Lab 1: Posture, Leg Length, and Upper Quarter Screens

Anterior: Plumb Line

Divides body into equal halves

Anterior: Head

Examined for lateral or rotary deviation

Anterior: Neck

Examined for lateral or rotary deviation

Anterior: Face

Mandible- symmetrical or asymetrical

Nose- should align with sternum

Anterior: Shoulder

Upper Trapezius muscles- symmetry, hypertrophy or atrophy

Shoulder level- roughly equal (dominant lower)

SC Joints- symmetry

AC Joints

Clavicles- Should be angled slightly superiorly, from proximal to distal and relatively symmetrical

Anterior: Elbow and Forearm

Olecranon- should be positioned posterior in standing with the cubital fossa facing the body

Proximal and distal end of humerus should be in a straight line

Carrying Angle- 5-10 degrees in male; 10-15 degrees in female

Anterior: Pelvis/Hip

ASIS

Greater Trochanter

Anterior: Knee

Patellae- look if rotated towards each other or away from each other

Tibial torsion

Anterior: Ankle and Foot

Malleoli

Toe out angle (usually 5-7 degrees)

Deformities- hammer toe, claw toe, hallux valgus

Pronation/Supination

Arch Height

Posterior: Plumb Line

Divides body into equal halves

Posterior: Head

Examined for lateral or rotary deviation

Posterior: Shoulder

Symmetry

Shoulder level- roughly equal (dominant lower)

Posterior: Scapulae

Superior border of scapula is at T2, Acromion should be slightly higher

Spine of scapula is at T3

Inferior angle at T7

Scapulae should be 3 inches from the spine

Positional Symmetry- look at the spines and inferior angles of scapulae

Abducted or Adducted- evaluate distance from T-spine to medial scapular borders

Winging

Posterior: Spine

Cervical through Lumbar spinous processes

Scoliosis:

• structural: does not reverse during flexion

• functional: straightens during forward trunk flexion

Posterior: Hip

Symmetry of the following:

• Iliac crests

• PSIS (level of S2)

• Gluteal Folds

• Greater Trochanter

Posterior: Knee

Varus/Valgus

Posterior: Ankle and Foot

Deviation of Achilles Tendon

Calcaneal valgum or varum

Foot pronation or supination

Lateral View: Plum Line

Should pass through:

• External auditory meatus

• Shoulder Joint

• Midway through trunk

• Greater trochanter of femur

• Slightly anterior to midline of knee

• Slightly anterior to lateral malleolu

Lateral View: Head

Forward Head Posture

Lateral View: Cervical Spine

Cervical Lordosis: excessive, reduced, normal

Lateral View: Shoulder

The humeral head should sit in line with the external auditory meatus

• if >1/3 is anterior, this would be considered an anterior humeral glide

Forward shoulder, normal

Lateral View: Thoracic Spine

Thoracic Kyphosis: excessive, reduced, normal

Lateral View: Abdomen

Flat, protruding

Lateral View: Lumbar Spine

Lumbar Lordosis: excessive, reduced, normal

Anterior Pelvic Tilt

Posterior Pelvic Tilt

Sway Back or Flat Back

Lateral View: Knee

Genu Recurvatum 

Flexed Knee Posture

Lateral View: Ankle and Foot

Obvious Deviations or Deformities

Foot Pronation or Supination/Arch Height

What is true/structural leg length discrepancy?

one leg is shorter/longer than the other due to structural differences (you were born like that)

How to test true/structural leg length discrepancy

1. Visual Method:

• Supine: hip and knees flexed

• Look at heigh of femur from the side and heigh of tibia from the front; is one longer?

2. Webster-Barstow Maneuver:

• Pt supine with hips and knees flexed

• Pt completes a bridge

• examiner passively extends legs and compared medial malleoli height

3. Direct Measurement w/ Tape Measure:

• Landmarks: ASIS to either medial or lateral malleolus (distal edge)

• 2-3cm difference ok

How to test apparent/functional leg length

Set up w/ Webster-Barstow Maneuver

1. Direct Measurement w/ Tape Measure:

• Landmarks: Umbilicus to medial malleolus

• 2-3cm difference ok

AROM of Upper Quarter Screening includes…

• shoulder flexion/extension

• shoulder abduction/adduction

• shoulder horizontal abd/horizontal add

• shoulder IR/ER

• Apley’s scratch test

• elbow flexion

• wrist flexion/extension

Beighton Scale of Hypermobility

1 point allocated for the ability to perform each of the following tests:

• Passively oppose thumb to forearm

• passively extend 5th MCP joint more than 90 degrees

• hyperextend elbow more than 10 degrees

• hyperextend knee more than 10 degrees

• place palms on floor flexing trunk with straight knees

Positive: 5/9 for adults, 6/9 for children

Myotomes

C5- Elbow flexors (biceps, brachialis)

C6- Wrist Extensors (ECRL, ECRB, ED)

C7- Elbow Extensors (Triceps)

C8- Finger Flexors (FDP)

T1- Finger Abductors/Adductors (ADM; Interossei)

Dermatomes

C3- Supraclavicular fossa at the midclavicular line

C4- Over the acromioclavicular joint

C5- Lateral side of the antecubital fossa just proximal to the elbow

C6- Dorsal surface of the proximal phalanx of the thumb

C7- Dorsal surface of the proximal phalanx of the middle finger (3rd digit)

C8- Dorsal surface of the proximal phalanx of the little finger (5th digit)

T1- Medial side of the antecubital fossa, just proximal to the medial epicondyle