Hip Inspection and ROM Assessment

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Questions and Answers

What is the expected degree of flexion when bending forward at the waist?

75 to 90° (correct)

90 to 105°

45 to 60°

60 to 75°

Which sign may indicate the presence of scoliosis during a spinal examination?

A symmetrical shoulder height

Increased lumbar lordosis

Normal spinal processes without tenderness

A rib hump and lateral curvature (correct)

What is the expected degree of lateral bending bilaterally when assessing spine range of motion?

35° (correct)

30°

40°

20°

During a hip flexion assessment, what position should the patient ideally be in?

Lying supine Signup and view all the answers

What is the expected degree of hyperextension when bending backward at the waist?

30° Signup and view all the answers

What action should be used to measure the degree of spinal rotation during an assessment?

Using a scolimeter Signup and view all the answers

Which of the following conditions is commonly associated with increased lumbar lordosis?

Obesity Signup and view all the answers

What is the expected degree of forward and backward rotation during upper trunk motion assessments?

30° Signup and view all the answers

What is the expected normal range of motion for elbow flexion?

160 degrees Signup and view all the answers

During a shoulder inspection, which of the following observations may indicate a shoulder dislocation?

Asymmetry in size and contour Signup and view all the answers

When palpating the shoulder, which structure should NOT be included in the examination?

Patella Signup and view all the answers

What is the normal expected range of motion for pronation and supination of the elbow?

90 degrees each Signup and view all the answers

Which of the following should be observed during shoulder inspection?

Symmetry in contour Signup and view all the answers

How should a patient's shoulder be positioned when performing a shrug during range of motion assessment?

Shoulders shrugged up Signup and view all the answers

What is the maximum expected forward flexion range of motion for the shoulder?

180 degrees Signup and view all the answers

Which muscle insertions should be palpated near the greater tuberosity of the humerus during shoulder examination?

Supraspinatus and infraspinatus Signup and view all the answers

What is the expected degree of hip flexion when a patient raises their leg with the knee extended?

Up to 90° Signup and view all the answers

During a hip inspection, which landmarks should be primarily focused on?

Iliac crest and greater trochanter Signup and view all the answers

What is the expected range of degrees for hip abduction during an assessment?

Up to 45° Signup and view all the answers

When assessing internal rotation of the hip, what is the expected range of motion?

Up to 40° Signup and view all the answers

What should you expect during hip adduction assessment?

Up to 30° Signup and view all the answers

What body position is required to assess hip hyperextension?

Supine position with legs straight Signup and view all the answers

What is the maximum expected degree of hyperextension of the hip?

Up to 30° Signup and view all the answers

Which of the following is NOT a landmark to assess for asymmetry during hip inspection?

Length of the femur Signup and view all the answers

What is the expected degree of lateral bending when a patient bends their head to each side?

40° Signup and view all the answers

What should be assessed when palpating the cervical spine?

Paravertebral muscles Signup and view all the answers

What is the expected degree of rotation when a patient turns their head to each side?

70° Signup and view all the answers

Which muscle's strength is evaluated by applying opposing force during head rotation?

Sternocleidomastoid Signup and view all the answers

What is a key observation when assessing the cervical spine for alignment?

Concave curvature Signup and view all the answers

What indicates a grade of 3 or less in muscle strength testing?

No voluntary contraction Signup and view all the answers

What should be expected during bilateral muscle strength testing?

Symmetric strength with full resistance Signup and view all the answers

Which condition may indicate a need for further examination when subcutaneous nodules are present on the ulnar surface of the elbow?

Rheumatoid nodules or gouty tophi Signup and view all the answers

To assess muscle strength, what action should the patient perform against the examiner's hand?

Push against the hand Signup and view all the answers

What would indicate a weak muscle based on resistance testing?

The muscle shows some contraction with little resistance Signup and view all the answers

Which joint action should be assessed for wrist strength?

Wrist extension Signup and view all the answers

What does a full resistance to opposition in muscle testing indicate?

Normal muscle function Signup and view all the answers

Which grip strength test is often performed to evaluate the median, ulnar, and radial nerve functions?

Strength testing of the hand Signup and view all the answers

What symptom is most commonly associated with rheumatoid arthritis?

Inflamed joint with redness Signup and view all the answers

What should be noted while inspecting the knees in both flexed and extended positions?

The major landmarks of the knee Signup and view all the answers

Which of the following movements best describes plantar flexion of the foot?

Pointing the foot towards the floor Signup and view all the answers

What does chronic knee pain that improves with rest likely indicate?

Osteoarthritis progression Signup and view all the answers

When testing hip flexion strength, what must the patient do with their knees?

Maintain flexion of the hip with both knees either flexed or extended Signup and view all the answers

During a physical examination, what type of joint involvement may suggest gouty arthritis?

Inflamed metatarsophalangeal joint of the great toe Signup and view all the answers

During knee inspection, which feature may indicate knee effusion?

Loss of natural concavities Signup and view all the answers

In what way does morning stiffness associated with osteoarthritis typically present?

Lasts for about 15 minutes Signup and view all the answers

What should be evaluated in addition to hip flexion strength during an assessment?

Muscle strength during abduction and adduction Signup and view all the answers

What is expected when applying resistance during hip flexion strength testing?

The patient must maintain hip flexion against resistance Signup and view all the answers

What is the expected range of motion for dorsiflexion during foot assessment?

20° Signup and view all the answers

During lower leg alignment observation, one should primarily focus on what aspect?

The alignment of the knee and foot Signup and view all the answers

Which clinical finding might suggest the need for further investigation into septic joint conditions?

Heat and redness surrounding the joint Signup and view all the answers

Which of the following landmarks is NOT noted during knee inspection?

Patellar ligament Signup and view all the answers

What movement is described as inversion of the foot?

Tilting the sole of the foot towards the body Signup and view all the answers

What is the purpose of inspecting natural concavities above the patella during knee examination?

To identify potential swelling or effusion Signup and view all the answers

What injury is most likely indicated by immediate swelling and difficulty bearing weight after rolling an ankle during a jump?

Ankle sprain Signup and view all the answers

What symptom differentiates the low back pain case from typical disc herniation symptoms?

No numbness or weakness reported Signup and view all the answers

What is a characteristic feature of the elbow pain case in an athlete?

Gradual onset of pain with gripping Signup and view all the answers

What physical examination finding is most likely associated with the shoulder pain case in the older man?

Tenderness over the subacromial area Signup and view all the answers

Which symptom in a 50-year-old man's case indicates a possible diagnosis of gout?

Redness and swelling in the big toe Signup and view all the answers

In the basketball injury case, what mechanism of injury is most relevant?

Landing awkwardly on an extended foot Signup and view all the answers

What is the most likely cause of stiffness and pain that improves with rest in the low back pain scenario?

Muscle strain Signup and view all the answers

What type of joint issue is implied in the gradual onset pain experienced by the 40-year-old tennis player?

Tendinitis at the elbow Signup and view all the answers

Study Notes

Hip Inspection

Inspect the hips both from the front and the back while the patient stands.
Use the major landmarks of the iliac crest and the greater trochanter of the femur.
Note any asymmetry in iliac crest height, size of the buttocks, and number and level of gluteal folds.

Hip ROM - Flexion and Hyperextension

Ask the patient to raise the leg with the knee extended. Expect up to 90 degrees of hip flexion.
Ask the patient to swing the straightened leg behind the body. Expect up to 30 degrees or less hyperextension.
Ask patient to raise one knee to the chest while keeping the other leg straight. Expect up to 120 degrees of hip flexion.

Hip Abduction and Adduction

Ask the patient to swing the leg laterally and medially with the knee straight
Expect up to 45 degrees of abduction and up to 30 degrees of adduction.

Hip Rotation (Internal and External)

Ask the patient to flex the knee, keeping the foot on the table, and rotate the leg toward the other leg.
Expect 40 degrees of internal rotation.

Shoulder Inspection

Inspect the contour of the shoulders, the shoulder girdle, the clavicles, scapulae, and surrounding musculature.
Expect symmetry in size and contour of all shoulder structures.
Asymmetry or hollows may indicate a shoulder dislocation.
Observe for a winged scapula.

Shoulder Palpation

Palpate the sternoclavicular joint, clavicle, acromioclavicular joint, scapula, coracoid process, and greater tubercle of the humerus.
Rotate the arm and forearm externally to locate the biceps groove.
Palpate the muscle insertions of the supraspinatus, infraspinatus, and teres minor near the greater tuberosity of the humerus.
Note tenderness over the muscle insertions.

Shoulder ROM

Ask the patient to shrug the shoulders.
Ask the patient to raise both arms forward and straight up over the head. Expect forward flexion of 180 degrees.

Thoracic and Lumbar Spine

Key landmarks include spinal processes, scapulae, iliac crests, and paravértebral muscles.
The thoracic spine should be convex.
The lumbar spine should be concave.
The head is positioned over the gluteal cleft with straight vertebrae, symmetric shoulder, scapular, and iliac crest heights.
Kyphosis may be observed in aging adults.
Lordosis is common in obesity or pregnancy.

Spinal Palpation and Flexion Test

With the patient standing erect, palpate the spinal processes and paravértebral muscles.
There should be no muscle spasm or spinal tenderness.
Percuss each spinal process and paravértebral muscles for tenderness.
Ask patient to bend forward and touch their toes. Inspect for unexpected curvature.
Lateral curvature/rib hump may indicate scoliosis.
Measure the degree of rotation with a scoliometer.
Observe for lumbar curve reversal (back extension).

Range of Motion of the Spine

Ask the patient to bend forward at the waist. Expect 75 to 90 degrees of flexion.
Ask he patient to bend back at the waist. Expect 30 degrees of hyperextension.
Ask the patient to bend to each side. Expect 35 degrees lateral bending bilaterally.
Ask the patient to swing the upper trunk in a circular motion from front to side to back, while stabilizing the pelvis (Expect 30 degrees rotation forward and backward).

Evaluating Muscle Strength

Muscle strength is evaluated as part of a neurologic examination.
It is often integrated with range of motion assessment.
Resistance to opposition is tested by asking the patient to contract the muscle by extending or flexing the joint while applying force against the contraction.

Grading Muscle Strength

Muscle strength is graded on a scale ranging from no voluntary contraction to full strength.
A grade of 3 or less indicates disability and requires external support.
Weakness can result from muscle disorders, pain, or fatigue.

Hand and Wrist

During inspection, look for carpal dislocation, wrist fractures, and septic arthritis.
Palpation of the wrist should include the radius, ulna, scaphoid, 5th metacarpal, and carpal bone rows.
Range of motion should be assessed for wrist extension (70-90°), flexion (70-80°), ulnar deviation (25°), and radial deviation.
Median, ulnar, and radial nerve functions should be assessed during strength testing.
Special tests for the hand and wrist include: Gamekeeper's thumb, Jersey finger, mallet finger, flexor/extensor tendon injuries.

Inspection of Elbows

Inspect the elbows in both flexed and extended positions.
Observe for subcutaneous nodules on the ulnar surface, which may indicate rheumatoid nodules or gouty tophi.

Palpation of Elbows

Palpate the extensor surface of the ulna, the olecranon process, and the medial and lateral epicondyles.
Check for tenderness, swelling, or thickening of the synovial membrane.

Cervical Spine

Inspect the neck from both anterior and posterior positions to observe alignment.
Check for symmetry of skin folds and muscles.
The cervical spine should have a concave curve.
Palpate the posterior neck, cervical spine, and paravrtebral, trapezius, and sternocleidomastoid muscles.
The muscles should have good tone, symmetry in size, and no palpable tenderness or muscle spasm.

Cervical Spine Range of Motion (ROM) and Muscle Strength

Ask the patient to:
- Bend the head forward (chin to chest): 45° flexion.
- Bend the head backward (chin towards the ceiling): 45° extension.
- Bend the head to each side (ear to shoulder): 40° lateral bending.
- Turn the head to each side (chin to shoulder): 70° rotation.
Evaluate the strength of the sternocleidomastoid and trapezius muscles by applying opposing force.
During head rotation, cranial nerve XI is tested.
Place the lateral foot on the knee of the other leg and move the flexed knee towards the table.
Expect 45° external rotation of the hip.

Testing Hip Flexion Strength

Test hip flexion strength by applying resistance while the patient maintains flexion of the hip with both flexed and extended knees.
Evaluate muscle strength during abduction and adduction, as well as resistance to uncrossing the legs while seated.

Knee Inspection

Inspect the knees and their popliteal spaces in both flexed and extended positions.
Note the major landmarks:
- Tibial tuberosity
- Medial and lateral tibial condyles
- Medial and lateral epicondyles of the femur
- Adductor tubercle of the femur
- Patella
Inspect the extended knee for natural concavities on the anterior aspect, each side, and above the patella.
Loss of these concavities may suggest knee effusion.

Lower Leg Alignment

Observe the lower leg alignment.
A bursa may form, leading to a painful bunion on the foot.

Toe Deformities

Heat, redness, swelling, and tenderness are signs of an inflamed joint.
An inflamed metatarsophalangeal joint of the great toe may indicate gouty arthritis.

Foot and Ankle ROM and Strength

Ask the patient to:
- Point the foot towards the ceiling (20° dorsiflexion).
- Point the foot towards the floor (45° plantar flexion).
- Turn the sole of the foot towards and away from the other foot (30° inversion, 20° eversion).
- Rotate the foot away and towards the other foot (10° abduction, 20° adduction)
- Bend and straighten the toes (flexion and extension).
Apply opposing force during dorsiflexion, plantar flexion, abduction, adduction, and flexion/extension of the toes.

Case 1

A 65-year-old woman presents with chronic knee pain that worsens with activity and improves with rest.
She reports stiffness in the morning that lasts about 15 minutes.
She has noticed decreased range of motion in her knees and has difficulty climbing stairs and getting up from a seated position.
There is no swelling present.

Case 2

A 25-year-old basketball player presents with right ankle pain and swelling after rolling his ankle while landing from a jump.
He heard a "pop" at the time of the injury.
There was immediate swelling and difficulty bearing weight.
On examination, there is swelling around the lateral malleolus, making weight-bearing difficult.

Case 3

A 45-year-old man presents with acute low back pain after lifting a heavy object at work.
The pain radiates to his right buttock but does not go past the knee.
He reports no numbness or weakness but feels stiffness in his lower back.
Pain improves with rest but worsens with bending or lifting.

Case 4

A 40-year-old woman who plays tennis regularly complains of gradual onset pain in her right elbow that worsens with gripping objects.
She has difficulty with activities such as lifting, twisting doorknobs, and holding a tennis racket.
On examination, tenderness is noted over the lateral epicondyle of her elbow.

Case 5

A 55-year-old man presents with pain and swelling over his left shoulder that worsens with overhead activities like reaching or throwing.
The pain has been present for several weeks and is worse at night when lying on that side.
On examination, there is tenderness over the subacromial area, and range of motion is limited by pain.

Case 6

A 50-year-old man complains of sudden, severe pain in his big toe.
He woke up in the middle of the night with redness, swelling, and intense pain in the joint of his right big toe.

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Description

This quiz covers the assessment of hip joints through inspection and range of motion (ROM) techniques. It includes evaluating hip flexion, hyperextension, abduction, adduction, and internal/external rotation. Ideal for students in medical or physiotherapy fields seeking to enhance their clinical skills.