Professional Documents
Culture Documents
PELVIS
PASSIVE MOVEMENTS
• no true passive movements but provoking or stress tests
• goal: look for reproduction of patient` s symptoms!!!!
Functional test:
• Patient standing relaxed
• palpate SIASs and SIPSs, note differences
Trendlenburg` s sign :
• stand or balance on one leg
• pelvis on nonstance leg raises : neg
• palvis drops : positive
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• tight hamstrings would cause pelvis post rot or spine flex
• WHEN?:
If examiner is unsure wheather there is neurological involvement
Lower motor neuron lesion: involve nerve roots, peripherial nerve produce findings of flaccidity
• WHY? / AIM:
To find out if there is neurolog. Involvement
Test reflexes and sensation (s.b.)
Deep tendon reflexes are performed to test the tegrity of spinal reflex
• HOW? / DEMANDS:
2
• if difficult to elicit: patient asked to clench teeth or squeeze hands together (Jendrassik
maneuver) when testing lower limb – the legs, when testing upper limb
• à increase facilitative activity of spinal cord and accentuate minimally active reflexes
2) superficial reflexes:
• stroking skin with sharp object
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3) pathological reflexes
• indicate upper motor neuron lesions if present on both sides
• indicate lower motor neuron lesions if present on one side
• Hyporeflexia or areflexia indicates lesion of peripheral nerve or spinal nerve roots
• Hyporeflexia or areflexia can be seen in absence of muscle weakness or atrophy because of
involvement of efferent loop
• Hyperreflexia indicates upper motor neuron lesion
• If cervical enlargement is involved some reflexes are exaggerated, some decreased
WHEN?:
• same time as reflex tests
WHY? / AIM:
• to check cutaneous distribution of various peripheral nerves and dermatomes around joint being
examined
• determine the extent of sensory loss
• determine whether loss is caused by nerve root lesions, peripheral nerve lesions or compressive
tunnel syndromes
• determine degree of functional impairment
HOW?:
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• Examiner must be able to differentiate between sensory loss involving a nerve root
(dermatome!) or a peripheral nerve!
• Quick scan: examiner runs relaxed hand over skin to be tested bilaterally; ask patient whether
there are any differencesin sensation
• Patients eyes may be open
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• WHEN?:
• if there are capsular patterns
• WHY / AIM?:
• ???
• HOW / DEMANDS:
• 1) patient should be relaxed and fully supported
• 2) examiner should be relaxed and should use a firm but confortable grasp
• 3) one joint should be examined at a time
• 4) one movement should be examined at a time
• 5) the unaffected side should be tested first
• 6) one articular surface is stabilized while the other is moved
• 7) movements must be normal and not forced
• 8) movements should not cause undue discomfort
JOINT POSITION
Facet (spine) Midway between flexion and extension
Temporomandibular Mouth slightly open
Glenohumeral 55° abduction, 30° horizontal adduction
Acromioclavicular Arm resting by side in normal physiolog.
Position
Sternoclavicular Arm resting by side in normal physiolog.
Position
Ulnohumeral (elbow) 70° flexion, 10° supination
Radiohumeral Full extension, full supination
Proximal radioulnar 70°flexion; 35° supination
Distal radioulnar 10° supination
Radiocarpal (wrist) Neutral with slight ulnar deviation
Carpometacarpal Midway: abduction – adduction, flex – extension
Metacarpophalangeal Slight flexion
Interphalangeal Slight flexion
Hip 30° flexion, 30° adduction, slight lat rotation
Knee 25° flexion
Talocrural (ankle) 10° plantar flexion,. Midway: max inversion –
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exversion
Subtalar Midway: extremes of ROM
Midtarsal Midway extremes of ROM
Tarsometatarsal Midway: extremes ROM
Metatarsophalangeal Neutral
Interphalangeal Slight flexion
JOINT POSITION
Facet ( spine) Extension
Temporomandibular Clenched teeth
Glenohumeral Abduction and lat. Rotation
Acromioclavicular Arm abduction 90 °
Sternoclavicular Max shoulder elevation
Ulnohumeral (elbow) Extension
Radiohumeral Elbow flexed 90° ; forearm supinated 5°
Proximal radioulnar 5° supination
Distal radioulnar 5° supination
Radiocarpal (wrist) Extension with radial deviation
Metacarpophalangeal ( fingers) Full flexion
Metacarpophalangeal ( thumb) Full opposition
Interphalangeal Full extension
Hip Full extension, med rotation
Knee Full extension, lat rotation of tibia
Talocrural (ankle) Max dorsiflexion
Subtalar Supination
Midtarsal Supination
Tarsometatarsal Supination
Metatarsophalangeal Full extension
Interphalangeal Full extension
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PALPATION
WHEN?:
Only after tissue at fault has been identified
WHY / AIM? :
Palpation for tenderness used to determine the exact extent of lesion within that tissue
Only if tissue lies superficial and within easy reach of fingers
HOW?!
1) discriminate differences in tissue tension and muscle tone:
spasticity,
collapse of muscletone during testing,
rigidity = involuntary resistance during passive movement without collapse
flaccidity = no muscle tone
6) variations in temperature
7) tremors,
fasciculations => contraction of number of muscles innervated by a single motor axon
pulses:
ARTERY LOCATION
Carotid Anterior m. sternocleidomastoideus
Brachial Med. of arm midway shoulder – elbow
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Radial Wrist lat m. flex. Carpi radialis tendon
Ulnar Wrist between m.flex. digitorum
superficialis and flex. Carpi ulnaris tendons
Femoral Femoral triangle: sartorius, add. Longus, lig.
Inguinale
Popliteal Post aspect of knee, deep and hard to
palpate
Post. Tibial Post aspect of med. malleolus
Dorsalis pedis Between first and sec metatarsal bones
superior
loud, snapping, pain free noises of tendons usually caused by cavitation in which gas bubbles form
suddenly and transiently owing to negative pressure in joint!