4TH LE

• Abduction


  Skeletal muscle movement which involves moving away an extremity from the midline of the body
• Skeletal Movement


  • Depression - Lowering of a body part
  • Elevation - Raising of a body part
  • Retraction - Moving backward
  • Protraction - Moving forward
  • Circumduction - Moving in a circular fashion
  • Opposition - from original position to placing in the middle of palm
  • Reposition - Back to original position
  • Extension - straightening, increasing the joint angle
  • Flexion - Bending, decrease of joint angle
  • Inversion - turning inward
  • Eversion - Turning outward
  • Pronation - Turning downward
  • Supination - Turning upward
  • External Rotation - turning away from midline
  • Internal Rotation - turning toward midline
  • Abduction - moving aways from midline
  • Adduction - moving towards midline
• Equipment


  • Tape measure
  • Goniometer (optional)
  • Skin marking pencil (optional)
• Gait


  • Note base of support, weight-bearing stability, foot position, stride & strength & cadence of stride, arm swing
• Sample documentation: Gait


  • smooth c̄ equal stride & good base of support
• Stature/Posture


  • Observe curvature of cervical, thoracic & lumbar spine
• Sample documentation: Stature/Posture


  • erect s̅ exaggerated curvature of cervical, thoracic & lumbar spine. Spine is straight.
• Abnormal Findings


  • Kyphosis - Increased frontal and back curvature of upper spine
  • Lordosis - Inward curvature of lumbar spine
  • Scoliosis - Spine forms "s" curvature

  
• Symmetry


  • Note upper & lower extremities
• Sample documentation: Symmetry


  • upper & lower extremities symmetric
• Range of Motion


  • Note ROM of the following: cervical spine, thoracic & lumbar spine, shoulders, arms, elbows, wrist, hands & fingers, hips, knees, ankles & feet
• Sample documentation: Range of Motion


  • Normal ROM of the Cervical Spine
  • Normal ROM of the Thoracic & Lumbar Spine
  • Normal ROM of the Shoulder
  • Normal ROM of the arms & elbows
  • Normal ROM of the wrist
  • Normal ROM of the hands & fingers
  • Normal ROM of the hips
  • Normal ROM of the knees
  • Normal ROM of the ankles & feet
• Sample documentation: Crepitus


  • Not noted
• Sample documentation: Fasciculations


  • Not noted
• Sample documentation: Bone deformities

  • Not noted
• Abnormal Findings: Bone Deformities


  • Boutonniere deformity - abnormal flexion of the proximal interphalangeal joint
  • Swan neck - abnormal flexion of the distal interphalangeal joint
  • Heberden's & Bouchard's Nodes (osteoarthritis)

  
• Muscle Strength Rating


  • 5 - active motion against full normal resistance
  • 4 - active motion against some resistance
  • 3 - active motion against gravity
  • 2 - passive ROM (gravity removed and assisted by examiner)
  • 1 - slight flicker of contraction
  • 0 - no muscular contraction
• Sample documentation: Muscle Strength

  • No specific rating provided
• Phalen's test


  • Wrist flexed 90 degrees pointing downwards for 60 seconds
• Sample documentation: Phalen's test


  • no tingling, numbness, or pain noted
• Tinel's test


  • Find the median nerve or the ulnar side of the nerve of the px; percuss lightly
• Sample documentation: Tinel's test


  • no tingling, numbness, or pain noted
• Lasègue's test


  • Px in supine position; raise one leg all the way up
• Sample documentation: Lasègue's test

  • no back & leg pain noted

  
• "Bulge knee" test


  • Touch either side of the knee, stroking upwards; observe bulge of fluid to indicate sign of synovial effusion
• Sample documentation: "Bulge knee" test


  • no bulge of fluid appears on medial side of knee
• "Ballottement" test


  • Px in supine; thumb and index finger of nondominant hand should hold the patella. Dominant hand should push the patella down to the femur. Feel for fluid wave or clicks (positive findings; synovial effusion)
• Sample documentation: "Ballottement" test


  • no movement of patella noted
• McMurray's test


  • Px in supine; flex the knee and hip of the patient. One hand on the side of the knee, and one hand on the heel of the px.
• Sample documentation: McMurray's test

  • no pain or clicking noted
• Spinal accessory nerve (CN XI)


  Innervates the neck muscles namely the trapezius & sternocleidomastoid muscles
• Left of px is naas rightside, right of px is naas leftside
• Bulge knee test


  Stroke thrice on the median, then place hand on lateral side of the knee. If there is a bulge, it means positive for synovial effusion.
• Synovial effusion: bulge knee test & ballotement test
• Carpal tunnel syndrome: Phalen's and Tinel's test
• Herniated nucleus pulposus: Lasegue test
• Torn meniscus/ "locking in of knee": McMurray's test
• Common for athletes
• Equipment Needed


  • Examination Gloves
  • Pencil & Paper
  • Cotton-tipped Applicators
  • Newsprint to read
  • Ophthalmoscope
  • Paper clip
  • Penlight
  • Snellen Chart
  • Sterile cotton ball
  • Substances to smell or taste such as salt, sugar, vanilla, lemon juice, coffee
  • Tongue depressor
  • Tuning Fork
  • Tape measure
  • Objects to feel such as key or quarter
  • Test tubes containing hot & cold water
  • Reflex (percussion) hammer
• Levels of Consciousness


  • Alert - Awake & responsive
  • Lethargic - Easily aroused with mild stimulation & can maintain arousal without need of continuous simulations
  • Somnolent - Aroused by voice or touch; can follow commands, but need constant stimulation to maintain arousal
  • Obtunded - Aroused by verbal & painful stimulation; verbal output unintelligible
  • Stuporous - Unresponsive; only aroused by vigorous repeated painful stimuli; no response to verbal stimuli
  • Comatose - Unresponsive to any type of stimulus; deep tendon reflexes absent