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-Inspect for joint symmetry, alignment, bony deformities, swelling
-Inspects and palpates tissues for skin changes, nodules, muscle atrophy, tenderness, warmth
-Assesses circulation (cap refill, pulses), sensation (touch toe, compare side to side), movement (push away, pull towards) -Gait (stance, swing, strike, limp, pace)
-Inspects hip - contour of greater trochanter, iliac crest for alignment (iliac crest level on both sides) and resting posistion (assess for atrophy, deformity, contracture)
-Palpates iliac crest, anterior/posterior superior iliac spine (under dimples just above butt), sacroiliac joint (dimpes: tenderness- sacrililitis), greater trochanter
-W/ painful hip palpate bursae below inguinal ligament (trochanteric bursistis vs tendonitis vs muscle spasm vs ITB tendonitis)
-Assess ROM show with passive, then have them do active: flexion (knee to chest), extension (behind you), abduction (move leg away from midline), adduction (move leg toward midline), internal rotation, external rotation)
-Strength: resisted hip flexion and extension, resisted hip abduction and adduction
-Assess inguinal structures (NAVEL- place heel on opposite knee, palpate along inguinal lig--> assess for tenderness/lymphadenopathy, synovitis, arthritis, bursitis, poas abscess, infection) -Inspects (contours, shape, alignment, resting position). Symmetry of quads, effusion, popliteal swlling (baker's cyst)
-Identifies structure of the knee: femur, tibia, fibula, patella, quadriceps, hamstring, calf muscles, ACL (crosses obliquely from anterior medial tibia to lateral femoral condyle), PCL, MCL, LCL (lateral femoral epicondyle and head of fibula), and patellar ligament, lateral and medial meniscus.
-Palpates: quad insertion above patella, patella and patellar tendon (inserts distally in tibial tuberosity), tibiofemoral joint (thumbs in soft tissue of depression on either side of patellar tendon), medial/lateral meniscus, assess medial and lateral joint compartments, MCL/LCL origin insertion, assess patellofemoral compartment (trace patellar tendon distally ntil palpate tibial tuberosity- ask pt to extend knee to ensure intact, could be torn if tender), suprapatellar pouch (above patella- 10cm)
-ROM passive then active: knee flexion (hambstring, bring heel to butt), extension (quad, straighten leg out), internal rotation (while sitting, swing lower leg toward midline, external rotation (while sitting swing lower leg away from midline)
-Strength: resisted knee flexion (testing hamstring), resisted knee extension testing quads)
-Demonstrates Effusion tests: Bulge sign (milk downward apply medial pressure, tap knee behind lateral margin), Balloon sign (place thumb and index finger of R hand on each side of patella from below, w/ L hand compress suprapatellar pouch and feel for fluid entering spaces), Ballotting the patella (milk quad down, hold above patella, and tap
-Demontrates McMurry test for meniscal injury (pendulum, feel click/pop/pain = +)
-Demonstrates varus (LCL) and valgus (MCL) stress testing
-Demonstrates Anterior Drawer (ACL) and Posterior Drawer (PCL) tests -Inspects (contour, shape, alignment, resting position)
-Identifies structures: achilles tendon, calcaneous, medial and lateral malleolus, metatarsals, PIP, MTP, DIP, phalanges
-Assess gastrocnemius (calf), soleus (beneath calf), muscles and achilles tendeon: note any defects, tenderness, swelling.
-Performs Thompson test for achilles tendon rupture: place leg (shin) on chair, squeeze calf muscle tcauses calf to contract = plantarflexion (-) (+ if no plantarflexion)
-Palpates: ankle joints and ligaments noting tenderness or swelling (ligamentous injury, infection), achilles tendons (for nodules, tenderness), posterior (heel) and inferior (below heel) calcaneous and plantar fascia for tenderness (bone spurs, fascitis, gout), MTP joints for tenderness (compress forefoot to assess for tenderness like with RA), heads of 5 metatarsals and groves b/w them for pain or tenderness (metatarsalgia, Morton's neuroma)
-ROM passive then active: plantarflexion, dorsiflexion, eversion (sole of foot out), inversion (sole of foot in)
-Differentiate findings with arthritis vs ligamentous strain (arthritic joint painful when moved in any direction, whereas ligamentous strain produces max pain when ligament in stretched)
-Ottowa Anke Rules (malleolar zone pain and any of following: PT at posterior edge/tip of lateral malleolus, PT at posterior edge/tip of medial malleolus, inability to bear weight)
-Foot XRAYS (PT at bast of 5th metatarsal, PT at navicular, Inability to hear weight -Inspects, identifies and palpates structures of the elbow: radius, ulna, biceps, triceps, lateral epicondyles (tennis elbow), medial epicondyles (golfers elbow), olecranon process
-Assess ROM: flexion (bend elbow), extension (straighten your elbow), supination (turn palms up), pronation (turn palms down) -Inspects, identifies and palpates structures of the hand/wrist: snuffbox (scaphoid), metacarpals, MCP, PIP, DIP
-Assess ROM of wrist: flexion (palms down, point fingers toward floor), extension (palms down, point fingers to ceiling), adduction (palms down, fingers toward midline), abduction (palms down, fingers away from midline)
-Demonstrates: Tinnel's (tap over median nerve, + aching and numbness), Phalen's sign (press back of hands together, + numbness/tingling)
-Assess ROM of fingers: flexion (make a fist), extension (extend and spread out fingers), abduction (spread fingers apart), adduction (bring fingers together
Assess ROM of thumb: flexion (thumb to palm), extension (thumb to index finger and out), abduction (palm up raise thumb up), adduction (back down), opposition (touch thumb to each finger tip) -Inspects contours, bony anatomy, muscle contour, atrophy, scapular winging)
-Identifies structures: scapula, humerus, clavicle, deltoid, SITS muscles insert at greater tubercle (supraspinatus directly under the acromion, infraspinatus posterior to and above teres minor, teres minor posterior and inferior to the supraspinatus, subscapularis inserts anteriorly and is NOT palpable)
-Palpates: acromion, sternoclavicular and acromioclavicular joints, bicipital groove and tendon, anterior and posterior glenohumeral joint line
-Assess ROM: flexion (raise arms in front of you and overhead --> anterior deltoid and pec), extension (raise arms behind you --> posterior deltoid, lats, teres minor), abduction (raise arms out to side and up to ears --> supraspinatus), adduction (cross arm in front of body --> subscapularis, teres minor, pecs), internal rotation (hand cuffed, thumb touch scapula --> subscapularis, anterior deltoid), external rotation (rubber band --> infraspinatus, teres minor)
-Strength: resisted forward elevation, resisted external and internal rotation
-Crossover Test: AC joint, adduct arm across chest, touch my hand and resist (+pain in the AC joint = OA of AC joint)
-Apley Stratch Test: touch opposite scapula from above and below (difficult = RC d/o or adhesive capsulitis)
-Neers Test: tests RC to r/o tendintis, bursistis, impingement: Press on scapula with one hand interally rotate with thumb down and raise pt's arm with other (pain+=inflammation or RC tear)
-Hawkin's Impingement Sign: Forward flex arm to 90 degrees, then interanally rotate (pain = impingement)
-Empty Can Test (supraspinatus strength) against resistance
-Infraspinatus Strength: rubber band ext rot
-Forearm Supination: elbow side/grab had to shake. Have pt supinate and flex while you resist (+test is pain over bicep tendon -->inflammation of biceps tendon and possible RC tear)
-Drop arm test: have pt hold arm out to ade at shoulder level and lower slowly (+ test is not able to hold arm or cannot control lowering --> RC tear) 