thomas test
Thomas’s test for fixed flexion deformity of the hip - testing hip extension
- Place one hand under the small of the back to feel the lumbar region. Other hand scoops both legs up, flexing hips and knees
- Flex hips as far as possible, feeling lumbar spine flattening against hand
- “Can you straighten you left leg” whilst holding the other in the same position
- This tests hyperextension of the L side. In deformity, leg won’t be lowered fully or curvature remains in spine
patella tap
Stroke down from mid thigh to above knee to empty the suprapatellar pouch
Keep hand there
With fingertips of other hand, press down briefly and firmly over the patella
Cause is Knee effusion
“hands behind head” tests what msk
Full shoulder abduction and external rotation of glenohumeral joint
how to test supraspinatus
Initiates abduction (below 90degrees, then deltoid takes over)
how to test infraspinatus
External rotation
how to test subscapularis
internal rotation
how to test teres minor
external rotation
how to test deltoid
Abducts after 90 degrees (before than, supraspinatus does it)
how to test trapezius
shrug shoulders
Controls scapula movement
Clunky, symmetry, smoothness
shoulders examination initial two active movements (screen), and what are they testing for
hand behind back holding hands pushing up the back — internal rotation, abduction, extension
hands behind head — external rotation, abduction, (extension)
shoulder external rotation
elbow at side, elbow flexed 90 deg
normal range of motion in shoulder abduction
120 deg
subacromial space pathology seen as
what are some examples of subacromial space pathology
painful arc - painful in middle section, not painful at bottom or top of the arc
- Osteophyte impingement - Grows down from acromioclavicular joint
- Subacromial bursitis
- Supraspinatus tendonitis
acriomoclavicular joint pathology seen as
painful at the top of the arc only - 120-180 deg
deltoid abduction
self fist bump. doctor tries to push arms down
shoulder internal rotation
hands behind back, whats the highest vertebra you can touch
lift off test=
tests what
their hand behind their back and pushing against your hand
Subscapularis internal rotation only
how to test subscapularis internal rotation only
lift off test
their hand behind their back and pushing against your hand
acromioclavicular joint
scarf test =? and why isnt it done
put hand of test arm over other shoulder. Doctor lifts the elbow so it is in line with shoulders and further adducts the joint.
acromioclavicular joint
postive test = pain
painful arc test
pain in middle of arc of ab/aducting shoulder- arm by side to above head
- Osteophyte impingement - Grows down from acromioclavicular joint
- Subacromial bursitis
- Supraspinatus tendonitis
nerves vs vertebrae in cervical spine
nerves come out above vertebra (c3 nerve exits above c3 vertebra), except for C8 - which comes out below C7
normal cervical spine flexion
chin to chest
80 deg
normal cervical spine extension
head look up
50 deg
normal cervical spine rotation
watch tennis
80 deg each way
normal cervical lateral flexion
ear to shoulder
45 degrees in each direction (90 degrees total)
schobers test
whilst standing, mark levels of dimples and 10 cm above and 5cm below this
ask them to touch their toes
distance should increase from 15cm to 20cm
normal straight leg raising
80-90 degrees,
Tibial nerve stretch test
possibly = bowstring test idk
- Flex their knee and hip (hand on ankle and thigh/knee)
- Gently extend knee. This will cause the tibial nerve to bowstring across the popliteal fossa.
- Palpate over hamstring tendons on each side. Ask if sore
- Palpate over nerve in middle of popliteal fossa. Ask if sore
- Positive test = pain when nerve pressed but NOT when hamstring tendons are pressed
Femoral nerve stretch test
Flex knee
Then extend the hip
This stretches the femoral nerve
Positive = pain in back/ front of thigh
nail pitting can indicate
psoriasis
Onycholysis =
indicates
Onycholysis = nail lifted off bed
fungal disease
koilonchya
nail spooning
melanoma nail presentation
dark pigment / black in nail - often in base / skin fold at base
Paronychia
White / pale skin adjacent to the nail = pus
Nail needs to be removed + pus drained
Onychogryphosis
One side of the nail grows quicker than the other
Look thick and curvy like a ram’s horn
Arachnodactyly
long thin fingers eg marfans
wrist flexion and extension normal
90 Deg each
describe thumb abduction
what nerve does this test (when done against resistance)
90 deg perpindicular to palm
median
fromans test =
hold piece of paper between thumbs and fists (thumbs together). try to pull paper away
postive = thumb DIP joint flexion
dorsal interossei not working
what action tests ulnar nerve
adduction and abduction of fingers
wrist drop signifies which nerve palsy
radial
carpals tunnel treatment
Neutral Wrist splint (for night) Steroid injection (into carpels tunnel) Surgery
normal hip flexion
what should be noted about hip flexion
120 deg
Lumbar flexion can contribute, masking limitation
normal hip abduction
45 degrees
normal hip adduction (moved across other leg)
25 deg
normal hip rotation (foot used as indicator)
45 degrees each way
normal hip extension (lying on front)
20 deg
measuring limb lengths (both!)
Legs stretched out as far as possible. Ensure they are lying straight:
Measure length from umbilicus/xiphisternum (either fine) to medial malleolus = apparent length
- Record and compare both sides
Measure length from anterior superior iliac spine to the medial malleolus = true length
Ripple test aka bulge test
Hold the thigh just above the knee firmly with one hand - empty suprapatellar pouch
Stroke with other hand in upside down U and see for fluid movement (keep hand on suprapatellar pouch)
= fluid in knee - is it freely moving, or locked in position?
normal knee flexion
140 deg
ligament pathologies when doing knee valgus/ varus stresses
Ligament lax / ruptured → movement may occur but painless
Ligament strained but intact → limited movement and painful
mc murrays test
- tests for what
Meniscus injury – click /clunk +/- pain, and feel something pop out
when medial / lateral meniscus stressed (how confuses me - see notes)
