History and Examination

Spine

History and Examination

History

pain: where(leg versus back),radiation,when,type,nocte,aggrevating,relieving,how long,cough, sneeze
other: stiffness,deformity,numb,weak,bladder,bowel

scoliosis(when,how,who,progress,pain,neuro,growth,menarche,family history,treatment,previous XR)
function: walking,limp,supports,distance,stairs,socks,toes,transportation
past history: treatment,injury,surgery,similar episodes

Exam Standing

look: shoes,sticks,spine,scars,waist,hair,defomity (scoliosis

kyphosis,kyphos,lordosis hypokyphosis)
scoliosis(balance,shoulders,rib prominence,loin creases)
feel: LLD,Trendel,pelvic obliquity,steps
move: spine flexion:2 pts 10 cm apart move 5 cm.

           spine ext.:including wall test
           lateral flexion, rotation & rib excursion
           scoliosis: list & mobility

Exam Supine

look: asymetry,wasting,deformity,scars,atrophy
feel: pulses
move: crossed-SLR,SLR,Lasaugue,bowstring
power & nerovascular: sensation,power,tone,coordination,abdominal reflex,tendon reflex, anal reflex
SIJ,hip & knee

Exam Side

fem stretch
glut med test

Exam Prone

look:bony tendernes steps ,soft tissue
feel: glut.
move: hip internal and external rotation and extension
power

Waddel (3/5)

tenderness: superficial or non anatomic
simulation tests: axial load & pelvic rotation
distraction tests: SLR seated
regional distrbance
over reaction

Any individual sign counts as a positive sign for that type
3 or more of the 5 types is clinically significant


Hip

History and Examination Summary

History

pain: where,radiation,when,type,nocte,aggrevating,relieving,how long,start up,
other:stiffness,deformity,giveway,lock
function:walking,limp,supports,distance,stairs,socks,toes,transportation
past history:treatment,injury,surgery,similar episodes

 

Exam (Standing)

look:shoes,sticks,spine,scars,waist,defomity
feel: LLD,Trendel
move:spine,gait

 

Exam (Supine)

look: asymetry,wasting,deformity
feel: pulses & crepitus
move: Thomas' test,flexion,extension,abduction,adduction,internal ratation in flexion,external rotation in flexion
LLD: Real and apparent,Galleazzi,Bryant
power & nerovascular

 

Exam (Side)

Ober test for abduction contracture. Abduct hips & flex knee to relax the ITB.

Then allow hips to come together. If they do = no abduction contracture
glut med test

 

Exam (Prone)

look: Glutei
feel: Glut.
move: Internal rotation,external rotation,extension
power

 

Trendelenburg Test (Hardcastle & Nade, 1985)

Examiner stands behind patient to observe angle of pelvis
Patient asked to raise from the floor the side not being tested

hip should be at 0 - 30o flexion
support weight bearing side only
stance side usually elevated if normal
Positive test if non stance side cannot be elevated or position cannot be maintained for 30 sec
Once balanced the patient is asked to raise the non stance side of the pelvis as high as possible, support may be given on the stance side
If leans too far over weight bearing side correct so that the vertebral prominences between the shoulders are over the centre of the hip joint and weight bearing foot
If elevation of the pelvis is not maximal or maintained also positive test indicating abnormal hip mechanics


Knee

History and Examination Summary

History

pain:where,radiation,type,when,nocte,aggrevating,relevieving,how long,stairs,start up
other:locking,swell,giveway,stiffness,deformity
function:walking,limp,support,squat,kneel,stairs,toes,socks
past history:treatment,injury,surgery,sim episodes

Exam (Standing)

look:shoes,sticks,spine,back,side,front,scars,swelling,deformity,wasting,redness
feel:LLD (Trendel)
move; gait,single leg stance,hop,squat

Exam

look:swelling,wasting,deformity,fixed flexion deformity
feel:pulses tape,effusion & synovium(X-fluct,tap, bulge),temperature,posterior whole knee systematically
move:crepitation,passive extension,active extension,active flexion,passive flexion
ligs:
varus/valgus testing
Lachman,anterior draw,Slocum test,Flexion-rotation-drawer test,Pivot shift test,Jerk test,Merv Cross
Lacmann,posterior draw,push back,90/90+dynamic reverse pivot shift(Jakob),ext rot. recurvatum(Hughston)
menisci:McMurray(flex,abd,e.r.>ext.,add,i.r.),Steinman

Exam PFJ

look:size,shape,position,vastus medialis oblique muscle
feel:articular surface,quadrant glide,tilt(n=0-15),grind,Q angle(n=15M,20F)
move: crepitations,passive apprehension,
rotational alignment

Exam (Prone)

1.pop fossa,pulses,Apley,Staheli


Foot and Ankle

History and Examination Summary

History

pain: where,radiation,type,when,nocte,aggrevating,relieving
other: instability,giveway,swell,deformity,cosmesis,stiffness,numbness,tingling
function: walking,limp,shoes,sticks,sports,work
past history: treatment,injury,surgery,injections,similar episodes

Exam (Standing)

look: shoes,sticks,calipers,front,side,back,single toe rise,Coleman
feel: spine
move: gait,toe walk,heel walk

Exam (Supine)

look:sole of foot (wear pattern),plantar keratoses

dorsal corns (soft & hard), swelling, deformity, redness, scars
feel: pulses, sole of foot, MT heads,MTP jts,interMT spaces,toe

tug,"Lachman",plantar fascia, rest of foot/ankle:systematic
move:ankle,subtalar,midtarsal,MTP, IPJ
ligs:ankle-AP drawer etc
power,neuro: (tib post, tib ant,peroneals etc.)


Shoulder

History and Examination Summary

History

pain: where,radiation,type,when,nocte,aggrevating,relieving,how long
other: stiffness,deformity,clunk,giveway,instability
function: coat,wash back,bra,toilet,comb,feed,high shelf, lift weight,throw,pull,work,sport,recreation
past hist: neck,treatment,injury,surgery,similar episodes

Exam neck

Exam

look: swelling,wasting,deformity,scars,bicep,undressing
feel: S/C joint,clavicle,A/C joint,acromion,tuberosities & groove,scapula,rotator cuff,deltoid bursa,axilla,biceps tendon
move: Crepitation,active & passive then gleno-humeral alone,elevation,abduction,arc & drop arm,internal rotation,cross body adduction
resisted: abduction,abduction at 90,external rotation,Gerber's lift off test
spec:
impingement:passive & active with varying rotation
biceps:Speed's & Yergason's
instab:anterior apprehension,relocation,A/P draw,Sulcus,Wynn jerk test, push pull (and test for ligamentous laxity)
power,neuro,vascular


Elbow

History and Examination Summary

History

pain: where,radiation,type,when,nocte,aggrevating,relieving,how long
other: stiffness,lock,deformity,clunk,giveway,instability
function: coat,wash back,bra,toilet,comb,feed,high shelf, lift weight,throw,pull,work,sport,recr.
past hist:neck,treatment,injury,surgery,similar episodes

Exam Neck and Shoulder

Exam

look: swelling(olecranon bursa or RA nodule),wasting, deformity,scars,bicep,undressing
feel: temp,nodules,synovial thickening,fluid,tenderness bony landmarks
move: crepitus,active & passive ROM (flex/ext,pro/sup)
ligs: varus valgus,PLRI (postero-lateral rotatory instability)
power,neuro,vascular


Wrist

History and Examination summary

History

pain: where,radiation,type,when,nocte,aggrevating,relieving,how long
other: stiffness,deformity,numb,click,clunk,catch,weakness,giveway
function: back pocket,toilet,opposite underarm,eat,comb,rise from chair,dress,pull,throw,work,sport,recr
past history:neck,treatment,injury,surgery,similar,episodes

Exam Neck, Shoulder and Wrist

Exam

look:swelling,wasting,deformity,scars,ulnar styloid,red,
feel:warmth,tenderness,bony landmarks
move:crepiations,active & passive ROM (dorsiflexion, palmarflaexion,radial and ulnar deviation, supination and pronation)
spec:Watsons,Shuck,L/T ballot,midcarpal,piano key, TFCC load,Tinnel,
power,neuro,vascular: (incl. grip strength)


Hand

History and Examination summary

History

pain: where,radiation,type,when,nocte,aggrevating,relieving,how long
other:stiffness,swell,parasthesia,deformity,weakness
function:washing,feeding,hygeine,taps,jars,carrying keys,pens,buttons
past history:neck,treatment,injury,surgery,similar episodes

Exam Neck, Shoulder and Elbow

Exam

look:swelling(olec bursa or RA nodule), wasting, deformity, scars, undressing
feel:temp, nodules, synovial thickening, fluid, tenderness
move:crepitus, act. & passive, flex/ext, pro/sup
functionpinch(pen), power (hold 2 fingers), key, large object, hook
spec:Bunnell, FDS, FDP, Tinell, Finkelstein, Phalen
power,neuro,vascular