Lower Extremities // Lecture 3-4 (Exam #1) Flashcards

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National institute on aging in 2021

83% of adults in 60s-70s had used at least 1 prescription drug in the last 30 days

about 33% had used 5+ drugs


subjective examination

70-90% of evaluation is done in subjective (talking to people)


subjective examination questions

  • Do they have an existing disease?
  • What else is going on?
  • Family history that can increase risk of health problems?
  • What meds they on?


S. Examination Process

  1. chart review
  2. medication review
  3. Look at PROs (patient-reported outcome)
  4. Talk to the patient (Funnel Technique)
  5. Systems review
  6. Check your red/yellow (mental health) flags
  7. screening questions
  8. 3-5 diagnosis
  9. objective testing


S.E: Good questions to ask

  • WHat brings you in today?
  • How can I help you?
  • When did it start?
  • Patterns?
  • Have you PT before?
  • Ever had surgery?
  • Limitations?
  • Goals?



  • medical emergency
  • ask if they have a "plan"
  • need to ask permission to take them to ER


Objective Examination

  1. Vitals
  2. Inspections
  3. Palpation
  4. Join and muscle function assessment
  5. Active ROm
  6. Manual muscle testing
  7. passive ROM
  8. Joint stability testing
  9. Stress Testing
  10. Joint play


Objective Examination: Vitals

BP (systolic/distaolic). heart rate, respiratory rate


Objective Examination: palpation

  • not very reliable/quantitative => more qualitative
  1. bones, ligaments, muscles and tendons
  2. palpate all structures, begin away from pain site and progress toward suspected injury


Objective Examination: Joint and muscle funtion assessment

  • perform bilaterally
  • which test depends on you
  • AROM, PROM, manual testing, joint stability testing, stress testing, joint play


Objective Examination: Active ROM

  • how much the patient can move themselves
  • Goniometry- the center of goni is the center of joint you are moving


Objective Examination: Manual muscle testing

  • at midrange of joint
  • stabilize limb proximatly => press distal to muscle attachment=> grade up => do not let me move you
  • testing force output


Objective Examination: Passive ROM

  • patient is relaxed, provider moves the joint
  • if range ok (no pain) => provide over-pressure
  • PROM>ROM => muscular problem
  • AROM> PROM (and limited)=> may be joint problem


Objective Examination: Joint stability testing

  • apply specific stress to noncontractile tissue
  • hypermobile (more laxity than normal)
  • hypomobile (below normal laxity)
  • laxity (clinical; sign of the amount of "give" in a joint, shown in stress testing
  • instability (join't inability to function under stresses of function activity)


Objective Examination: Stress testing (compare bilaterally)

  • Grade I, firm: slight ligament stretch, pain, regular laxity
  • Grade II, soft: partial tearing of fibers, increased joint play ("opens up") in compare to other side,
  • Grade II, empty: complete tearing, excessive tearing, restricted by tendons (2nd restraints)


joint play

  • rolling, spinning, gliding
  • procedure: relaxe patient in loose-pack position, apply glide/distractinf stress, assessed degree of movement, compare bilaterally


special tests

  • specific to selected tissues
  • results compared: side to side, cause provocation, cause alleviation
  • reported as positive or negative


neurological screening

  • is a nerve root involved?
  • symptoms: numbness or weird sensations, abnormally weak
  • dermatomes: which parts of skin are innervated by which nerve groups (preform bilaterally)


neurological screening: dermatomes

  • which parts of skin are innervated by which nerve groups (preform bilaterally)
  • patient eyes closed and head turned away
  • discrimination test: light tough, sharp and dull, 2-point


motor testing

  • tests another muscle innervated by same nerve root
  • 1 muscle weak= suspect muscle pathology or peripheral nerve pathology
  • 2 muscles weak= suspect nerve root od peripheral nerve pathology


reflex testing

  • increased response neuron lesion = upper motor
  • decreased response neuron lesion = lower motor
  • Deep tendon reflex (DTR)= muscle stretched+relaxed, patient look away, strike tendon with reflex hammer (0-4+ // 2= normal response)


Lower quarter neuro screen

  • L1-L5
  • S1-S2


Upper neuro screen

  • C4-C8
  • T1


Vascular screening

  • capillary refill (nail beds)
  • pulses (LE: femoral, posterior tibial, dorsal pedal) (UE: brachial, radial, ulnar), systemic (carotid)