Search Results

Tibialis anterior Ask the patient to walk on their heels with their feet inverted; the tibialis anterior tendon can be seen. With the patient’s feet resting over the edge of the couch, ask the patient to actively dorsiflex and invert their foot to reach your h...

Ankle ( Figure 35.37 ) /uni25CF Dorsiflexion . Test dorsiflexion with the knee both flexed and extended. If restriction is greater with the knee extended than flexed, the contracture is principally in the gastrocnemius. Restriction that is equal in all knee posi ...

Ankle stability Trauma to the ankle is a common cause of instability . Accurate assessment may be di ffi cult in the acute setting because of pain. /uni25CF Anterior draw test . With the foot resting over the bed, hold the heel with one hand and the front of ...

Anterior cruciate ligament The most sensitive test for evaluation of the ACL is the Lachman test. /uni25CF The Lachman test ( Figure 35.32 ). Flex the knee to 15–30° and pull the proximal tibia gently forwards. Exces - sive laxity may indicate rupture of the...

Assessment of joint hypermobility Increased movement and flexibility of a joint can often cause joint pain and symptoms of instability . A formal assessment of joint mobility can help document the degree of mobility . The Beighton score alone cannot be used ...

CLINICAL EXAMINATION OF THE FOOT AND ANKLE The foot can be divided into three parts: the hindfoot (calca neus, talus), the midfoot (navicular, cuboids, cuneiforms) and the forefoot (metatarsals and phalanges).

CLINICAL EXAMINATION OF THE HAND AND WRIST The hand and wrist should be thought of as one functional unit. The muscles may be divided into extrinsic (the muscle bellies in the forearm) and intrinsic (origins and insertions within the hand alone). The ‘flexors’ ...

CLINICAL EXAMINATION OF THE HIP JOINT The hip is a synovium-lined ball-and-socket joint. Typical clinical diseases of the hip that may be encountered in children and adults are shown in Table 35.10 . A patient complaining of hip pain should undergo a careful...

CLINICAL EXAMINATION OF THE KNEE The knee is a synovial hinged joint. There are three compart - ments: medial, lateral and patellofemoral. The quadriceps, quadriceps tendon, patella, patellar tendon and tibial tuberos - ity constitute the extensor mechanism of...

CLINICAL EXAMINATION OF THE SHOULDER Pain arising from the shoulder joint may be felt anterolaterally . Referred pain may present from the cervical spine, heart, mediastinum and the diaphragm.

Cervical spine Look Ensure that the shoulders, back muscles and scapulae can be seen. Look for muscle wasting and asymmetry of the neck creases and check that the shoulders are level and that there is a normal cervical lordosis (range 20–40°). Feel Stand behi...

ELBOW The elbow is a hinge joint formed by the articulation of the ulna and radius with the humerus.

Extensors and flexors Asking the patient to grip two of your fingers in their fist tests the power of the extensors of the wrist (radial nerve) because Jules Froment , 1878–1946, Professor of Clinical Medicine, Lyons, France. they are needed to brace the wris...

FURTHER READING Beighton PH, Horan F . Orthopedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg 1969; 51-B : 444–53. Ellenbecker TS, Nirschl R, Renstrom P . Current concepts in examination and treatment of elbow tendon injury . Sports Health 2013; ...

Feel Ask the patient if they have any areas of tenderness. Ensure that you do not cause the patient pain – watch their face as you feel. It may be easier (especially with children) to feel the normal side first. tion in Pyrford, UK, which became international...

Finger flexors ). /uni25CF Superficialis tendon test . The flexor digitorum pro - fundus (FDP) usually has one muscle belly from which tendons to all of the fingers arise. The FDP can be immo - bilised by holding all of the fingers (except the one being ws the su...

Flat foot flexibility Use the windlass and Jack’s tests to distinguish a flexible from a fixed flat foot ( Figure 35.40 ). /uni25CF Windlass test . Ask the patient to stand on their toes and observe the arch of the foot on the medial aspect. As soon as the patien...

General principles Apley described a useful and systematic approach to clinical examination. This approach is divided into three parts: 1 look; 2 feel; 3 move.