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Spinal Exam
- Look
- Normal shape, no kyphosis/lordosis
Feel
- Spinal processes
- sacroiliac joints
- paraspinal muscles -> Spasm/Tenderness
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Spinal exam cont.
Move
- Flexion -tough toes
- Extension
- Fingers adjacent to spinal process to show movement
- Lat. Flexion-> Hands down thighs
- Rotation -> seated, arms @ sides
- C-spine
- -flex/ext/rotation/lat flex
Temporo-mandibular joint
Additional
- Peripheral pulses
- Reflexes
- Straight leg raise
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Hip Exam
- Look-scars
- -swelling
- -deformity
- -gluteal muscle wasting
- -assymetry
- -length discrepancy (True/Apparent)
- Feel
- G. Trochanter
- -trochanteric bursa -> inflamm/heat
Warmth @ Hip, Knee & Ankle
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Hip Exam cont.
- Move (N.B. Active & Passive)
- -Flexion; stabilise iliac crest, move @ knee
- -Rotation; bend knee, int/ext rotation
- -Abduction; stabilise opposite hip, leg away
- -Adduction; Stablise same hip, leg move medial
- -Extension; Assist hamstring curls
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Hip Exam cont
- Function
- Gait;
- -trendelenburg
- -Antalgic (Limping)
- -Short Limb
- Additional Tests
- -Thomas' Test
- Flex knee, w. hand under back @ Lumbar region
- For fixed flexion deformity
- -Trendelenburg Test
- Lift leg, bum drop on opposite side
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Knee Exam
- Look
- -Assymetry
- -Errythema/rash
- -Scarring
- -Quad wasting
- -Deformity; Fix flex/valgus/varrus
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Knee Exam cont.
- Feel
- -Warmth (mid thigh to calf)
- -Effusion; Patellar tap/bulge test
- -Popliteal Swelling
- -Pain; Patelar/Joint Line/Tibial Tuberosity
Move
- -Flex & Extend (0-140 degrees) Feel for crepitus
- -Hyperetension -> Pull up @ ankles
Additional:
- Cruciates -> Ant. Drawer test (ACL)
- Collaterals (Med/Lat bending of knee)
- McMurrays(Menisci)
- -Hold @ foot & Flex knee, outward = m, inward = l feel for clicks
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Feet & Ankles
- Look
- -symmetry
- -joint swelling
- -Clawed Toes
- -Hallux Valgus
- -Calluses
- -Footwear -> insoles/abnormal wearing
- Feel
- -temperature
- -Pulses -> Dorsalis Pedis &Post. Tibial
- -Metatarsal Squeeze
- -Tarsal J's
- -Ankle Joint line
- -Sub-talar joints
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Foot & Ankle cont.
- Move
- Dorsi & Plantar flex;
- -Hallux
- -Ankle Joint
- Inversion/Eversion;
- -Subtalar J
- Function-Gait
- -Weight bearing -> Alignement/Arches
- -Achilles T
- -Align of hindfoot (Varrus/Valgus)
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Neuro I (Upper Limbs)
- Inspection
- -wasting
- -tremor
- -posture
- -fasciculation
- Tone
- - Rotate & Ext. Wrist -> Cogwheeling
- ->quick suppination; Spastic catch
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Neuro I cont.
- Power
- -Shoulder;
- Elbows out, push against (above & below)
- -Elbow
- Boxing gloves, pull = biceps, push = triceps
- -Wrist
- Flex/Ext against resistance
- -Fingers
- Grip 2 finger (C5&6)
- Abduction w. resistance
- Thumb Ab/ADduction
- OK sign
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Neuro I cont.
- Reflexes
- -biceps/triceps/suppinator jerk
- Reinforce w. clenched teeth
Co-ordination
Finger -> Hand -> Nose
Hand Clapping; Dysdiodokinesis
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Neuro II (Lower Limbs)
- Inspection
- -Wasting
- -Posture
- -Fasciculation
- Tone
- 1. Hip & Knee
- -Log rolling, hand under & lift knee (Inc tone, heel off)
- 2. Ankle
- -90deg flex knee
- Sharp move of ankle -> Clonus
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Neuro II cont.
- Power
- -straight leg lift w. resist
- -Knee Ext w. resist
- -Pull against flexed knee
- -Foot Dorsi/Plantar Flex w. resist
- -Inversion w. resist
Reflex
- -Knee/Ankle/Plantar Flex
- Reinforce w. Hand Clasp
Co-ordination
- Rub shin w. heel
- Heel to toe walking
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