ALS Lecture 4 - Examination of the Limbs DONE

Question 1

gait cycle

Answer 1

1 foot contacts ground -> same foot contracts ground

Question 2

2 phases of gait cycle

Answer 2

stance, swing

Question 3

stance phase

Answer 3

foot in contact with ground

Question 4

swing phase

Answer 4

foot not in contact with ground

Question 5

stance phase constitutes what percent of gate cycle?

Answer 5

60

Question 6

5 movements in stance phase

Answer 6

heel strike, foot flat (loading response), mid stance, terminal stance (push off), toe off (pre-swing)

Question 7

heel strike

Answer 7

heel is first bone to touch ground

Question 8

foot flat (loading response)

Answer 8

weight onto reference leg

Question 9

foot flat (loading response) is important for

Answer 9

weight-bearing, shock absorption, forward progression

Question 10

mid stance

Answer 10

alignment (leg below body), balance body weight on reference foot

Question 11

terminal stance (push off)

Answer 11

heel of reference foot rises while toe still on ground

Question 12

toe off (pre-swing)

Answer 12

toe of reference foot rises, swings int air, beginning of swing phase of gait cycle

Question 13

swing phase constitutes what percent of gate cycle?

Answer 13

40

Question 14

3 parts to swing phase

Answer 14

initial swing, mid swing, terminal swing

Question 15

pathological disorders of gait (4)

Answer 15

antalgic, slapping foot, foot drop, trendelenburg

Question 16

antalgic gait

Answer 16

pain in any limb, pt walks with limp so foot on painful side on ground less

Question 17

slapping foot gait

Answer 17

weakness in dorsiflexors, in heel strike foot can’t come up

Question 18

foot drop gait

Answer 18

completely weak dorsiflexors, in swing foot dangles, toes strike floor and higher step

Question 19

trendelenburg gait

Answer 19

weakness of hip abductors gluteus medius and minimus, on side pt is standing on, lean over to shift centre of mass to other side so they don’t fall

Question 20

orthopaedic exam

Answer 20

look, feel, move, x-ray

Question 21

look in orthopaedic exam

Answer 21

deformity, muscle wasting, scars, gait abnormalities

Question 22

move in orthopaedic exam

Answer 22

range of movements, resisted movement for muscle power

Question 23

GALS screening examination

Answer 23

gait, arms, legs, spine

Question 24

shoulder joint type

Answer 24

ball and socket

Question 25

shoulder range of movement

Answer 25

large

Question 26

should be able to abduct arthritis up away from body ______ degrees

Answer 26

180

Question 27

shoulder abduction test

Answer 27

stand behind patient, feel bottom of scapula, feel scapula move as arm abducts

Question 28

what degree of shoulder abduction is by scapulothoracic joint?

Answer 28

60-180

Question 29

what degree of shoulder abduction is by glenohumeral joint?

Answer 29

120-180

Question 30

shoulder external rotation and abduction test (1)

Answer 30

abducted position, humerus is externally rotated, uncomfortable if previous anterior dislocation

Question 31

shoulder external rotation and abduction test (2)

Answer 31

apley scracth test, see how far pt can reach over shoulder

Question 32

shoulder internal rotation and abduction test

Answer 32

see how far pt can get hand up back, measured as level on thoracic spine also bring arm across to shoulder (at front)

Question 33

shoulder flexor power test

Answer 33

stabilise joint, resist arm move forwards

Question 34

shoulder extensor power test

Answer 34

stabilise joint, resist arm move backwards

Question 35

shoulder adductor power test

Answer 35

stabilise joint, resist arm move down towards body

Question 36

shoulder abductor power test

Answer 36

stabilise joint, resist arm move up away from body

Question 37

shoulder elevation power test

Answer 37

put hands on shoulders and resist shoulders shrugging

Question 38

test for shoulder sensation (which nerve and where)

Answer 38

axillary, sergeant's stripe

Question 39

elbow joint type

Answer 39

hinge

Question 40

elbow flexion power test

Answer 40

support elbow, test flexion against resistance

Question 41

elbow extension power test

Answer 41

support elbow, test extension against resistance

Question 42

elbow supinator power test

Answer 42

support elbow, test forearm supination against resistance

Question 43

elbow pronation power test

Answer 43

support elbow, test forearm pronation against resistance

Question 44

wrist dorsiflexion is ___degrees

Answer 44

70

Question 45

wrist palmar flexion is ___degrees

Answer 45

80

Question 46

demonstrate ulnar and radial deviation of wrist

Answer 46

done

Question 47

metacarpophalangeal flexion is ___degrees

Answer 47

90

Question 48

metacarpophalangeal extension is ___degrees

Answer 48

30-45

Question 49

proximal interphalangeal joint flexion is ___degrees

Answer 49

0-100

Question 50

distal interphalangeal joint flexion is ___degrees

Answer 50

90

Question 51

distal interphalangeal joint flexion is ___degrees

Answer 51

10

Question 52

test for long extensor power

Answer 52

movement of metacarpophalangeal joints against resistance

Question 53

test for finger flexor power

Answer 53

grip patient’s fingers and pull up while asking them to resist

Question 54

test for finger abductor power

Answer 54

spanning hand, move fingers away from midline, ask them to resist adduction movement and keep fingers open

Question 55

test for finger adductor power

Answer 55

use a paper or banknotes the patient holds between their fingers and try to pull the note

Question 56

pinch grip

Answer 56

picking up small objects

Question 57

power grip

Answer 57

hand makes space for item being held, flexing all joints in the hand

Question 58

thomas test for fixed flexion deformity of hip (3 steps)

Answer 58

1. lie patient on flat, firm couch 2. place hand under lumbar lordosis 3. flexion of hip should eliminate lumbar lordosis

Question 59

test hip extension

Answer 59

lie patient on front, lift leg, should be 20-30 degrees

Question 60

test hip abduction (2 steps)

Answer 60

1. feel anterior superior iliac spine on leg being tested. | 2. abduct hip, feel with other hand

Question 61

test hip adduction

Answer 61

on back, push leg over other leg

Question 62

test hip external rotation

Answer 62

use foot to rotate hip out

Question 63

test hip internal rotation

Answer 63

use foot to rotate hip in

Question 64

femoral neck anteversion ____degrees

Answer 64

10-15

Question 65

trendelenburg test (3 steps)

Answer 65

1. pt stand on leg with problem 2. put fingers on anterior superior iliac spines 3. feel dip on opposite side

Question 66

knee joint type

Answer 66

hinge type synovial

Question 67

hyperextension of knee is ___degrees

Answer 67

-10

Question 68

flexion of knee is ___degrees

Answer 68

130-140

Question 69

knee deformities (3)

Answer 69

genu varum, genu valgum, genu recurvatum

Question 70

genu varum

Answer 70

bowed legs, common arthritis

Question 71

genu valgum

Answer 71

knock knees, arthritis on outside of knee, away from midline

Question 72

genu recurvatum

Answer 72

back knee, hyperextension of knee

Question 73

test medial collateral ligament stability

Answer 73

push knee into valgum position (inwards), stabilise knee with one hand and stretch ligament

Question 74

test lateral collateral ligament stability

Answer 74

push knee into varus position (outwards)

Question 75

Drawer test use

Answer 75

assess suspected rupture cruciate ligament in knee

Question 76

Drawer test method for ACL

Answer 76

1. pt lay back, feet flat, knees up 2. stabilise feet, pull tibia forward 3. if CAN be pulled forwards = positive drawer test = ACL rupture

Question 77

Drawer test method for PCL

Answer 77

1. pt lay back, feet flat, knees up 2. stabilise feet, push tibia backwards 3. if CAN be pushed backwards = positive drawer test = PCL rupture

Question 78

test for quadriceps muscle power

Answer 78

resist leg extension

Question 79

test for hamstring muscle power

Answer 79

resist leg flexion

Question 80

schober test is for

Answer 80

lumbar spine flexion and extension

Question 81

schober test (2 steps)

Answer 81

1. compare fixed point on spine about 10cm apart using 2 fingers 2. ask pt to bend forwards to touch toes, 10cm should go to 15cm, then lean back 3. ask pt to run hand down each thigh

Question 82

true leg length

Answer 82

affected limb is physically shorter than other

Question 83

apparent leg length discrepancy

Answer 83

pelvis tilted up on one side, e.g. scoliosis, one leg seems shorter

Question 84

measure leg length from

Answer 84

umbilicus to medial malleolus of ankle

Question 85

if one leg is definitely shorter, check if tibia or femur is shorter by

Answer 85

position hip at 45, knee at 90, if tibia shorter knee not as high from front, if femur shorter knee further back than side

Question 86

rotator cuff is an important

Answer 86

shoulder joint stabiliser

Question 87

rotator cuff is a (what type of thing?)

Answer 87

tendon

Question 88

rotator cuff attaches to

Answer 88

greater tuberosity of humerus

Question 89

muscles of the rotator cuff

Answer 89

supraspinatus, infrapsinatus, teres minor, subscapularis

Question 90

drop arm test is for

Answer 90

rotator cuff function

Question 91

drop arm test

Answer 91

1. hold patient arm out at side 2. release hand, ask pt to keep arm in place 3. if major rotator cuff tear arm will drop a bit

Question 92

L4 lesion motor loss

Answer 92

tibialis anterior, resisted dorsiflexion of foot

Question 93

L4 lesion reflex loss

Answer 93

missing knee jerk reflex, definite L4 problem

Question 94

L4 lesion sensation loss

Answer 94

L4 dermatome on medial part of lower leg/foot

Question 95

L5 lesion motor loss

Answer 95

extensor hallucis longus, extension of big toe

Question 96

L5 lesion reflex loss

Answer 96

none

Question 97

L5 lesion sensation loss

Answer 97

L5 dermatome on dorsum of foot

Question 98

S1 lesion motor loss

Answer 98

peroneus longus and brevis, eversion of foot

Question 99

S1 lesion reflex loss

Answer 99

very specific to ankle jerk reflex

Question 100

S1 lesion sensation loss

Answer 100

S1 dermatome on lateral part of lower leg/foot