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Look The inspection begins as soon as you enter the examination room. Look for any walking aids. Remember to look at the whole patient and not just at the joint of interest. For example: /uni25CF look at the hands for rheumatoid arthritis; /uni25CF look at th...

Lumbar spine Examination should include the pelvis, hips, lower limbs, gait and peripheral vascular system as well as the lumbar region. Irritation of nerves in the lumbar spine can mimic problems in the lower limb. Always consider referred pain. Lumbar spine...

Metatarsophalangeal joint Test extension (70–90°) by asking the patient to lift the toes to the ceiling and test flexion (45°) by pointing the toes to the floor. Normal toe-o ff requires 35–40° of dorsiflexion. Metatarsophalangeal joint Test extension (70–90°) by...

Midtarsal joint Hold the heel with one hand and move the forefoot medially - (adduction = 20°) and laterally (abduction = 10°) with the other hand. Midtarsal joint Hold the heel with one hand and move the forefoot medially - (adduction = 20°) and laterally (ab...

Move There are three stages to assessing movement. The words used to describe a particular movement are shown in Table 35.3 /uni25CF Active . Ask the patient to move the joint within the limits of their pain. /uni25CF Passive . Move the limb or joint yourself...

Neurological Focus your examination on the C5 to T1 nerve roots. These supply the upper extremities ( Figure 35.5 ). Figure 35.5 Spurling’s test for cervical spine nerve root entrapment. The examiner turns the patient’s head to the affected side while extendin...

SPINE The spinal column consists of 33 vertebrae with 23 interver tebral discs. This is supported by numerous ligaments and paraspinal muscles. When observed from the front (coronal plane) with the patient standing and the hips and knees fully extended, the h...

Snapping hip Snapping hip is a condition in which the patient feels a snap ping sensation or hears a popping sound in their hip when they walk, get up from a chair or swing their leg around. The snapping sensation occurs when a muscle or tendon (the strong tis...

Special tests Achilles tendon Feel the gastrocnemius and soleus bellies and the whole length of the tendon for gaps (rupture), tenderness or swelling. Also Patrik Haglund , 1870–1937, Swedish orthopaedic surgeon. Theodore Campbell Thompson , 1902–1986, Americ...

Special tests and diagnoses Special tests and diagnoses

Special tests /uni25CF Trendelenburg test ( Figure 35.29 ). Face the patient and ask them to place their hands on the palm of your hands for support. Then ask them to stand first on one leg, then the other. Increased pressure from the opposite hand as they tak...

Subtalar joint ( Figures 35.38 and 35.39 ) Hold the talar neck and ask the patient to move their heel from side to side. Repeat using a hand on the heel to move the joint and apply a varus and valgus stress while feeling for movements of the talus. Holding th...

Subtalar joint flexibility Ask the patient to stand on their toes and observe the heel from behind; the heel moves normally from valgus to varus, indicating flexibility . The Coleman block test is used to assess the flexibility of the subtalar joint. Ask the pat...

Take a history /uni25CF Presenting complaint . Start with an open-ended question. Ask the patient to ‘explain what the problem is’ in their own words and ask the patient what their hopes and expectations are from the interview . /uni25CF History of the presen...

Tarsometatarsal joint stability Stability can be assessed by pushing each joint up and down. Standing lateral radiographs may be used in addition. Tarsometatarsal joint stability Stability can be assessed by pushing each joint up and down. Standing lateral rad...

Tarsometatarsal joint Hold the midfoot and manipulate each metatarsal up and down to estimate the passive range of movement. (b) Figure 35.37 (a) Ankle dorsi /f_l exion and (b) ankle plantar /f_l exion. Tarsometatarsal joint Hold the midfoot and manipulate ea...

Thoracic spine Pathology commonly presents with pain and deformity . The thoracic spine is normally convex with a gentle kyphosis (normal range 20–45°). Thoracic spine Pathology commonly presents with pain and deformity . The thoracic spine is normally convex ...

Thumb and thenar eminence /uni25CF Abductor pollicis brevis, opponens pollicis and flexor pollicis brevis can be tested together by oppos - ing the thumb to the little finger. (b) Figure 35.11 (a) Tinel’s test; (b) Phalen’s test. Figure 35.12 Palpating the anato...