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80 Cards in this Set
- Front
- Back
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TART
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T: Tissue, texture changes
A: Asymmetry R: Restriction T: Tenderness |
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Four things to observe during GAIT initial observation
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General: limp, asymmetry, smooth/hesitant/uneven steps
Feet: foot position. Are the toes in, or out? Heel to toe weight transfer Hip motion: lateral (when hips swing side to side. People with osteoarthritis) or vertical (when all the weight is on one leg, due to injury) HAT: Head, Arms, Torso. arm swing, side to side excursion, head movement |
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Perform structural exam for proprioception/balance and explain trendelenberg sign
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Make patient squat on both feet and observe their up and down motion.
Make patient stand on either legs with eyes open, observe for wobble Place hand on iliac crest on one side, and ask the patient to lift up that corresponding leg. The iliac crest must have moved up with the leg lift (otherwise have trendelenberg sign and might mean fractured femoral head or severe coxa vara |
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what muscle is affected if trenderlenberg sign is affected
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Gluteaus medius weakness, hip dislocation, fractured femoral head or severe coxa vara (abnormal shaft-neck angle of femur)
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Why are carrying angle different in men and women
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Women have wider hips, so wider angle
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Why evaluate iliac crest and greater trochanter in anterior and posterior positions
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Iliac: sacral region. Gluteus medius. Vertebrae
Greater trochanter: muscles, dysfunction associated with legs Iliac crest tells if problem with pelvis like rotation or something. Greater trochanters tell if something wrong with femur, which could explain why someone would have their knees bend in too much or out too much Sacrum tells you if rotation or problem with sacrum, PSIS would tell if problem with pelvis. SO they are close but both measure different structures |
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Knees close together
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Knock knee, genu valgum
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Knees widely spread apart
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bowleg, genu varus
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Flat foot? more likely to walk like ?
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FLat foot: pes planus, goes along with lateral deviation
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What is anti-Gravity line (lateral screening)
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Ear lobe, bodies of cervial vertebrae, acromion process, bodies of lumbar vertebrae, slighly posterior to hip joint, slightly anterior to axis of knee joint, just anterior to lateral malleolus
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Face anterior screen
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First passively observe eyes, nose, jaw and lips for symmetry
Ask patient to smile and then frown and check for symmetry |
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What is the military brace
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This is when shoulders appear retracted in the lateral screen
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What are the three vertebral curves
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1) cervival lordosis (in)
2) thoracic kyphosis 3) lumbar lordosis 4) sacral kyphosis |
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What is the hyperextension of knees
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Genu recurvatum
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Perform functional exam of shoulders
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(observe posteriorly) In a standing position, bring both arms above head and touch the backs of hands. observe the space between the elbow and the ears (this relates to muscle of shoulders)
Bring the arms at shoulder length, and have them touch. Observe quality of motion, and ROM |
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How to test for scoliosis
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Ask patient to sit on a chair, and slowly bend forward with arms between the legs. Observe the shoulder muscles on either sides. If one side is significantly different, then pt has scoliosis
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Scheuermann's disease
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Excessive kyphosis of thoracic vertebrae (look like a hump)
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Ears anterior screening
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observe and palpate the mastoid process (behind and below ear). Are they symmetrical
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TMJ (temporomandibular joint) (anterior screening)
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Palpate the zygomatic bone and ask patient to open and close their mouth slowly. Feel either sides for symmetry.
Observe tip of jaw for deviation (mentum) and if deviation is present it's an imbalance of lateral/medial pterygoid muscles |
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Static head position (anterior screening)
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is it centered, left/right
is it tilted or rotated |
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Acromion processes (anterior screening)
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Palpate acromion process put the thumbs towards each other, and draw an imaginary line. check for symmetry
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Carrying angle (anterior screening)
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Ask patient to place their arms to the side, in the anatomical position. Check the angle at the elbow on either sides for symmetry. Women will have wider angle because of their hips and men will have a smaller angle.
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Rib Cage(anterior screening)
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Look to see if rib cage is on the same plane.
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Iliac Crest (anterior screening)
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Put forefingers pointing to the rear on the iliac crest, facing the patient head-on. Check for symmetry
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Greater Trochanters (anterior screening)
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Place forefinger facing towards to the rear on the greater trochanters (which is located dorsally from iliac crest) . check for symmetry
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Knees(anterior screening)
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Look at the pt's knees, are the legs straight from hip to ankle?
Check to see if knees are closed together or far apart? (genu valgum, genu varus) |
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Feet and Arches(anterior screening)
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Look to see if any deviation observed on foot angulation when standing statically.
Medial deviation: pigeon toed lateral deviation: duck feet pes planus: flat foot Lateral deviation and flat foot go together |
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How many items on posterior exam, and what items?
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11 items.
Ears, shoulders, acromion process, inferior border of scalpulae, iliac crests, pelvis (static), (functional), spine (scoliosi/scheuermann) (functional/flexion ROM) (functional evaluation-side bending), feet |
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What are the items on anterior test
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Face, ears, TMJ, Static head position, acromion process, carrying angle, rib cage, iliac crest, greater trochanters, knees, feet and arches
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Ears (posterior screening)
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check for symmetry
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Acromion process (palpate) (posterior screening)
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Go to the back of the patient, and observe their acromion process superior and inferior
Doctor is standing in behind |
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Pelvic exam (static and functional exam)
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Static: Patient stands, and doctor sits on the stool so the doctor is eye level of PSIS. check for symmetry, and asymmetry indicates pelvic rotation
Functional exam: While patient is standing, and doctor is sitting on the stool. Place thumb on base of PSIS and bend forward and see where the thumb moves. The thumb that moves furthest has the innominate dysfunction Doctor is standing in behind |
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Spine (scoliosis screen/scheuermann's disease)
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Doctor is sitting on the stool, and is sitting facing the patient's back. While the doctor watches, the spine ask the patient to slowly bend down. If there's asymmetry between left and right muscle masses of the vertebral column then the patient has "scoliosis"
If the thoracic region has excessive kyphosis (hunchback), then scheuermann's disease Doctor is standing in behind |
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Abnormal end feeling
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• Early muscle spasm (protective spasm after injury)
• Late muscle spasm (chronic tissue change) • Hard capsular (frozen shoulder) • Soft capsular (synovitis, swelling of knee following injury) |
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Spine (functional evaluation - flexion ROM)
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This is when you test how far the patient can go to touch their toes with their knees straight. (DIP, PIP, MCP, Palm) . Doctor is standing in behind
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Spine (functional evaluation - side bending)
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Patient is standing straight and bending over to the side as far as they can go. The side that goes the farthest is the side with the lumbar somatic dysfunction. Doctor is standing in behind
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Feet
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Observe the arches and achilles tendon.
if arches are bent medially (valgus), if arches are bent laterally (varus). This indicates structural foot problems |
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Cervical spine (seated screen)
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Flexion/extension: up and down. 90 degrees (jaw to chest) 45 degrees (extension)
Left/right side-bending: 45 degrees 45 degrees Left and right rotation: 90 degrees You do all of this with hand on shoulder. Note ROM differences, end feel, and quality of motion |
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Cervical musculature (palpitation)
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The patient is seated and doctor goes to the lower border of occupit and runs his fingers across shoulder to acromion processes. check for TART
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Tissue Texture change of thoracic, ribs, and lumbar
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Stand behind the patient and palpate the musculature that's parallel to vertebral column. These are the erector spinae muscles.
Then palpate to the lateral border of the scalpulae. Palpate down to the iliac crests to include lumbar spine. |
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Is there a difference between the shape of the spinous processes of the thoracic and lumbar spine?
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The thoracic spines are sharper than the lumbar spinous which are flatter.
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Upper thoracic spine (functional evaluation)
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From behind, while the patient is seated, place one hand on the head and the other the either sides of the transverse processes on the cervical spines. Move the head in sidebening way left to right feeling the transverse process.
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Mid thoracic spine
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While doctor is behind the patient, place two fingers between T5 (halfway between spine), and with the other hand which is located midway between the neck and acromion (cervicothoracic junction) push down towards the table to induce sidebending. The force that is applied is directed towards the other hand.
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Lower thoracic spine
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Doctor from behind places one hand on the tip of the shoulder, and the other two fingers are placed on either sides of lower thoracic. With the hand on the shoulder, push down towards the table
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Sacrum and PSIS
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Places hands on iliac crest and allow thumb to drop to sacral sulci which is located inferior to PSIS. Evaluate the sulci for superior/inferior... left/right and depth
Find PSIS, and evaluate for superior/inferior...left/right and depth. |
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Why palpate both PSIS and sacrum sulci if they're both so close together?
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PSIS: pelvic rotation
Sacrum sulci: sacrum rotation/asymmetry |
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Seated flexion test
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From behind, the doctor places thumbs on the PSIS and asks the patient to bend forward. The side in which PSIS moves LAST is the side with dysfunction.
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Why test for seated flexion test and standing flexion test?
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Standing: Sacral-iliac joint dysfunction or innominate bone rotation
siting: can't be innominate bone rotation. only can be SI joint dysfunction |
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Where do you start the supine exam? What is the first landmark evaluated? What are the first fascial tests? Where could the problems be?
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Do the hip flop to align and center the body on the table. Grab ankles, place thumbs on the inferior lateral malloleus pointing down. Evaluate the tops of thumbs for leg length.
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If there is a discrepancy with leg length, where could it be?
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It could be with hip joint, femoral head (ask)
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Lower extremity fascial drag
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Grab the ankles and gently pull towards to see if doctor can spot any restriction. This is done with patient facing up,
Then sway legs side to side and again note for any restrictions |
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Straight leg raise (supine)
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Go to the side of the patient (dominant eye), and place one hand on the ASIS, and grab the corresponding leg at the ankle and raise till you feel ASIS move, and note arc of movement.
Should be able to move this 90 degrees, but declines with age. ask patient if there's any back pain, which can be associated with bulging disk. |
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Knee, distal leg (internal and external rotation)
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Pt is facing up. Go to the side of the patient and grab the ankle in one hand, and the knee on the other hand. Place doctor's knee on the table and balance the popliteal on it, and place that hand on the patella. Then with the hand placed on the ankle, twist the ankle left to right.
These motions are counter-clockwise/clockwise (internal/external rotation of the ankle) Note for end feel, and quality of movement |
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Hip (internal and external rotation)
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Patient is facing up and doc to the side. Flex the knee 90 degrees and place one hand under the popiteal, and the other hand on the ankle. Rotate the femur and lower leg by moving ankle closer to doctor and away from doctor
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ASIS evaluation for Inominate Rotation
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Standing laterally to patient (dominant eye) place thumbs towards each other on top of the ASIS. Evaluate
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Iliac Crest evaluation for inminate shear
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Stand to the side of the patient with dominant eye over midline. Place thumb on top of iliac crest and forefingers pointing towards the ground. Evaluate
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ASIS compression for evaluation of the SI (sacroiliac) joints (supine)
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Standing laterally, dominant eye over midline. Place hands over the ASIS and compress down one side, and then the other side. Observe for differences between the sides. Side with the resistriction is the side with restricted SI joint
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Pubic Symphysis (Supine)
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Doctor is lateral, dominant eye over midline. Using the heel of your hand, palpate down till the pubic symphysis is felt. Then switch over, and place the thumbs on either sides of the pubic bones to evaluate for symmetry (superior/lateral)
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Lumbar Evaluation (Supine)
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Standing laterally to the patient, slide hands onto the backside of the patient. Gently lift either side of the iliac crest and evaluate which side is harder or easier to lift. The side that is harder to move is restricted, and you can write it as "lumbar vertebrae is restricted to the patient's left/right"
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Rib and Respiratory motion evaluation
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Standing laterally to the patient, place hands on the lower ribs with the thumbs pointing towards the diaphragm. Palpate the motion of the patient as the patient breathes.
Listen with your hands for independent rib movement, and relative excursion of the whole lower rib cage |
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Thoracic Cage compliance (Supine)
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Standing laterally with eyes midline, place hands with thumb facing diaphragm on either sides of lower rib cage and compressing one side and then the other (and evaluating)
Then place medial part of the hand on the sternum and gently pushing down. this also tests for compliance |
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Upper Rib motion/sternum (Supine)
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Doc standing laterally, places hand on either sides of upper rib (right below bra lie). Listen and feel for inhale/exhale motions of patient. Is there asymmetry between sides?
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Diagraphgm Screen (Supine)
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Doc standing to the side of pt, and places hand right below ribs and evaluate for motion of respiration
Go across the sides of the body (tip of 12th rib is often the mid-axillary line) symmetry/tenderness |
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Thoracic Inlet and Clavies(Supine)
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Doc stands lateral to patient, places finger tips on anterior border of trapezius (lateral to neck) and let palms rest on clavicles
Palpate the inlet and the clavicle and evaluate the motion during respiration Place thumb or fingertips at the sternoclavicular joint and ask the patient to shrug and assess movement of sternoclvicuar joint. Evaluate tenderness, asymmetry, tissue restriction, restriction of clavicular movement |
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Cervical Motion (Supine)
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Doc goes to the head of the patient. Doc places finger tips on occiput and palpates for MUSCULATURE till T1.
Then go back to Occupit and palpate transverse processes looking for asymmetry and restriction Then cradle occiput and rotate head left to right and sidebend left to right and observe for any restrictions. |
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TMJ and Jaw motion (Supine)
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Doc is at patient's head. Place hand on zygomatic bone and ask patient to open mouth and close mouth slowly and evluate for symmetry. Check for any clicks, pops, sliding motions.
Muscules that are affected are lateral medial petegroid |
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Mesenteric Ganglia Evaluation (Supine)
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Figure out where the xiphoid process and umbilicus are, and mentally divide up the distance into thirds. Feel for any tense tissue.
Upper third: celiac ganglion Middle: superior messenteric ganglion Just above umbilicus: inferior mesenteric ganglion |
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Iliac Crest (prone)
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Place thumbs on top of iliac crest and check for symmetry
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Sacral Sulci (prone)
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pt is face down, make sure the head of pt is neutral.
Locate sacral sulci, located inferior to PSIS. Evaluate for depth, position. symmetry. tenderness |
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Inferior Lateral angels (ILA) (prone)
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Palpate down the sacrum till you get to butt bone. Very close to the butt hole. Evaluate the symmetry of the bone
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Ischial Tuberosity (prone)
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Palpate up the pt's thigh till you hit the gluteal fold and you'll hit the bone which is the ischial bone. Palpate medially till you find the tuberosity of ischial bone. Check for symmtry
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Femoral extension or hip flexor evaluation (prone)
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While patient is face down, go to the side of the patient. Lift the leg by grasping above the knee and lift till the physiological barrier, and with the other hand, palpate the sacrum and note its movement
ROM: 20 degrees |
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What are the five landmarks/tests of the pelvis
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1) Iliac crest
2) sacral sulci 3) inferior lateral angels (ILA) 4) Ischial Tuberosity 5) Femoral Extension of Hip Flexor Evaluation |
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Innominate sheer
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When PSIS and ASIS are both raised up
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Rotated
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PSIS or ASIS will either be higher at one end or lower on the other end
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Knee Extensors (prone)
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Pt facing down, doc to side grabs leg and brings it close to butt as possible. Normal ROM is to contact the butt with foot. If there's a symmtery problem/ROM it's the quadriceps
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Soft tissue, fascial restriction, thorax, lumbar (prone)
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Pt is facing down, and doc on the side. Places plams flat on the back and moves it cranially, caudally, and side-to-side. See if any restrictions. Do this to major areas of thorax areas.
Then place hand on upper thoracic, closest the side doc is standing, and place other hand on the ASIS on the other side. Pull on ASIS, while pushing down on upper thoracic. do this on other sides and evaluate for symmtry |
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Soft tissue, fascial restriction, lower extremities (prone)
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Place hands on area between hip to knee and do movements in all 4 directions.
Place hands on area between knee and ankle and do movements in all 4 directions. |
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What is the difference between soft tissue restriction and deep tissue restriction
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soft tissue: surface restrctions
deeper: push pull fascial restriction |
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Regional Springing - Thorax, lumbar, sacrum
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Place palms on either sides of the vertebral column and press down (testing for spring) and work that all the way down the column to the sacrum
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