introduction, explain procedure, take consent, ask patient to relax and have exposure to the upper limb or lower limb.
Inspection
UL & LL
- twitching
- tremors; sit relax - extend hand to check
- ulcers
- abnormal positions / deformity
- scars
- muscle bulks
- compare right & Left
- Bleeding
- Varicose Vein
- Between toes, heels for diabetic foot
Palpation- (Tone/Power assessment)
UL Tone
- Compare right and left
- Examine and assess all the joints
- Shoulder, elbow, wrist major sites to examine
Examined by - asking patient to relax, move all these major points by moving them in all directions to assess; then comment on the tone (Hyper-Normal-Hypo tonia’s)
Power
- Compare right and left
- Examine and assess all the joints - to check power of muscle
- Shoulder, elbow, wrist major sites to examine
- Adduction Abduction, Flexion, Extension, internal external rotation, inversion eversion of major point, then assess.
Scaled at 0-5
| Grade | Muscular Respone |
|---|---|
| 0 | No contraction detected |
| 1 | Barely detectable flicker or trace of contraction |
| 2 | Active movement with gravity eliminated |
| 3 | Active movement against gravity |
| 4 | Active movement against gravity and some resistance |
| 5 | Active movement against resistance without evident fatigue - “Normal” |
3+ if the patient can extend his arm against gravity - then test for resistance by pushing it downward then comment the finding.
4 if resistance, none 5
LL Tone ask patient to relax, exposure
- Rolling Patient
- Movement of all major joint of Hip, Knee, Ankle to assess, any rigidity, tonia’s against all directions
Power
- please raise lower limb - extend both upper limb if not fall = 3+
- Resistance test - 4+ some resistance, 5+ against resistance
- Do the same with all major joints of Hip, Knee, Ankle, and toes against all directions
Hip - abduction adduction Knee - extention flexion Ankle - dorsiflexion plantar flexion Toes - inversion eversion
Reflexes
UL
- Using Reflex hammer to test for reflex arc of UL
- Biceps (cubital fossa) , Triceps (??cc), Supinator Reflexes (Brachioradialis)
- Make sure to stand away from reflex of muscle, and dont hold tendon
- Hit against your finger over tendon - best to palpate it prior to testing to confirm location
Clinch hand for reinforcement
LL
- Using Reflex hammer to test for reflex arc of LL
- Knee Jerk (Below patella at tibial tuborisity groove) , Ankle (Dorsiflexion - Plantar Flexion - gastroileus muscle (cc))
- Make sure to stand away from reflex of muscle, and dont hold tendon
- Hit against your finger over tendon - best to palpate it prior to testing to confirm location
stretch leg for reinforcement
Cerebellar Function
UL Finger nose test - Overshooting/Normal/Same position/slow motion
- Ask patient to Touch his nose then your finger
- Change to three position of Finger to the patient
- Then compare both limbs
Rapid Alternating movements - Skipping
- Ask patient to start clapping with one hand slowly, then change movement rapidly alternating movement with one hand then the other.
LL Heel Chin - Rigidity
- Ask patient to move heel to his chin, check if its straight line up and down
Roomberg’s Test - Fall Explain the procedure, ask patient to close his eyes Support The patient Prior to test as they may fall from front and back with your arm- then check reaction.
Gait - Ataxia, Scissor, Swinging Forward, backward, Heel to toe, walking over heel and toe walking.