1
Q
Wrist/Hand Physiology
A
- carpels, metacarpels, phalangees, scaphoid
- always consider FOOSH
- there are so many nerves, blood vessels
- any trauma concerns go to hospitals due to complexity of hand anatomy
2
Q
Inspection of Hand/Wrist
A
- Check for symmetry
- Check for redness, swelling , deformity, bruising, muscle wastage (thenar eminence), rashes, discolouration
- dupuyentrens contracture? = diabetes
3
Q
Movement of Wrist/Hand
A
- test pts full ROM
- flexion, + extension
- abduction + adduction
- ask pt to do a fist, spread out, an okay sign (peace sign for report)
4
Q
Palpation of Hand/Wrist
A
- palpate the head of the radius
- palpate the scaphoid
- palpate the phalanges
- systematically palpate the carpels and metacarpals
- palpate the wrist joint
- palpate anatomical snuffbox (pain=fractures)
- check strength on both sides
- check radial pulse
- compare temp
- check distal sensation
5
Q
Shoulder Physiology
A
- 3 bones, scapula, humerus, clavicle
- it has 3 joints
- due to increases ROM, usually anteriorly dislocates
6
Q
Shoulder Special Test
A
Drop arm test - pt abducts to 90° then slowly lowers it. Pain/weakness is positive test for torn rotator cuff
7
Q
Palpation of Shoulder
A
- palpate bony structures
- any pain?
- check CRT
- check radial and brachial pulse
- again, looking for SLIPDUCT signs
- palpate muscle tone
- feel for normal temp
8
Q
Inspection of Shoulder
A
- check for symmetry
- check for signs of trauma, bruising, swelling, redness
- check for ‘step’ over AC joint, the SC and sub-aceomegaly joint
- deformity, scarring, muscle wastage, rashes
9
Q
Shoulder Movement
A
- Test all ROM
- flexion + extension
- abduction + adduction
- internal + external rotation
10
Q
Elbow Inspection
A
- check for symmetry
- check for signs of trauma, redness, swelling, bruising, deformity
- any scarring, muscle wastage, rashes
11
Q
Palpation of Elbow
A
- palpate the bony landmarks
- palpate the decreased for swelling and pain
- assess perfusion, limb temp, CRT
- feel for pulses
- feel for peripheral sensation and axillary nerve function at deltoid
12
Q
Elbow Physiology
A
- it’s a synovial joint
- 3 bones; humerus and ulnar
- joint is susceptible to 3 fractures; radial head, olecranon and a humerus fracture
- Tennis elbow (lateral epicondylitis) = pain from where forearm tendons connect to a OUTSIDE bony lump in the elbow. Pain/weakness causes difficulty gripping
- Golfers Elbow (medial epicondylitis) = pain where the tendons in forearm connect to the INSIDE of the bony lump in the elbow. Pain/weakness cause difficulty gripping
13
Q
Movement of Elbow
A
- flex the elbow to 90°, apply downward pressure to palm while supporting elbow
-flexion + extension - Supination + pronation
14
Q
Hips Pathophysiology
A
- significant trauma is needed to fracture the pelvic bone itself
- A fracture to the femoral head is more common
- any suspicion of pelvic trauma should lead to anaelgesia and binding for haemorrhaging control
- incontinence is a sign of nerve dmg
15
Q
Palpation of Hips
A
- feel the hips for pain and tenderness
- would feel for femoral pulse if indicated
- palpate bony prominences
- compare leg temp, colour, sensation and strength
16
Q
Inspection of Hip
A
- look for symmetry
- look for deformity, swelling, redness, rashes, bruising, muscle wastage, scarring, discolouration
- look for evidence of a NOF - shortening and rotation and unable to move leg
- look out for a do distension (haemorrhage)
- assess mobility and gait
17
Q
Movement of Hip
A
- test full ROM
- flexion + extension
- abduction + adduction
- lateral and medial rotation
- don’t move if suspected NOF
18
Q
Knee Pathophysiology
A
- a complex joint that’s a popular source of pain, swelling and locking
- ligaments, tendons, cartalidge (meniscus) can all produce pain
19
Q
Palpation of Knee
A
- palpate the knee and bony prominences
- palpate the head of the fibula
- feel for the popliteal pulse (just behind the knee)
- assess distal sensation and temp
20
Q
Inspection of Knee
A
- check for symmetry
- check for redness, swelling, bruising, deformity, muscle wastage, rashes, scarring, discolouration
- look for symmetry in quads (ruptured ACL)
- assess mobility/gait (limp = minor or major injury eg fracture or arthritis)
- abnormal guilt = injury, something neuro or foot problems
21
Q
Ottawa Knee Rules
A
- aged 55 and over
- inability to weight bear/4 steps immediately after injury
- inability to flex the knee to 90°
- tenderness isolated at the patella
- tenderness at the head of the fibula
- exclusion criteria = chronic, >18, pregnancy, burn/lac
- any of them indicate an x-ray is needed
22
Q
Movement of Knee
A
- use passive, active and resisted movements to take the knee through its full ROM
- flexion + extension
- observe pt walking, standing and sitting
23
Q
Movement of the Foot
A
- in the absence of pain/swelling, carry out passive, active, resisted movement to test full ROM
- flexion + extension
- inversion + eversion
- toe flexion and extension (active and passive)
24
Q
Ottawa Ankle Rules
A
- inability to weight bear/take 4 steps immediately after injury
- bony tenderness in posterior edge or tip of lateral malleolus
- bony tenderness at the base of the 5th metatarcel
Bony tenderness at the navicular bone
25
Inspection of the Foot/Ankle
- compare both sides for symmetry
- check for endless, swelling, bruising, deformity, muscle wastage, discolouration, rashes, scarring
- assess mobility and gait
26
Palpation of Foot/Ankle
- palpate the bones in lower leg/ankle/foot
- palpate for Achilles tendon, fibula, calf and 5th metatarcel
- palpate Ottawa landmarks
- feel the pedal pulse
- test peripheral sensation and temp
Simmonds Test= pt is kneeling on chair, squeeze calf to test for Achilles function
