Ankle Examination

LOOK Expose both lower legs for comparison. Observe standing and walking. Examine shoes for uneven wear. Symmetry, swelling, discolouration Deformity pes planus pes cavus bunions, Varus & valgus, Nails fungal infection ingrown toenails. FEEL Palpate proximal fibula, tibia, ATFL - anterior talofibular ligament CFL calcaneofibular ligament PTFL posterior talofibular ligament, Medial & lateral collateral structures, Achilles tendon, Tarsal Tunnel, Calcaneus, navicular, cuboid, 5th MT and metatarsals. Examine pulses, and sensation, and temperature. PALPATION Active plantar/dorsi flexion, inversion, eversion. Mid tarsal joints (grasp heel and move from side to side.) Toe flexion, extension, abduction, adduction. Repeat with resisted movements Ant drawer test, squeeze test, Ottawa Rules pain around malleolus with bony tenderness (posterior edge of lat/med malleolus to 6cm. X-ray

The foot has 3 sections - hindfoot : Talus & Calcaneum. Midfoot: Cuboid, Navicular, cuniform bones & Arches. Forefoot: phalanges & Metatarsals.

Knee Examination
LOOK Ensure both legs visible: limb length, hip position, quads wasting. Check gait. Swelling (effusion or haemoathrosis) / pre, supra infrapatellar bursa. Popliteal cysts or swelling. Deformity, bruising, wounds/. FEEL Bony tenderness: femoral/tibial epicondyles, patella, fibula, tibia, ankle. Check for crepitus, mobility of patella, Knee flexed at 90o - Joint line tenderness (menisci), med/lat collateral ligaments. Patella tendon. Joint effusion bulge/shift, patellar fluctuation. Stroke medial/lateral aspect of legs, compare sensation. Pedal pulse. MOVE Extension 0o, Flexion 130o, straight leg raise. Stress both collateral ligaments at 0 and 30o Valgus MCL Vargus LCL Mcmurrays to determine meniscal damage

Test anterior and posterior cruciate ligaments through ant/post drawer test.

Hip Examination
LOOK Observe gait, gluteal wasting, pelvic tilt, Assess single leg standing. Flexion deformity. Leg length, rotation. FEEL Palpate greater trochanter for tenderness, pubic symphysis, adductor origins, ASIS, AIIS, Iliopsoas, piriformis, sacro-iliac joints ischial tuberositiess MOVE Knee flexed at 90o assess active hip flexion check end- feel. Assess internal & external rotation passive and active. Leg straight assess abduction, adduction. Resisted movements hip flexed: knee bent iliopsoas Knee straight adductor longus, Knee bent adductor magnus Hip rotated: Knee extension rectus femoris, flexion hamstrings. Check for any inguinal hernias.

Shoulder Examination
LOOK Undressed to observe general posture, back/neck alignment. Shoulder contours, swelling, bruising, wounds, muscle wasting. Inspect clavicle, scapula, ACJ/SCJ, humerus & elbow. FEEL Palpate shoulder: humerus- upper, greater & lesser tuberosity, the bicipital groove and insertion of supraspinatus, ACJ, clavicle, SCJ, Scapula. Palpate, elbow, cervical spine, and scapula spine. Note skin temperature. MOVE Test initiation of abduction to 180o (intact supraspinatus) Test flexion 160, extension 70 adduction 50 internal/external rotation 45 & circumduction. Resisted movements abduction 10o (supraspinatus), 90o (deltoid), internal/external rotation, extension, flexion, elbow flexion. Assess scapula-thoracic movement - abnormal winging. End-feel at limit of movement soft hard spongy

Observe for painful arc active and passive.

Elbow Examination
LOOK Triangulation of contours (olecranon, medial, lateral, epicondyle) Swelling, bruising, wounds, redness, (any bursa), deformity. Inspect biceps and triceps for integrity. Check carrying angle. FEEL Palpate elbow: joint line, head of radius. Medial/lateral epicondyles, olecranon, radius & ulna. Stress collateral ligaments by valgus/vargus application. Check for crepitus, palpate ulna nerve tinels sign ( tap nerve repeatedly) Check tension of biceps, triceps. Examine nerve distribution Note skin/joint temperature. MOVE Extension 0o flexion 150o pronation 90o supination 90o Active, passive and resisted movement. Check wrist and shoulder movement. Cozen test stabilise elbow, make fist and pronate, radially deviate wrist then extend against resistance = lateral epicondylitis. Extend and supinate = medial epicondylitis

Wrist Examination.
LOOK Compare both wrists. Swelling, deformity wounds, redness FEEL Palpate elbow: Medial/lateral epicondyles, olecranon, radius & ulna. Palpate carpal bones, metacarpals, phalanges anatomical snuff box in ulna deviation, perform thumb compression. Examine nerve distribution median ulna radial nerves. Note skin temperature

MOVE Extension (70o) Flexion (90o) Radial (20o) & Ulna deviation (55o) Check elbow and hand movements Resisted movements flexors & extensors. Xray if any ROM, severe pain, significant mechanism or bony tenderness.

Hand Examination
LOOK Wounds,swelling, bruising, cascade, deformity, mottled, red, extensor lag, nodules

Stress collateral ligaments If unstable do this post xray.

FEEL Palpate elbow, forearm and wrist for tenderness Palpate metacarpals, fingers and thumb for tenderness and abnormality. Examine nerve distribution (median, radial, ulna & digital nerves) Note skin temperature and capillary refill.

MOVE Observe general movement of hand. Test flexors (FDP-long and FDS-Short individually. Test power against resistance. Check 7 thumb movements Add,Abd,Flex,Ext,Palm.abd,oppos,dorsal ext.