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What type of joint is a fibrous or synarthroses?
Sutures of the skull, immovable
What type of joint is a cartilaginous or amphiarthrosis?
Vertebral bodies of the spine (slightly moveable), ribs
What type of joint is a synovial or diarthroses?
freely moveable
Which type of synovial joint has a wide range of rotary motion with rounded convex surface articulating with concave cuplike cavity?
Spheroidal (shoulder/hip); ball and socket
Which type of synovial joint has motion in one plane, is flat/planar/or slightly curved allowing only a gliding motion?
Hinge (flexion/extension), (elbow/IP joints of hand and foot)
Which type of synovial joint has movement of two articulating surfaces not dissociable, allowing for flexion or extension, rotation and motion in the coronal plane?
Condylar (knee/jaw)
What is the order for the physical exam?
Inspection, Palpation, Range of motions, Strength, Neurovascular status, Stability, Special tests
What must you ALWAYS be during the exam?
systematic
What are techniques for the physical exam?
direct attention to function as well as structure, visualize the underlying anatomy, recall key elements of history
What part of the exam includes: gait, position/posture, symmetry, discoloration of skin or joints, tumors, deformity?
Inspection
What part of the exam includes tenderness or swelling, muscle tone or crepitus, temperature change, tumor (evaluation), inflammation?
Palpation
What could be noted with a hot temperature change?
Inflammation (gout/arthritis), infection
What could be noted with a cold temperature change?
Vascular compromise
What part of the physical exam includes AROM and PROM?
Range of motion
In which range of motion does the patient do the moving?
Active
In which range of motion does the examiner do the moving and assess for crepitus?
Passive
Which ROM is completed first?
Active!!! ALWAYS
What is the grading system for range of motion?
Manual muscle strength testing
What is a 0/5 for the MMT?
No evidence of contractility
What is a 1/5 for the MMT?
Slight contractility, no movement
What is a 2/5 for the MMT?
FROM (function range of motion), gravity eliminated
What is a 3/5 for the MMT?
FROM with gravity
What is a 4/5 for the MMT?
FROM with gravity and some resistance
What is a 5/5 for the MMT?
FROM against gravity, full resistance
What is the most active joint in the body?
TMJ
What could you see with inspection of the TMJ?
swelling or redness
What is the inability to open mouth due to pain
Trismus
When examining the upper extremities, what position should the patient be?
Seated
What bony prominences do you palpate for the upper extremities?
SC joints, clavicle, AC joints, bicipital groove, scapulae, olecranon processes, epicondyles, joints of wrists and fingers
What ROM do you test for shoulder?
Flexion, extension, abduction, adduction, external and internal rotation
What ROM do you test for elbow?
Flexion, extension, pronate, supinate
What ROM do you test for wrist?
Flexion, extension, ulnar and radial deviation
How do you test for ROM of hands?
Extend and spread fingers then make a first
What are fine muscle tremors?
Fasciculation
Where is the subacromial bursa?
Under the deltoid
What bony landmarks do you palpate for the shoulder?
Acromion process, clavicle (distal tip), A/C joint, bicipital groove and tendon, greater tubercle of the humerus, coracoid process of scapula
How many degrees can you abduct the arms w/out scapular motion? with?
90 degrees; 180 degrees
How many degrees is shoulder flexion?
170-180
How many degrees is shoulder extension?
60
How many degrees is shoulder abduction?
180
How many degrees is shoulder external rotation?
90 degrees
How many degrees is shoulder internal rotation?
70
During inspection how should the shoulder be to palpate medial, lateral epicondyles and the olecranon process?
Flexed to 70 degrees
Which way are your palms during supination?
Palms side up
Which way are your palms during pronation?
Palms side down
What landmarks do you palpate for the wrist?
Distal radius and ulna, anatomical snuff box, dorsal surface (with thumbs)
What landmarks do you palpate for the hand?
8 carpal bones, 5 metacarpals (compress the MCP joint)
What landmarks do you palpate for the fingers?
Proximal, middle, and distal phalanges
What position is the patient in during examination of the lower extremities?
Supine and seated
What bony prominences are you palpating for the lower extremities?
Iliac crest, greater trochanter, patella, suprapatellar pouch, tibial plateau, femoral epicondyles, lateral/medial malleoli of ankles, MTP and IP joints of toes
What soft tissue do you palpate for the lower extremities?
Muscles of thigh, lower leg, popliteal fossa, knee joint space, achilles tendon
What is the phase when the foot is on the ground and bears weight (foot flat, midstance)?
Stance
What is the phase when the foot moves forward and does not bear weight (heel strike and push-off)?
Swing
What are you observing for when examining the hip?
Width of the base, shift of the pelvis, flexion of knee
What are you inspecting the lumbar spine for?
slight lordosis, symmetry of leg length, anterior and posterior surfaces for muscle atrophy and bruising
What do you palpate on the anterior surface of the hip?
Iliac crest, iliac tubercle, anterior iliac spine
What do you palpate on the posterior surface of the hip?
Posterior superior iliac spine, greater trochanter, ischial tuberosity, sciatic nerve
What ROM do you test for hips?
Flexion, Extension, ADduction, aBduction, internal rotaion, external rotation,
What is active examination for the hip?
Patient flexes knee to chest
What is passive examination for the hip?
Examiner internally and externally rotates the hip
What are you observing in the knee while seeing gait?
Alignment and contour of the knee, atrophy of the quadriceps, loss of normal hollows around the patella
How should the patient be positioned while palpating the knee?
Sitting on the edge of the table
What ROM do you test for knees?
flexion and extension while sitting, internal and external rotation (rotate the foot medially and laterally)
What is the degree of flexion for knees?
130
What is the degree of extension for knees?
0
What is the degree of external rotation for knees?
30
What is the degree of internal rotation for knees?
20
What are you looking for when observing ankle, feet, toes?
Deformities, nodules, swelling, calluses, corns
What are you palpating on ankles, feet, toes?
Anterior aspect of ankle joint, achilles tendon, heel and plantar surface, metatarsophalangeal joint, compress metatarsal forefoot, exert pressure proximal
What ROM do you test for ankle, feet, and toes?
Dorsiflexion and plantarflexion, inversion and eversion of the ankle, flexion and extension of the toes
What do you palpate for the cervical spine?
Spinous processes (C7 most prominent), paravertebral, SCM, trapezius
What is the degree of extension of C-spine?
55
What is the degree of flexion of C-spine?
45
What is the degree of rotation of C-spine?
70
What is the degree of lateral bend of C-spine?
40
What ROM do you test for thoracic and lumbar spine?
Flexion, extension, lateral bend, rotation (patient’s pelvic must be stabilized for all EXCEPT flexion)
How is the SI joint identified?
Dimple over the posterior superior iliac spine
How is flexion tested and how many degrees is it for thoracic and lumbar spine?
Patient bends forward to touch their toes; 85
How is extension tested and how many degrees is it for thoracic and lumbar spine?
Hands on iliac spine for support and have patient bend backwards as far as possible; 20
How is lateral bending tested and how many degrees is it for thoracic and lumbar spine?
stabilize hips and patient run a hand down their leg; 30
How is rotation tested and how many degrees is it for thoracic and lumbar spine?
Stabilize hips and patient rotate; 45
