7958495
Description
Flashcards by Ashutosh Kumar, updated more than 1 year ago
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Created by Ashutosh Kumar
about 7 years ago
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| Question | Answer |
| Examination of the shoulder: | Look: With the shoulder fully exposed, inspect the patient from the front, from the side and from behind. Checking for posture, muscle wasting, scars and symmetry. Feel: Assess temperature over the front of the shoulder. Palpate the body landmarks for tenderness; sternoclavicular, clavicle, acromioclavicular, acromion process and around scapula. Palpate the joint line- anterior and posterior. Palpate muscle bulk of supraspinatus, infraspinatus and deltoid muscles. Move: Ask the patient to put their hands behind their head to assess external rotation. Behind their back to assess internal rotation; if restriction, note how far patient can reach e.g to lumbar, lower thoracic etc. With elbow flexed at 90 degrees and tucked into patient’s side, assess external rotation of shoulder. Loss may indicate frozen shoulder. Ask patient to raise arms in front and behind to assess flexion and extension respectively. Ask patient to abduct arm to assess for painful arc (10-120) Assess abduction from behind patient and observe scapular movement. Function: Getting the hands behind back |
| Examination of the hip: | Examination of the hip: Look: With the patient standing, assess for muscle wasting (gluteal muscle bulk in particular) With patient lying flat and face up, observe the legs, comparing one side with the other- is there an obvious flexion deformity of the hip? If there is a suggestion of leg length disparity, assess true leg lengths using a tape measure; from ASIS to medial malleolus of ankle on same side. Compare measurements. In a fractured neck of femur leg is shortened and externally rotated. Checks for scars overlying hip. Feel: Palpate over the greater trochanter for tenderness. Move: With the knee flexed at 90 degrees, assess full hip flexion, comparing one side with the other and watching the patient’s face for signs of pain. Assess for fixed flexion deformity of the hip by performing Thomas’ tes. Keep one hand under the patient’s back to ensure that normal lumbar lordosis is removed. Fully flex one hip and observe the opposite leg. If it lifts off the couch then there is a fixed flexion deformity in that hip (As the pelvis is forced to tilt a normal hip would extend allowing t |
| Examination of hip Part 2: | With the hip and knee flexed at 90 degrees, assess internal and external rotation of both hips. This often limited in hip disease. Asses the hip and proximal (gluteal) muscle strength by performing the Trendelenburg test. This involves the patient alternately standing on each leg alone. In a negative test the pelvis remains level or even rises. In an abnormal test the pelvis will dip on the contralateral side. Function: Assess gait looking for antalgic (limping) gait or Trendelenburg (waddling) gait. |
| Knee examination: | Look: From the end of the couch and with the patient’s legs straight, observe the knees, comparing one with the other for symmetry and alignment. Is the posture of the knee normal? Look for valgus and varus deformity. Check for a knee flexion deformity. Check for muscle wasting or scars. Look for redness suggesting inflammation or infection. Look for obvious swelling. Check for a rash suggesting psoriasis. Feel: Using the back of your hand, feel the skin temperature, starting with the mid-thigh and comparing it to the temperature over the knee. Compare one knee to the other. Palpate for tenderness along the borders of the patella. With the knee flexed to 90 degrees, palpate for tenderness and swelling along the joint line from the femoral condyles to the inferior pole of the patella, then down the inferior patella tendon to the tibial tuberosity. Feel behind the knee for a popliteal (Baker’s) cyst. |
| Knee examination Part 2: | Assess for an effusion by performing a patellar tap (slide your hand down the patient’s thigh, compressing the suprapatellar pouch. This forces any effusion behind the patella. With two or three fingers of the other hand push the patella down gently. In a positive test the patella will bounce and tap). Assess for a fluid bulge by cross fluctuation (stroke medial side of knee upwards towards the suprapatellar pouch. This empties the medial compartment of fluid. Then stroke the lateral side downwards. The medial side may refill producing a bulge of fluid, indicating the presence of an effusion). Move: Ask the patient to flex the knee as far as possible to assess active movement. With patient fully relaxed, assess passive movement (place one hand on knee feeling for crepitus). With the knee flexed to 90 degrees, check the stability of the knee ligaments. Look initially from the side of the knee, checking for a posterior sag or step-back of the tibia, suggesting posterior cruciate ligament damage. Anterior and posterior drawer tests. |
| Knee examination part 3: | Medial and lateral collateral ligaments tests with knee flexed at 15 degrees. Function: Ask the patient to stand and then walk a few steps, looking again for varus or valgus deformity. |
| Examination of the spine: | Examination of the spine: Look: Observe the patient standing. Look initially from behind the patient for any obvious muscle wasting, asymmetry, or scoliosis of the spine. Look from the side for normal cervical lordosis, thoracic kyphosis and lumbar lordosis. Feel: Feel down the spinal processes and over the sacroiliac joints for alignment and tenderness. Palpate the paraspinal muscles for tenderness. |
| Examination of the spine part 2: | Move: Assess lumbar flexion and extension by placing two or three fingers over the lumbar spine. Ask the patient to bend to touch their toes. Your fingers should move apart during flexion and back together during extension. Ask the patient to run each hand in turn down the outside of the adjacent leg to assess lateral flexion of the spine. Next assess the cervical spine movements. Ask the patient to: tilt their head to each side, bringing the ear towards the adjacent shoulder (lateral flexion); turn their head to look over each shoulder (rotation); bring their chin towards their chest (flexion); and tilt their head backwards (extension). With the patient sitting on the edge of the cough to fix their pelvis and their arms cross in front of them, assess thoracic rotation (with your hands on the patient’s shoulders to guide the movement). With the patient lying as flat as possible, perform the straight leg raise test; dorsiflexion of the foot with the leg raised may exacerbate the pain from a nerve entrapment. Assess reflexes and strength. |
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