What are the 5 general principles of examination?
- Introduction
- Look
- Feel
- Move (active then passive)
- Function
What are you checking for in look?
- Deformity
- Swelling
- Rashes or other skin changes
- Muscle bulk or wasting
What are you checking for in “feel”?
- Temperature
- Palpate swellings for fluctuance
- Tenderness around joints
What are you doing in “move”?
- Full range of movement
- Active then passive
What is the normal range of motion for cervical:
- flexion
- extension
- lateral flexsion
- lateral rotation
Flexion - 80 from neutral
Extension - 50 from neutral
Lateral flexion - 45 from neutral
Rotation - 80 from neutral
What spinal nerve routes control reflexes for:
- biceps
- triceps
- knee
- ankle jerk
Biceps - C5/6
Triceps - C7/8
Knee - L3/4
Ankle jerk - S1/2
What special tests are done in hand examination?
- Phalen’s test
- Hand held in full flexion for 60 seconds, positive if patients symptoms elicited by this
- Tinel’s test
- Lightly tap over median nerve as passes through wrist, positive when tingling in thumb, index and middle finger
What special tests are done in hip examination?
- Trendelenburg test
- Patient stands in front, hold iliac crests, positive if pelvis drips on the side of non-weight bearing leg
- Thomas test
- Assessment of fixed flexion deformity
- Place hand under patients lumbar spine, fully flex normal hip until you feel lumbar spine flatten in hand, observe opposite leg and if it is lifted of bed then there is fixed flexion deformity of that hip
What are you looking for when assessing gait as part of hips?
- Limps
- Antalgic - pain on weight bearing
- Trendelenburg dip - weak abductors giving waddling gait
- Ataxic gait - wide based and marked clumsiness
- High stepping - presence of foot drop
What is valgus and varus?
- Valgus
- Distal part deviated laterally from midline
- Varus
- Distal part deviated medially from midline
What are the 2 tests to test for knee effusion?
- Patellar tap
- Moderate or large knee effusion (>50ml)
- Bulse sign
- Small effusion
- Empty medial compartment
What tests are done to assess cruciate ligaments?
- Posterior draw test
- Observe both knees when at 90 degrees and hips at 45 degrees for one tibia lying posterior to other
- If sad present, pull forward to test
- Anterior draw test
- Check both tibial tuberosities aligned from side
- Pull tibia forwards to attempt to draw forwards
What are you checking for in gait for feet?
- Normal cycle of heel strike and toe off
- Height of step, as in foot drop
What are you checking for in gait for knee?
- Limp
- Valgus/varus deformity
- Fixed flexion gait
