Upper and Lower Extremity

Question 1

Ulnar ABduction

Answer 1

• pt in seated position w/ elbow extended (not locked) hand in supination
• apply valgus force: pushing on lateral elbow jt apply medial translational force
• counterF on wrist on medial wrist laterally
• note hard or soft end feel
• SD described as ease of motion towards ulnar ABduction, w/ restriction towards ulnar ADduction
• perform bilaterally
• documented in objective of SOAP as ulnar ABduction SD

Question 2

Ulnar ADduction

Answer 2

• pt seated w/ elbow extended (not locked), hand supinated
• apply varus force on elbow (ulnohumeral joint): contact medial elbow w/ lateral translatory force
• push on lateral wrist medially (counterF)
• note hard or soft endfeel
• SD as ease of motion in ADduction w/ restriction to ulnar ABduction
• perform bilaterally
• documented in objective of SOAP as ulnar ADduction SD

Question 3

Radial Head Motion: Posterior Glide

Answer 3

• dr. facing seated pt.
• contact radial head b/n thumb and index finger w. one hand and stabilize wrist w/ other hand
• apply posterior glide to radial end
• note end feel
• assess forearm protonation in conjuction w/ posterior glide, noting restriction and ease of motions
• posterior radial head SD will have ease of motion to posterior glide and forearm protonation w/ restriction to anterior glide and supination
• perform bilaterally
• documented in objective of SOAP as posterior glide SD

Question 4

Radial Head Motion: Anterior Glide

Answer 4

• dr. facing seated pt
• stabilize wrist w. one hand grasp radial head b.n thumb and index finger w. other hand
• apply anterior glide noting end feel
• assess supination and note ease/restriction of motion
• state anterior glide radial head SD will have ease of motion to anterior glide and supination and restriction to posterior glide and protonation
• perform bilaterally
• document in objective portion of SOAP as anterior radial head SD

Question 5

Wrist Flexion

Answer 5

• dr. facing seated pt.
• contact pts. hand and grasp radius ulna w. other hand
• place wrist into flexion and extension noting freedom of motion in posterior glide w/ restriction of carpals to anterior glide
• state wrist flexion coupled with freedom of motion in dorsal glide of carpals
• perform bilaterally
• document in objective of SOAP as writst flexion/posterior carpal glide SD

Question 6

Wrist Extension

Answer 6

• dr. facing seated pt
• place wrist into extension stabilizing wrist w/ other hand
• state freedom of motion in extension and restriction to flexion
• coupled with extension is freedom in the anterior/ventral glide of the carpals
• perfrom bilaterally
• documented in the objective of SOAP as wrist extension/ anterior carpal glide of SD

Question 7

ABduction of Wrist

Answer 7

• dr. facing seated pt
• arm in supination, abduct wrist (radial deviation) and adduction (ulnar deviation) notion freedom of motion in abduction and restriction in adduction
• perform bilaterally
• documented in objective of SOAP as wrist ABduction SD

Question 8

ADduction of wrist

Answer 8

• dr facing seated pt
• one hand place wrist into adduction (ulnar deviation) other hand stabilize distal radius/ulna
• note freedom in adduction and restriction to abduction (radial deviation)
• perform bilaterally
• documented in objective of SOAP as wrist adduction ( ulnar deviation) SD

Question 9

Finger ABduction

Answer 9

• dr. facing seated pt
• hand in supination
• perform on all digits EXCEPT thumb
• apply force to move distal end of jt away (contact proximal phalanx) from midline (long finger/3rd digit) and towards midline (ADduction) while stabilizing distal metacarpal
• state ease of motion into ABduction and restriction to adduction
• perform bilaterally
• documented in objective of SOAP sepcific to laterality, # of digit, and jt being passive moved eg: right 2nd metacarpophalangeal joint ABduction SD
  *

Question 10

Finger ADduction

Answer 10

• dr. facing seated pt, w/ forearm in supination
• contact distal metacarpal w/ one hand and proximal phalanx with other hand
• move distal end of jt away from midline and toward midline
• stating ease of motion toward midline (ADduction) and restriction of motion away from midline (ABduction)
• perform on all 4 lateral digits
• perform bilaterally
• noted on objective in SOAP as # finger, laterality, jt and ADduction SD eg: right 2nd metacarpophalangeal jt ADduction SD

Question 11

ABduction of Thumb

Answer 11

• dr. facing seated pt
• hand in supination
• contact distal metacarpal of thumb and proximal phalanx of thumb
• ABduct distal joint in anterior and posterior direction
• ease of motion in ABduction of joint and restricted to ADduction
• perform bilaterally
• noted in objective of SOAP as thumb ABduction SD

Question 12

Finger Flexion

Answer 12

• dr. facing seated pt
• contact distal metacarpal and proximal phalanx
• apply force to distal end of jt into flexion
• state ease of motion toward flexion and restriction of motion to extension
• perform bilaterally and all 4 lateral digits
• noted in objective of SOAP as right 2nd MCP flexion dysfunction

Question 13

Finger Extension

Answer 13

• dr facing seated pt w/ hand supine
• contact distal metacarpal and proximal phalanx of digit
• apply force on distal jt placing finger into extension
• perform on all four lateral digits
• perform bilaterally
• noted in objective of SOAP note eg: right 2 metacarpophalangeal extension SD

Question 14

GH jt

Answer 14

• dr. contact olecranon while blocking linkage at shoulder region
• passive flexion: 180
• passive extension: 60
• passive ABduction: 180
• passive horizontal ADduction: 40-50
• passive external and internal rotation: 90
• contact proximal humeral to assess anterior/inferior glide and posterior/superior glide passively
• perform bilaterally, noting for asymmetries
• name SD found at GH jt
• noted in objective of SOAP as GH SD

Question 15

AC jt

Answer 15

• dr. facing seated pt
• contact AC jt and palpate for tenderness and tissue texture changes
• bring GH into 60 coronal ABduction and 60 horizontal ABduction to max. AC jt motion
• maintain the position, student assess rotational aspect of AC jt by internally and externally rotating GH jt
• perform bilaterally, assessing for asymmetries
• name internal or external AC SD based on ease/restriction of motion
• noted in objective of SOAP as AC jt SD

Question 16

SC jt Flexion/Extension

Answer 16

• pt supine, fingers placed bilaterally anteriorly in clavicular head (lateral to sternum)
• pt flex shoulders to 90 and then reach toward the ceiling
• proximal clavicle moves posterior as pt reaches toward ceiling as distal clavicle moves anteriorly
• pt returns shoulders back to neutral (horizontal extension) states proximal clavicle moves anterior and distal clavicle moves posterior
• perform bilaterally they can assess for asymmetries
• horizontal extension SD w/ restriction to horizontal flexion is most common
• noted in objective of SOAP as SC SD

Question 17

SC jt ABduction and ADduction

Answer 17

• pt lays supine
• place index fingers of both hands on superior aspect of clavicle heads
• ask pt to shrug shoulders (ABduction)
• states proximal end of clavicles move inferiorly and distal clavicles moves superiorly as you shrug
• as pt moves shoulder back into neutral (ADduction) states proximal end clavicle moves superiorly and distal end of clavicle move inferiorly
• perform bilaterally, assessing for asymmetries
• noted in objective of SOAP as SC jt SD

Question 18

Scapulothoracic jt

Answer 18

• pt in lateral recumbent facing dr
• contact inferior angle of scapula w/ caudad hand and the acromion w/ cephalad hand
• perform scapular elevation: upper trapezius and levator scapulae M
• scapular depression: lower trapezius and lower rhomboids
• scapular protraction: serratus anterior
• scapular retraction: rhomboids and middle trapezius
• upward rotation: serratus anterior adn upper trapezius
• downward rotation: levator scapulae and rhomboids and latissimus dorsi
• perform bilaterally assessing for asymmetries
• name SD
• noted in objective of SOAP as ST SD

Question 19

Anterior/Posterior lateral malleolus

Answer 19

• pt supine w. knee flexed and foot flat
• contact lateral malleolus w/ thumb and index finger of one hand
• apply anterior and posterior force assesing gliding motion
• note asymmetry
• ease of posterior glide w/ anterior glide restriction => posterior glide lateral malleolus SD
• noted in objective of SOAP w. laterality noted

Question 20

Talus evaluation

Answer 20

• pts supine, dr facing
• contact foot and apply passive force to place ankle into dorsiflexion (15-20) and plantarflexion (50-65)
• motion occuring be/n talus and tibia/fibula
• talus plantar flexion SD: ease of motion for plantar flexion and restriction to dorsiflexion
  
  • vice versa
• noted in objective of SOAP w laterality

Question 21

Calcaneus evaluation

Answer 21

• pts supine, dr. standing at foot of table
• ankle placed in standing position ( slightly dorsiflexed putting ankle into 90) to avoid excess laxity in subtalar jt
• contact calcaneus apply passive inversion to 35 and eversion to 20
• states motion b.c talus and calcaneus (subtalar jt) called subtalar motion
  
  • 10 for subtalar inversion and eversion
• calcaneus inversion SD: ease of motion for inversion and restriction towards eversion
  
  • vice versa true for calcaneus eversion SD
• noted in objective of SOAP noting laterality

Question 22

Navicular evaluation

Answer 22

• pt supine, dr at foot of table
• contact navicular w/ thumb and index finger
• apply passive force for dorsal and plantar gliding
• state motion should demonstrate symmetry
• dorsal navicular SD: ease of motion to dorsal gliding and restriction to plantar gliding
  
  • vice versa true for plantar navicular glide SD
• common to have plantar glide SD
• dorsal navicular associated w/ tight plantar fascia
• noted in objective of SOAP w. laterality

Question 23

Cuboid evaluation

Answer 23

• pts supine, dr at foot of table
• contact cuboid bone b/n thumb and index finger
• apply passive dorsal and plantar gliding motion
• stating motion should be symmetric
• plantar cuboid SD= ease of motion to plantar glide and restriction to dorsal glide
  
  • vice versa true for dorsal cuboid SD
• noted in objective of SOAP w. laterality
• more common to have plantar glide cuboid SD**
• plantar cuboid associated w/ posterior fibular head***

Question 24

cuneiform eval

Answer 24

• pt supine, dr at foot of table
• contact cuneiform b/n thumn and index finger
• apply plantar and dorsal glide noting ease and restriction
• state symmetry for both glides is normal
• name different SD
• more common to have plantar cuneiforms SD***
• noted in objective of SOAP w. laterality and specified cuneiforms (1-3)

Question 25

Metatarsal eval

Answer 25

* pts supine, with dr at foot of table * contact distal metatarsal w/ thumb and index finger * block linkage at neighboring metatarsals w/ other hand * apply plantar and dorsal gliding motion noting ease and restriction * name different SD possible * state symmetry normal * more common to have plantar SD\*\*\* * noted in objective of SOAP w/ laterality and _metacarpal # specified_

Question 26

Metatarso-phalangeal eval

Answer 26

* pt supine, dr at foot of table * contact MTP jt w/ thumb and index finger * block linkage at metatarsal head w/ other hand * apply force for _dorsi/plantarflexion, ABduction/ADduction, internal/external rotation_ * state motion should normally by symmetrical * name all possible SDs (6) * noted in objective of SOAP w. laterality and **# of jt**

Question 27

Hip jt flexion/extension

Answer 27

* pt supine, dr. facing pt * passive flexion and block linkage noting 90 ROM * assess bilaterality * hip extension w/ pt in prone, block linkage noting 15-30 ROM * assess bilaterality * state possible SDs * noted in objective of SOAP w. laterality

Question 28

Internal/ External rt of hip jt

Answer 28

* pt supine, hip and knee flexed 90 **OR** prone w. knee flexed 90 * apply passive internal rotation noting 30-40 ROM and block linkage * assess bilaterality * apply passive external rotation notive 40-60 ROM and block linkage * assess bilaterality * for prone pts external rt linkage at ipsi GLUT and interal rt linkage at contra PSIS * name possible SDs * noted in objective of SOAP w. laterality

Question 29

ABduction/ADduction hip jt

Answer 29

* pt supine, dr at foot of table * passive ABduction noting 45-50 ROM * passive ADduction noting 20-30 ROM * name possble SDs * noted in objective of SOAP w. laterality

Question 30

internal/external rt of knee jt

Answer 30

* pt supine, dr. same side as side being assessed OR prone w/ knee flexed to 90 * hip and knee flexed to 90 * student assess passive internal rt. of tibia noting 10 ROM * passive external rt. noting 10 ROM * assess bilaterally * movements are in relation of tibia to distal femur * name possible SD s * noted in objective of SOAP w. laterality

Question 31

ABduction/ADduction of knee

Answer 31

* pt supine, stand at side being assessed * ADduction: contact lateral distal femur and medial ankle: apply VALGUS force assessing for ease/restriction * assess bilaterally * contact medial distal femur and lateral ankle apply: VARUS force assessing for ease/restriction * assess bilaterally * state possible SDs * noted in objective of SOAP w. laterality

Question 32

proximal fibula eval

Answer 32

* pt supine, stand at side being treated * knee flexed, foot flat on table (can also perform w. knee extended) * contact fibular head w/ thumb and index finger * apply anterior and posterior gliding force * assess bilaterally * note eases and restriction stating possible SDs * noted in objective of SOAP w. laterality