What do you do for inspect in a hip exam?
- general inspection: clinical signs, objects/equipment, anterior, lateral and posterior inspection of hips
- gait: ask to walk back and forth room and observe for any gait abnormalities
What do you do for feel in a hip exam?
- temperature
- hip joint palpation
- leg length assessment - true and apparent
What do you do for move in a hip exam?
Active:
- active hip flexion (move knee to chest)
- active hip extension (straighten knee so it’s flat on bed)
Passive:
- passive hip flexion
- passive hip extension
- passive hip internal rotation
- passive hip external rotation
- passive hip ABduction (move ankle laterally, hand on contralateral iliac crest)
- passive hip ADduction (move ankle medially, hand on contralateral iliac crest)
What do you do for special tests in a hip exam?
Thomas’ test:
- place hand below lumbar spine, passively flex hip of unaffected leg, observe contralateral limb
- repeat both sides
Trendelenburg’s test:
- standing, place their hands on your forearms for stability and palpate iliac crests
- ask patient to stand on one leg, observing fingers for evidence of lateral pelvic tilt
- repeat both sides
What do you do for inspect in a shoulder exam?
- general inspection
- clinical signs
- objects and equipment
- anterior, lateral and posterior inspection - press hands on wall for winging scapula
What do you do for feel in a shoulder exam?
- temperature
- shoulder joint palpation: sternoclavicular joint, clavicle, acromioclavicular joint, acromion, coracoid process of scapula, head of humerus, greater tubercle of scapula, spine of scapula
What do you do for movement in a shoulder exam?
Active:
- “both hands behind head”
- “both hands behind back”
- “hands behind back and reach upwards”
- “reach for ceiling”
- “stretch arms behind”
- “raise arms out in arch and touch hands above head”
- “keep arms straight and cross them over”
- “elbows by sides, forearms out”
- abduct shoulders whilst palpating scapula ( “raise arms out in arch and touch hands above head”)
Passive:
- same as above
What do you do for special tests in a shoulder exam?
Empty can test:
- arm out and diagonal as if emptying can
- push down on arm whilst patient resists
Painful arch:
- passively abduct arm to maximum point, ask patient to bring back down
External rotation against resistance:
- done w/ slight abduction (arm out slightly)
Internal rotation against resistance:
- arm against back pushing out against resistance
What do you do for inspect in a knee exam?
- clinical signs
- objects/equipment
- anterior, lateral and posterior inspection of knee
- gait
What do you do for feel in a knee exam?
- temperature
- measurement of quadriceps bulk w/ tape measure, 20cm above patella
- palpation of extended and flexed knee
- assess for joint effusion: patellar tap and sweep test
What do you do for inspect in a hand exam?
- clinical signs
- objects/equipment
- dorsal + palmar inspection
What do you do for feel in a hand exam?
palms up:
- temperature
- radial pulse + ulnar pulse
- thenar + hypothenar eminence bulk
- palmar thickening
- median + ulnar nerve sensation (touch thumb and pinkie finger sides)
palms down:
- temperature
- radial nerve sensation
- MCP joint squeeze
- bimanual joint palpation
- anatomical snuffbox and wrist palpation
- elbow palpation
What do you do for move in a hand exam?
Active movement:
- finger extension (splay fingers)
- finger flexion (make a fist)
- wrist extension (palms together, extend wrists)
- wrist flexion (back of hands together, flex wrists)
Passive movement:
- same as above
Motor assessment:
- cock wrists back, don’t let me pull them down
- splay fingers, don’t let me push them together
- palms up, thumb to ceiling don’t let me push it down
Function:
- power grip
- pincer grip
- pick up small object
What do you do for special tests in a hand exam?
- Tinel’s test: tap over carpal tunnel
- Phalen’s test: hold wrists in forced flexion 30-60 seconds
