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othopaedics > clinical exam for ortho > Flashcards

clinical exam for ortho Flashcards

1
Q

what to look at on the foot

A 
callouses
big toe 
lesser toe 
asymmetry
skin changes
obvious deformity
nails
mid/hind foot deformity 
plantar arch
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2
Q

what to feel for on the foot

A

ask if any tenderness
pulses: dorsalis pedis, posterior tibial pulses
temperature
deformities
squeeze MTPJ, mid tarsal, anterior joint line, subtalar joint (individual toe if deformity)
palpate achilles tendon

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3
Q

movements of the foot

A

active then passive
1. inversion and eversion
2.big toe dorsiflexion and plantar flexion
3. ankle dorsi and plantar flexion
4. passive only twist midtarsal joint and
subtalar hold at heel and twist foot

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4
Q

normal inversion and eversion angle

A

30 and 20

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5
Q

normal big toe dorsi and plantar

A

70 and 45

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6
Q

normal ankle dorsi and plantar

A

20 and 40

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7
Q

patient standing look front on

A

deformities in forefoot on weightbearing

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8
Q

patient standing look side on

A

arches

ask patient to stand on tiptoes

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9
Q

patient standing look from back

A

achilles tendon thickening and valgus or varus

ask patient to stand on tiptoes to see if normal varus

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10
Q

special tests for the foot

A

-gait

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11
Q

patient standing knee look

A
  • general health
  • walking aids, orthosis
  • alignment of knees v/v
  • quad muscles wasting
  • ertythema of knee
  • large effusions/ haemarthrosis
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12
Q

patient standing side knee

A
  • fixed flexion deformity
  • scars
  • baker cyst from OA
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13
Q

patient standing back knee

A
  • muscle wasting
  • scars
  • alignment of legs
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14
Q

patient standing special tests for knee

A

-gait

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15
Q

patient lying look knees

A
  • trunk 45 degrees
  • scars on knee(midantline)
  • patella effusion
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16
Q

patient lying feel knees

A

ask if any pain
-erythema
-feel for heat
-patellar tap
-sweep test/ cross fluctulence- look other side for bulge
-palpate the knee structures with knee 90degrees
patella tendon, patella, quad tendon, medial and lateral femoral condyle, medial and lateral collateral lig, joint line tibia plateau and condyle
(look at face)

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17
Q

patient lying movement tests knee

A
  • straight leg raise: look for discomfort
    bend knee and rotate for pain- both knees
  • flexion and extension of knee active and passively
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18
Q

flexion and extension of knee norm

A

140 and -10

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19
Q

collateral ligament knee test

A

medial and lateral
for medial hold ankle medially and knee laterally and push against each other
then vice versa

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20
Q

cruciate knee test

A 
anterior and posterior drawer (check for sac post)
anterior:
-flex knees
-sit on their foot 
-feel in the joint line 
-pull the tibia towards

posterior: push the tibia in

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21
Q

meniscal knee test

A

McMURRAY provcation test

  • trying to provoke pain by trapping meniscus
  • grab the foot and flex and extend the knee when applying twisting force
22
Q

special tests for knee

A
  • collateral ligaments
  • anterior and posterior drawer
  • meniscal mcmurray
23
Q

hip exam look patient standing from front

A
  • general health
  • walking aids
  • posture
  • quads wasting
  • surgical scar
24
Q

hip patient standing from side

A

spine alignment
flexion of knee
contractures at ankle
scars on hip

25
Q

hip patient standing from back

A 
spine, shoulders level
straight spine
pelvis level-feel iliac crest
atrophy of buttocks
scars 
muscle wasting leg
malalignment
26
Q

special test standing for hip

A
  1. tredelenburg gait- get to stand on one leg and feel iliac crest, fatigue - sit infront of patient
  2. gait
27
Q

patient lying look hip

A

as pain anywhere

  • feel iliac crest
  • feel hand bredth below IC for GC and palpate
28
Q

patient lying move

A
  1. straight leg raise and flex knee for spinal pathology
  2. Thomas’s test: flex unaffected knee and put hand on lumbar spine and then flex that hip right up and straighten out affected
  3. hip flexion active then passive
  4. external and internal rotation with knee flexed
  5. abduction and adduction: put hand on pelvis and with straight leg move out/in over other leg
  6. hip extension: lies face down and put hand on pelvis and lift each leg
29
Q

functional/ special tests for the hip

A
  1. leg length
    true=ASIS to medial mall
    apparent=umbilical to medial mall-for both legs
    2.
30
Q

apparent leg length difference causes

A

due to pelvic tilt or in the spine scoliosis

31
Q

true leg length differences causes

A

hip dysplasia or previous fracture

32
Q

normal hip flexion and extension

A

125 and 20

33
Q

normal hip abd and adduction

A

45 and 30

34
Q

normal internal and external hip rotation

A

40 and 45

35
Q

thomas test positive result

A

affected knee can’t extend or can’t keep back on table or can’t flex knee >80

36
Q

patient sitting looking hands with pillow

A
  • general health
  • look at elbows for nodules
  • look at hands for…
  • palm asymmetry, deformity, muscle wasting, thickenings Dupytren, erythema
  • dorsal: muscle wasting- guttering and 1st dorsal space, pitting, splinter haemorrhages, nodules, synovitis
  • specific RA disease and OA disease
  • scars: mcpj RAsurgery
37
Q

feel hand exam

A

ask if pain
feel pulses radial and ulnar compare both
thickening of palm
temperature over joints
wasting of eminences
squeeze:MCPJx2, dip and pip joints each, wrist squeeze

38
Q

movements hand

A 
1. wrist flexion and extension: prayer sign
passive then active hold wrist and move
2. radial deviation and ulnar deviation 
3.spread fingers wide
4. make a fist
5. can assess finger individually passive
6.thumb/ finger flexion and extension
7. thumb/ finger add and abd
39
Q

special tests for hand nerve tests

A
  1. median nerve motor: to thenar look for wasting and ask patient to bring thumb up to ceiling against resistance
  2. sensation median on tip of index finger
  3. motor ulnar at hypothenar wasting, push little finger out against resistance
  4. sensation ulnar tip of little finger
  5. motor radial nerve push fingers up against resistance and wrist up
  6. sensation radial nerve over 1st dorsal space
40
Q

specific tests for median nerve hand

A
  1. phalen’s test: flex the wrist up with elbow and hold for 30s to see if numbness
  2. tinel’s test: tap over carpal tunnel to produce numbness
41
Q

function test for hand

A
  • grip on your finger
  • fine pinch grip stop pulling finger out
  • hold a pen
42
Q

shoulder exam look from front

A
  • general health
  • muscle wasting
  • erythema
  • scars-delopectoral scar
  • clavicle prominences medial from dislocation or fracture
43
Q

shoulder look from side standing

A
  • posture
  • asymmetry in height
  • lateral scar, arthroscopy
  • prominences of clavicle
  • prominence of deltoid
44
Q

shoulder back look

A
  • asymmetry in height
  • fullness in fossa
  • no spine
  • muscle wasting
  • scars
45
Q

feel shoulder

A

ask if pain

  • temperature on sternoclavicular, acromioclavicular front rotator cuff and back
  • tenderness over sternoclavciular joint out along clavicle to acriomioclavicular and spine of scapula
  • extend the arm back to feel ant rotator cuff for tender
  • glenohumeral joint and -subacromial spaces and
  • greater tuberosity
46
Q

move the shoulder

A

-neck up/down, left and right, ear on shoulder
-hands behind head
-hands behind back (IR)
-abduction: passive and active to the top if poss
-extension: bring arm back as far as poss
-flexion bring arm forward as far as poss
active and passive
-external rotation bring arm out far as possible with tucked in
active and passive

47
Q

normal internal rotation level shoulder

A

t5

48
Q

normal flexion and extension of shoulder

A

150 and 40

49
Q

external rotation shoulder normal and internal rotation

A

45-60

and 90

50
Q

special test shoulder rotator cuff tests

A

Jobe’s test=supraspinatous
external rotation: infraspinatous and teres minor
subscapularis: gerber’s lift off and belly press test

othopaedics (21 decks)

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