stt assessment

8/11/2019 Stt Assessment

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• KNEES• CALF MUSCULATURE• ACHILLIS TENDON• ARCH OF THE FEET• MEDIUM MALLEULOS LEVEL

S6. BACK ASSESSMENT, ENTIRE SPINEALWAYS CHECK THE JOINT ABOVE AND BELOW

• ROM OF CERVICAL REGION

• flex, ext, rotation and lateral flex: ask if has any pain

• LUMBAR SPINE• fold from the waist down to the floor and come

back

• ext of the back

• lat flexion ( hand to lateral knee)

ANTERIOR VIEW:

• FACIAL EXPRESSION

• HEAD CARRIAGE

• HEAD-NECK-FLOW MIDLINE• SPASM, ATROPHY

• TRACHEAL DEVIATION

LATERAL VIEW:

• EVIDENCE OF TORTICULIS

•

NECK DEFORMITY• HYPER-IPO LORDOSIS

• ROUND SHOULDER

• RECTUM EXAVATUM/ CAMINATUM• OBSERVE THE BREATHING (PELVIC, ABDOMINAL)

POSTERIOR VIEW:

• HEAD CARRIAGE• SHOULDER-SCAPULAR LEVELS

• ANY ROTATION OF SHOULDER/ SCAPULA

•

SCOLIOSIS (ASK TO PZ TO TOUCH THE FLOOR WITH THEHANDS)

• MUSCLE SYMMETRY

NEUROLOGICAL TEST:ACTIVE ROM: ask to pz to sit on the bench, cross his hands onhis shoulders and bend forwardPASSIVE ROM: I test the ROM, palpating the spinous processesand the musculature on the side during flexion, extension, lat.flex and rotation; I check for any deviation.

Make resistance in every ROM, test the force.PALPATION:



start with pz prone.CONSTANT COMMUNICATION WITH THE PZ

• bony palpation from c6-c7 down to the spine• palpate TVP in every side• check facet joints•

check every rib, palpate them with a gentle compression ofboth side

• check muscle, tissue with the fingers. check lumbar, dorsal,trapezius, romboids, elevator scapula, paraspinal

• PtoA gentle compression to any spinal process with onehand over the other.

pz supine• check the sternum, costocartilagines• pectoral maior/minor, serratus

TEST:SLUMP TESTpz with hands crossed behind theback, pz seated, extend one leg anddorsiflex the foot and flex the trunkforward. repeat also in the otherside.Diagnostic sign for lumbar discherniation, impingement of nervesroute, spine or bone.

ADAM'S TESTtest for scoliosis. Bend the trunk forward from the waist, + sign

is any scoliotic curve.

LUMBAR ASSESSMENT

scan movements above and below (thoracic spine and hips). Icheck the thoracic flex, ext, rot, lat flex.SQUAT QUICK TEST FOR SI JOINTS: for any pain ortenderness in SI; squat and come back.For hip joint, check flexion (flex one knee toward the chest andcome back; keep it for 5 seconds), ext, abd of the leg, int/ext

rotation (lifting up one foot and int/ext rotate the hip



NB. if I work with a senior pz or with difficult in mobility, all thetests had to be performed on the bench, prone and supine, or wecan use the table for balance and do them in standing position

ANTERIOR VIEW:•

CHECK THE GAIT• CHECK ASIS LEVEL• SHOULDER LEVEL• MUSCULATURE

LATERAL VIEW:• HYPERKIPHOSIS-IPOKIPHOSIS• ASIS/PSIS LEVEL (0º-5º FOR MALE, 5º-10º FOR FEMALE)• GLUTEUS FOLDS, ANY ATROPHY• KNEE HYPEREXTENSION

POSTERIOR VIEW:• SHOULDER LEVEL• SCAPULA LEVEL• GLUTEUS FOLD• PSIS

• PALPATE ISCHIOTUBEROSITY• ASYMMETRY IN SPINAL MUSCLE

ACTIVE ROM: flex, ext, lat flex, rot

PASSIVE ROM: NO PASSIVE STRETCH FOR THE LUMBAR! RESISTED ROM: pz seated, I check the ROM of the trunkagainst my resistance, with hands crossed on shoulders

NEUROLOGICAL TEST

MYOTOMES TEST. Pz seated.

• L2: hip flex against my resistance, lift up the knee withoutcurve the torso forward.

• L3: extension of knee with resistance on ankle

•

L4: inversion of the foot• L5: big toe extension with resistance on big toe• S1: foot eversion with resistance on outside board

• S2: knee flexion with resistance on Achillis tendonCHECK THE WAY OF THE NERVES IN LEFT AND RIGHTSIDE AND ASK FOR ANY DIFFERENCE CHANGE OFSENSATION

DERMATOMES TEST

• L2: inner thighs• L3: medial thighs



• L4: on lateral thighs, down to the floor passing from theknee

• L5: in between big toes• S1: lateral edge of the foot• S2: inner calf

TENDON REFLEXES:• PATELLAR REFLEX FOR L4• ACHILLIS REFLEX FOR S1

PALPATION:On prone position, I palpate iliac crests, PSIS, S2, spinousprocesses from L1 to L5, TVP and facets joints, SI tuberosityinfraosseal and greater trochanter.I do ST palpation going little deeper than the last palpation;

check the glutes, the piriform (when it's inflamed could pinchsciatic nerve), paraspinals, QL, hamstring (if it pinches the sciaticnerve)On supine position, I check the ASIS level, palpate the pubis, theabdominal (asking pz to lift the head up), medium andtransverse, bend both knees and palpate the iliopsoas, nice andrelax, using diaphragmatic breathing. To find iliopsoas, ask pz tobend his knee to the chest and I should feel it tense, and fromhere palpate all the length.

SPECIAL TEST:• STRAIGHT LEG RAISE TEST (LASEQUE)

Pz supine, I medially rotate the leg and I rise it up as much as pzhas pain. + test for back pain, discal herniation conditions, legpain ( if pain, tingling).I check the result using "plug out": I medial rotate the hip, Iraise the leg up until the spot of pain, I lower the leg gently untilthe pain is gone and in this position I dorsiflex the foot toreproduce the pain. If the dorsiflexion is +, the pain hasneurological origen.

normally:0º-35º: no tension is applied on sciatic nerve35º-70º: tension is applied on sciatic nerve roots and pinchedthe disks ->irritation<70º: tension on sciatic nerve, and any pain more than thisdegree probably is a joint problem.

• BRAGARD'S TESTMy hand is underneath the spinous processes in lumbar area; Ilift the leg straight until the point of pain. + sign: if there is painexperience before that spinous processes separate fromthemselves, there is irritation in SI join. If the pain experience isin lumbar area, probably it's a problem of lumbar musculature.



• WELL LEG RAISEI test the unaffected leg: medial rotated, I raise the leg up: if the

pain is reproduced on the unaffected leg, it's a signal of largeprotrusion medial to nerve root.

S7. SI JOINT ASSESSMENT AND SHOULDER

ASSESSMENT

• scan exam above and below the joint: test the lumbar andhip joint.

• HIP ROM, I ask to pz to perform actively: flex, ext, abd,add, int/ext rotation.

•

SQUAT QUICK TEST• LUMBAR ROM: flex, ext, lat. flex, int/ext rotation

• CHECK THE GAIT

• WALK ON HEELS: check L4-L5 nerves • WALK ON TOES: check L5-S1 nerves.

If pz is unable to perform it: there is an impingement of thenerve.

ANTERIOR VIEW:• ASIS

•

iliac crest• greater trochanter level

• pie cavus• pie plano

SIDE VIEW:

• ASIS/PSIS level

• gluteus folds• atrophy or spasm on the gluteus

POSTERIOR VIEW:• scoliosis

•

symmetry of the muscles• spinous processes



• level PSIS• iliac tuberosity

SUPINE OBSERVATION: LEVEL ASIS, palpate around pubicbone

• GILLET'S TEST: to check the movements of SI joint. I put

one thumb on or under PSIS and the other thumb is onspinal process of L2: I ask pz to raise up one knee and Ishould feel the spinous process' thumb moves front as pzraise up the knee, and back as pz comes back with theknee. Then I put one thumb on PSIS, the other one onischial tuberosity and I ask pz to raise up the knee with mythumb on ischial tuberosity: this thumb should move frontand back.

• PASSIVE ROM: AP compression of SI with the edge of myhand.

•

AXILATERAL PRONE CONNECTING TEST: I putone thumb on PSIS and the other on L2, I ask pz toraise up the leg in the side of thumb on PSIS: Ishould feel a movement on PSIS.

• extension of the chest against resistance

• abduction: stress the SI joint, my resistance is on ankle.

• adduction: stress the gluts minimum, my resistance is onthe ankle, and I ask pz to pull the knees together.

NEUROLOGICAL TEST

MYOTOMES TEST. Pz seated.




• L3: extension of knee with resistance on ankle• L4: inversion of the foot• L5: big toe extension with resistance on big toe•

S1: foot eversion with resistance on outside board• S2: knee flexion with resistance on Achillis tendon

CHECK THE WAY OF THE NERVES IN LEFT AND RIGHTSIDE AND ASK FOR ANY DIFFERENCE CHANGE OFSENSATION

DERMATOMES TEST• L2: inner thighs• L3: medial thighs• L4: on lateral thighs, down to the floor passing from the

knee• L5: in between big toes• S1: lateral edge of the foot• S2: inner calf

TENDON REFLEXES:

• PATELLAR REFLEX FOR L4• ACHILLIS REFLEX FOR S1

PALPATION:

Pz prone, I check the paraspinal for any pain, tenderness, QL,gluteus, ischial tuberosity.Pz supine, I palpate abdominal area, iliopsoas and pubic bone.

• ANTERIOR DISTRACTING TEST (OR GAPPING TEST): hands crossed on ASIS, I apply a gently and nice pressuredown and outward and gently come back. + sign: pain inposterior gluteus or down all the leg.

• PATRICK'S TEST O FABER'S TEST or figure 4: toidentify limits on mobility, sour spasm or SI disfunction. Icross one leg on top of the other, putting the foot on the



position (take off the elbow and palpate the area aroundshoulder blade to armpit)

SPECIAL TESTS:• ANTERIOR APPREHENSION TEST: test for the anterior

stability of GH joint. Pz supine, put the shoulder in aneutral position (I put like a small pillow under the arm), Islowly extra rotate the arm, watching pz's expression andask him if he feels pain.

•

POSTERIOR STABILITY OF GH JOINT: same position, Iwill rotate the arm in internal rotation.

• SPEED TEST: test for the integrity of long byceps. Pzseated with palms facing front, he tries to lift up the armwhile I make resistance and at the same time, I palpatethe bycipal groove. + sign: pain or tenderness in bycepsgroove means byceps tendinitis.



• EMPTY CAN TEST: test the supraspinator. Pz seating orstanding, he abduces the arm following the angle ofscapula, thumbs down (internal rotation), stabilize thescapula and ask pz to push arms up against my resistance.

• NEER IMPINGEMENT TEST: to test any shoulderimpingement: stabilize the top of the shoulder and ask pz

to raise the arms up in abduction. + sign: pain in 160º-180º means an impingement in AC joint.



• LIFT OFF TEST: subscapularis test, it's the first test that I

do for an anterior complain of shoulder pain. Subscapularistrigger point refers to the anterior part of deltoid: bend theelbow and put the flat hand behind the back, lifted off. +sign: for tight subscapularis I cannot lift off my hand frommy back.

• THORACIC OUTLET SYNDROME: I extend the arm atshoulder level, I find the radio pulse then I bring the armback and external rotated at the same time, and from here

I ask pz to hold the breath and turn the face toward theextended arm. + sign: any decrease in radio pulse.



S8. ELBOW, WRIST AND FINGERS

ELBOWscan shoulders and wrists.for shoulder: flex, ext, abd, add, int/ext rotationfor wrist: flex (up), ext (down), ulnar/radial deviationOBSERVATION:ANTERIOR VIEW:

• angle of the elbow• cubitus varus or valgus• elbow level•

shoulder level• rush, scars..

ACTIVE ROM: flex, ext, pronation ( palm down), supination(palm up)PASSIVE ROM: pz seated, always do both sides RESISTED ROM: I apply resistance on the hand/wrist and Isupport the elbow. NEUROLOGICAL TESTMYOTOMES

pz seated:

•

C4: SHOULDER UP:ask pz to raise up the shoulders (I putmy hands to make resistance)

• C5: SHOULDER ABD: shoulders abduction againstresistance

• C6: WRISTS EXTENSION; pz makes fists with palms facingdown, then I ask to extend them against my resistance

• C7: WRISTS FLEXION: fists with palms facing up, flexion ofthe wrists against my resistance

• C8: FINGERS FLEXION: open the fingers and test thestrong of last DMcF (make fingers like curve); pz tries to

make the fist and I resist on my fingers



• T1: OPEN ABD-ADD FINGERS: my fingers inside pz'sfingers, I want to open outside all the fingers, against myresistance (abd-add fingers)

DERMATOMES •

C4: clavicle (from neck I come across the clavicle)• C5: shoulder• C6: from shoulders down to the thumbs with palms facing

up• C7: forearms down to middle fingers• C8: inside forearms until little fingers• T1: inner elbow

DEEP TENDON REFLEXES:• C5: Byceps tendon

•

C6: Brachio-radialis• C7: Tryceps

BONY PALPATION: medial epicondyle, super condyloline,oleocranon fossa, styloid process of the ulna, lat, epincondyle,lateral supercondylo line, deltoid tuberosity, come down to theradio head, to the radius style process.ST PALPATION: test the nerve on medial part of elbow with littletap, just to see that ulnar nerve is working and there is noimpingement or tingling sensation down to little finger.

I palpate the pronator, brachioradialis, flex carpi radialis, totryceps, byceps and brachialis. I just slide to break down thepulse and work on muscular bandle to medial nerve, carpiradialislongus, ext carpis, medialis brevis, extensors (as a group) to thetendon in the elbow.

SPECIAL TEST

• LATERAL LIGAMENT: pz seated, I nice and gently pushaway the medial part of the elbow far from the body. +sign: tingling.

•

MEDIAL LIGAMENT: pz seated, I nice and gentle pressthe lateral part toward the body. • LATERAL EPYCONDYLITIS: same position as we test C6,

pz makes the fist with palm facing down and he tries toextend the wrist against my resistance. + sign is for tenniselbow, lateral epicondylitis.

• lateral e., arm elevated less then 90º, I ask pz to do anulnar deviation: this movement stress the lateral aspect ofextensor muscles. +sign: pain.



• MEDIAL EPICONDYLITIS: hands like to test C7, pzmakes the fist with palm facing up, I ask pz to flex the

wrist against my resistance. + sign: golfer elbow.

• medial e. : arm elevated, straight on, hand pronated andfingers flexed, and I radio-elevate them. + sign: pain.

• ULNAR NERVE COMPROMISE OR IMPINGEMENT: tapping on the ulnar nerve, in the medial part of the elbow.

+ sign: tingling, pain.



WRIST AND FINGER

scan the elbow and fingersfingers: flex fingers like an half fist and extend the fingers away,

then make a fist and open the fingers again, abd/add fingers.elbow: flex, ext, pronation, supination.

OBSERVATION:hands relaxed, I check the number of fingers, size of the hand(average, small), resting position, any atrophy, callus, I checkthe knuckles, the fingernails (color, shape), any localized swallow(RA) , any node (OA), Bitshop nodes (RA) or any other deformitythat are indicative for RA.

ACTIVE ROM: for thumb: abd-add is according to anatomicplanes. For the wrist, I check flex, ext, ulnar/radial deviation.For fingers: flex the thumb across and extend it out, opposition(thumb to little finger), abduction (thumb away from the hand),adduction (thumb down to the hand).

PASSIVE ROM: flex, ext, ulnar/radial deviation for the wrist. Forfingers, open and close them, put one hand inside pz's hand andsqueeze his fingers and open them.

RESISTED ROM: flex, ext, ulnar/radial deviation. Open/close

the fingers, abd/add, thumb flex/ext, abd/add, opposition(pinza)

NEUROLOGICAL TESTMYOTOMES

pz seated:

• C4: SHOULDER UP:ask pz to raise up the shoulders (I putmy hands to make resistance)

• C5: SHOULDER ABD: shoulders abduction againstresistance

•

C6: WRISTS EXTENSION; pz makes fists with palms facingdown, then I ask to extend them against my resistance

• C7: WRISTS FLEXION: fists with palms facing up, flexion ofthe wrists against my resistance

• C8: FINGERS FLEXION: open the fingers and test thestrong of last DMcF (make fingers like curve); pz tries tomake the fist and I resist on my fingers

• T1: OPEN ABD-ADD FINGERS: my fingers inside pz'sfingers, I want to open outside all the fingers, against myresistance (abd-add fingers)

DERMATOMES



• C4: clavicle (from neck I come across the clavicle)• C5: shoulder• C6: from shoulders down to the thumbs with palms facing

up• C7: forearms down to middle fingers•

C8: inside forearms until little fingers• T1: inner elbow

DEEP TENDON REFLEXES:• C5: Byceps tendon• C6: Brachio-radialis• C7: Tryceps

BONY PALPATION: snuff box as an anatomical marker,scaphoid, lunate, triquedral, supinate the hand, pisiform,

capitate, trapezium, trapezoid, radio styloid.

gentle distraction of the wrist, proximal; in distal carpus Imobilize radio and ulna, pushing PA and AP. Ask for any pain,

tingling, ulnar styloid, metacarpal and mobilize them. Mobilizeany MCP, distal and proximal.

ST PALPATION: abd pollicis longus ( to find it, I ask to movethe thumb, ulnar deviation), extensor carpi radialis longus,extensor of fingers up until lateral condylus, common extensortendon (I ask to move the fingers), ext. carpial (ulnar deviation),I supine the arm, palmaris longus, common flexor tendon. Icheck metacarpal tunnel, flexor digital profundis, I check theradio arthery, flexi-carpi radialis, and pronators.

SPECIAL TESTS:



• FINKELSTEIN TEST: pz makes a fist with the thumbinside the fist and then makes an ulnar deviation of the fist,making tension along the radial part. + sign: tenosynovitis,De Quervain.

• BREATHLESS TEST: indicator for RA. I wrap my fingersaround pz's wrist and very gently I squeeze around medialand lateral distal carpus, between proximal and distalcarpus.

• PHALEN'S TEST: for carpal tunnel syndrome. Put the

dorses together (reverse praying position, fingers pointdown), flexing the tendon of carpal tunnel, and hold thisposition for 60 seconds. + sign: tingling, numbness,according to medial nerve distribution around the first 3fingers.

• REVERSE PHALEN'S TEST: to confirm a tunnel carpalsyndrome. Put the palms of the hands together (prayingpose) and hold the position for 60 seconds. + sign: medialnerve discrepancy and possible carpal tunnel.



• TINEL'S SIGN: I tap the inside part of pz's wrist over themedial nerve. + sign: if pz presents tingling, numbness,electric shock sensation, it could be present carpal tunnel.

S9. ASSESSMENT OF THE HIP AND KNEE

HIP

scan the SI joints and knee

• QUICK SQUAT TEST for SI joints

• test the knee: on standing position, ask for flexion (heelto glutes)

OBSERVATION: check the gait, the foot position, any antalgic

gait.ask to walk on heels to check L4-L5ask to walk on tiptoes to check L5-S1

ANTERIOR VIEW:

• anterior pelvis level• ASIS

• greater trochanter

• different distribution of weight on stand position

• pie plano- pie cavus

LATERAL VIEW:



• gluteus fold • gluteus musculature • hyperextension of knee

POSTERIOR VIEW:•

PSIS• greater trochanter, push it side to side• ischial tuberosity• gluteus fold• musculature

ACTIVE ROM: flex, ext, abd, add, medial/lateral rotation ( onstanding position)ASSISTIVE ROM: in supine position, I flex checking for the endfeel, ext, abd-add, int/ext rotation ( bending the knee externally

and rotate the leg/foot internally/externallyRESISTED ROM: supine position, flex, ext, abd-add, int/extrotation

NEUROLOGICAL TESTMYOTOMES TEST. Pz seated.


• L3: extension of knee with resistance on ankle• L4: inversion of the foot

•

L5: big toe extension with resistance on big toe• S1: foot eversion with resistance on outside board


DERMATOMES TEST• L2: inner thighs

• L3: medial thighs

•

L4: on lateral thighs, down to the floor passing from theknee• L5: in between big toes

• S1: lateral edge of the foot

• S2: inner calf

TENDON REFLEXES:

• PATELLAR REFLEX FOR L4

• ACHILLIS REFLEX FOR S1

BONY PALPATION



behind the extended knee and I let the leg goes down. +sign: the leg is superior to the table.

• HEEL TO THE BONE: prone position, I ask pz to flex theheel to the gluteus, I push the foot down to the ischialtuberosity. To check any rotational movement, to seewhich side is tighter.

• TRENDELLEMBURG TEST: pz stand up, I ask to raise upone leg. + sign: hip of raised knee fall drop: oppositemedial gluteus is weak.

• PAIN PROVOKING TEST: pz supine, I ask to bend a leg,about 30º of knee flexion, then I pinch the IT band, I keepit pressed down and with my other hand I will extend theknee. + sign: pain or tenderness in flex or ext because oftight IT band, IT band contracted.

KNEE

scan the hip and anklehip: flex, ext, abd, add, int/ext rotationankle: in seated position, I check plantar flexion (toe to the chin),dorsiflexion (toe to the floor), inversion or supination, eversionor pronation.

OBSERVATIONgait analisys, knee position, any antalgic gait.



walk on the heelwalk on tiptoes

ANTERIOR VIEW:• quads atrophy/spasm •

knee varus/valgus • check patella height and shape • foot cavus/planus • scars, bruise.. • foot position

LATERAL VIEW:• knee hyperextended or flexed • lordosis

POSTERIOR VIEW:• swollen of achillis tendon• popliteus cavus• calf• knee varum/valgus

ACTIVE ROM: flex/ext

PASSIVE ROM: in supine position, flex/ext by bending one legand putting one hand on top of the bended knee, supporting with

the other arm the other leg, int/ext rotation and check patellamovements in all the directions.

RESISTED ROM: flex/ext, dorsiflexion, plantar flexion of thefoot



•

L3: extension of knee with resistance on ankle• L4: inversion of the foot• L5: big toe extension with resistance on big toe

• S1: foot eversion with resistance on outside board


DERMATOMES TEST• L2: inner thighs

• L3: medial thighs



• L4: on lateral thighs, down to the floor passing from theknee

• L5: in between big toes• S1: lateral edge of the foot• S2: inner calf

TENDON REFLEXES:• PATELLAR REFLEX FOR L4• ACHILLIS REFLEX FOR S1

PALPATIONANTERIOR: patella-femoral joint line, MCL, LCL, tibial-patellawalking down to the tibia. I palpate quads around the knee,sartorius, gracilis, tibialis anterior, tibialis brevis and longus, ITband (iliotibial band).

POSTERIOR: byceps femoralis, semitendinosus,semimembranosus, check the back of the knee for any swellingor cyst, calf, anterior and inferior aspect of soleus, achillis tendon.

SPECIAL TEST: to check for any ligament injury or distraction

• APLEY'S KNEE DISTRACTION: A to P direction, pz prone,I bend his knee at 90º, I grab the ankle and I keep firmedthe knee to the table: I internally/externally rotate the foot.+ sign: painful and/or restricted movement means a

possible meniscus tears if the pain decrease; if the painincrease, it's sign of joint capsule or ligament sprain.

• APLEY'S KNEE COMPRESSION: to check the meniscus;same position of the previous test, I press down P to A thebended knee/foot, keeping firm the femur and then Igently rotate the foot internally/externally (I rotate theknee). + sign: pain, clicking, cracking if there is ameniscus tear



• LACHMAN'S TEST (ANTERIOR DRAWER): pz supine, Ibend one knee with the foot on the bench; I stop the footwith my leg, sitting on the bench and I put my handsbehind and back to the knee, nice and gently, pulling thetibia towards me. + sign: tibia bone will shift forward if

there is a broken ACL or an injury of ACL.

• POSTERIOR LACHMAN'S TEST (POSTERIORDRAWER): same position as the previous test, I stabilizethe foot with my weight and I press the tibia down andtranslating it backwards. + sign: if tibia will be pushed

backwards, there is a PCL injury.

• VALGUS STRESS TEST: I put one hand under the ankleand I slight little bend the knee; I will gently push the kneefrom lateral to medial, stressing MCL. + sign: pain,guarding, that are a signal for MCL injury.

• VARUS STRESS TEST: same position as before, I just

change my position to push the knee from medial to lateral.+ sign: pain, guarding, that means LCL injury.



S10. ASSESSMENT OF THE ANKLE

scan the knee and talus.for knee: flex/ext

OBSERVATION• check the walking, any antalgic gait, varus/valgus

• walk on heels to check L4-L5

• walk on tiptoes to check L5-S1•

check the sole of the shoes, if there is any unnaturalpattern

• with no weight bearing: observe the toes, skin, callus,abnormal pattern, swelling, edema

• with weight bearing: observe the angle foot position,kind of foot ( greek, egyptian, square), pie plano/pie cavus,big toe, hallux valgus, Morton's alignment, Achillisdeformity, calcaneus, Helb overpronation sign, any sign ofover pronation of the foot, that is the medial arching ofAchillis tendon.



ACTIVE ROM: walk back and forward, on heels and on tiptoes,walk on lateral and medial borders of the feet, just to stress theligament.PASSIVE ROM: take note of the endfeeling and pain ortenderness with the follow movements: dorsiflexion, plantar

flexion, inversion, eversion, midtarsal motion, abd and add.RESISTED ROM: I resist the movement of dorsiflexion, plantarflexion, eversion and inversion.



• L3: extension of knee with resistance on ankle• L4: inversion of the foot

•

L5: big toe extension with resistance on big toe• S1: foot eversion with resistance on outside board• S2: knee flexion with resistance on Achillis tendon

CHECK THE WAY OF THE NERVES IN LEFT AND RIGHTSIDE AND ASK FOR ANY DIFFERENCE CHANGE OFSENSATION

DERMATOMES TEST• L2: inner thighs• L3: medial thighs

•

L4: on lateral thighs, down to the floor passing from theknee

• L5: in between big toes• S1: lateral edge of the foot

• S2: inner calf

TENDON REFLEXES:

• PATELLAR REFLEX FOR L4• ACHILLIS REFLEX FOR S1

BONY PALPATION: MT joint down to sesamoid bones, alongthe first metatarsus to cuneiform, navicular, head of talus,medial malleolus, medial aspect of talus, 5th metatarsus to theboard, cuboid, calcaneus, all around the foot, lateral malleolus.

ST PALPATION: head of 1st metatarsus on the medial arch ofthe foot, tibialis posterior tendon, flex digitorum tendon,posterior arthery, tibial nerve, flexus hallucis longus tendon. Icheck tibialis anterior tendon, extensor hallucis longer tendon,digitorum tendon, anterior talus-fibula ligament, fibularis lonugsand brevis tendons, calcaneus, plantar fascia.



SPECIAL TESTS

• ANTERIOR DRAWER TEST: to check the stabilitybetween tibia and talus. Pz supine, with one hand Istabilize the ankle and with the other hand under thecalcaneus, I will gently pull from P to A (I can also pullfrom the foot too). + sign: transition of the talus, big

movement from the ankle joint, that's mean ATFligament/capsular sprain.

• KLEIGER'S (EXTERNAL ROTATION) TEST: to checkdeltoid ligament: I push the foot in inversion. + sign:

lateral gapping of ankle joint.



• FRACTURE DYSFUNCTION TEST: I squeeze the toesbelow the foot. + sign: sharp pain in the entire foot isindicative of stress fracture.

stt assessment

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