Professional Documents
Culture Documents
Dr Edna F Roche
Inspection
Palpation
Movement (active first then passive)
Measurement
Assessment of functional ability.
Inspection
Palpation
Feel the joint and periarticular areas for:
tenderness
warmth
effusion
'boggy' swelling (thickened synovium and fluid)
enthesitis
contractures
Range of Movement
Active
Passive only if active not full range
WATCH THE CHILD'S FACE THROUGHOUT
describe the angle from neutral.
1
For all joints: hands, wrists, elbows, shoulders, tm joints, cx spine, lumbar spine, hips,
knees, ankles, feet.
Start with child sitting on a chair/bed with the hands resting on the thighs.
Upper Limbs
Look at dorsum of the hand first; note any skin rash or muscle wasting.
Methodically inspect the wrist, MCP, PIP, DIP joints and Nails. Get the child to turn
the hand over and look at palmar same way.
Flex and extend the child's fingers while palpating over the flexor tendon sheathes (for
synovitis).
Thumb:
Can flex to contact the tips of the other fingers, and abduct from the index finger (50 0).
Now test function: grip strength, write with a pencil; use knife, fork, cup, spoon; hold
toothbrush; undo and do up buttons; turn key.
Elbows:
Supination and pronation should be tested with the elbow flexed (if possible) at 90 0 - a
pencil in the hand may help.
Functionally: check if child can turn an imaginary doorknob, comb hair, hang out the
washing, answer the telephone.
Shoulders:
2
1. 'Put your hands above your head' and demonstrate. Tests flexion (90 0) and
abduction (1800).
2. 'Give yourself a hug' and demonstrate. Tests adduction (450).
3. 'Scratch your back' and demonstrate. Tests external rotation (450).
4. 'Hide your hands behind your back' and demonstrate. Tests internal rotation (55 0)
and extension (450).
THORACOLUMBAR SPINE:
Inspect with child standing and then bending forward (for scoliosis or kyphosis).
Check ROM.
SACROILIAC JOINT
Lower Limbs
3
Squat (for proximal weakness or instability).
Hips:
Then test:
1. Internal rotation (350)
2. External rotation (450)
Both tested with hips at 900 flexion.
3. Abduction (500).
4. Adduction (300).
Note the pelvis should be stabilised (by handfixing the ASIS) when checking all these
movements.
Knees:
Feel - for temperature, tenderness and palpate entheses (10, 2, 6 o'clock position on
the patella) and for any synovial thickening or effusion.
Test for the 'bulge sign' by milking any joint fluid down the lateral aspect of the joint
(look for the bulge medially) and then stroke upwards on the medial aspect moving any
fluid present into the suprapatellar bursa. Test for a patellar tap (careful can hurt).
Measure - muscle bulk of thighs and calves if appear different (at fixed pt above patella
e.g. 5-10cm and 10cm below the tibial tuberosity). If not already done, measure leg
length.
Check for the 'drawer' sign signifying damage to the cruciate ligaments (anterior
cruciate ruptured is ruptured if there is movement when the leg is pulled forward;
posterior if movement when leg is pushed back).
4
Check for lateral mobility with the knee fully extended, for lesions of the medial/lateral
ligament; normally there is no lateral movement.
Check ROM
Note any crepitus or pain on moving the 1st MTP joint (may be selectively involved in
spondyloarthropathies).