Objective Assessment
Here are some basic layouts for objective assessments at each joint along with different possible tests that you can use. These should be used as a guide and should be adjusted depending on presentation of the patient.
SHOULDER
· Observation – check the patient’s symptoms now to gauge state at rest, severity and irritability.
· Clear above – Clearing the Cx Spine will ensure that the symptoms aren’t referring from the neck.
o Cx Spine AROM – Flexion, Extension, Side Flexion Right and Left, Rotation Right and Left
· AROM – Flexion, Extension, Abduction, Adduction, Internal Rotation and External Rotation
· PROM – Ensure for this that your hand is on the joint to feel for possible clunking, or catching in the joint - Flexion, Extension, Abduction, Adduction, Internal Rotation and External Rotation
· Strength – Flexion, Extension, Abduction, Adduction, Internal Rotation and External Rotation
· Palpation – e.g. Humeral head, Joint line, Scapula, A/C joint, S/C joint, clavicle
· Functional – Possible functional movements that may aggravate symptoms or display possible weaknesses in the joint – examples: reaching, press ups, lifting.
· Special Tests
o Scarf Test
o Hawkins-Kennedy
o Empty Can
o Speed’s
ELBOW
· Observation – check the patient’s symptoms now to gauge state at rest, severity and irritability.
· Clear Above - Clearing the shoulder will ensure that the symptoms aren’t referring from this area.
· AROM – Flexion, Extension, Supination, and Pronation
· PROM – Be sure to have your other hand supporting the joint to feel for any abnormalities in the movement - Flexion, Extension, Supination, and Pronation
· Strength – Flexion, Extension, Supination, and Pronation
· Palpation – e.g., radial head, olecranon, joint line.
· Functional – Possible functional movements that may aggravate symptoms or display possible weaknesses in the joint – examples: reaching, press ups, lifting.
· Special Tests
o Varus/Valgus Ligament Test
o Golfers Elbow – Flexion resistance
o Tennis Elbow – Extension resistance
o Middle Finger Extension – Tennis Elbow
o Tinel’s – tapping around the cubital tunnel to replicate symptoms.
WRIST/HAND
· Observation – check the patient’s symptoms now to gauge state at rest, severity and irritability.
· Clear Above - Clearing the elbow will ensure that the symptoms aren’t referring from this area.
· AROM – Flexion, Extension, Ulna deviation, Radial deviation, Supination, Pronation.
· PROM – Be aware of feeling of the joints during movement - Flexion, Extension, Ulna deviation, Radial deviation, Supination, Pronation.
· Strength – Flexion, Extension, Ulna deviation, Radial deviation, Supination, Pronation.
· Palpation – carpel tunnel, snuff box, radius, ulna.
· Functional – Possible functional movements that may aggravate symptoms or display possible weaknesses in the joint – examples: press ups, gripping.
· Special Tests
o Phalen’s – upside down pray to replicate carpel tunnel symptoms.
o Tinel’s – tapping around the carpel tunnel to replicate symptoms.
o 1st CMC Grind Test – To test for OA
o Finkelstein’s – thumb wrapped in fist, passively ulna deviation for De Quervain’s.
o What’s Test – Full wrist flexion, full thumb abduction, resist thumb extension to test for De Quervain’s
HIP
· Observation – check the patient’s symptoms now to gauge state at rest, severity and irritability.
· Gait Analysis – if appropriate
· Clear Above - Clearing the Lx Spine will ensure that the symptoms aren’t referring from this area.
· AROM – Flexion, Extension, Abduction, Adduction, Internal rotation, External rotation.
· PROM – Be aware of how the joint feels when moving its - Flexion, Extension, Abduction, Adduction, Internal rotation, External rotation.
· Strength – Flexion, Extension, Abduction, Adduction, Internal rotation, External rotation.
· Palpation – Iliac spine, ASIS, AIIS, Sacrum, Greater Trochanter
· Functional – Possible functional movements that may aggravate symptoms or display possible weaknesses in the joint – examples: squat, steps, lunges.
· Special Tests
o Trendelenburg – Single leg stand to test for week hip abductors.
o FABER/FADIR – To test for FAI and other hip pathologies.
o Femoral Stretch Test
o Slump Test
KNEE
· Observation – check the patient’s symptoms now to gauge state at rest, severity and irritability.
· Gait Analysis – if appropriate
· Clear Above - Clearing the Hip will ensure that the symptoms aren’t referring from this area.
· AROM – Flexion, Extension.
· PROM – Flexion, Extension.
· Strength – Feel the joint as it moves to be aware of any abnormalities - Flexion, Extension.
· Palpation – Joint line, patella movements, patella tendon.
· Functional – Possible functional movements that may aggravate symptoms or display possible weaknesses in the joint – examples: squatting, jumping, lunges.
· Special Tests
o Anterior Draw - ACL
o Lachman’s Test - ACL
o Posterior Push – PCL
o Varus/Valgus Test – MCL/LCL
o Clark’s Sign/Grind Test – PF Joint Pathology
o McMurray’s – Meniscus
o Joint Line Palpation – Meniscus
o Slump, SLR, and Femoral Stretch
FOOT/ANKLE
· Observation – check the patient’s symptoms now to gauge state at rest, severity and irritability.
· Gait Analysis – if appropriate
· Clear Above - Clearing the knee will ensure that the symptoms aren’t referring from this area.
· AROM – Plantarflexion, Dorsiflexion, Eversion, Inversion, Pronation, Supernation.
· PROM – Be aware how the joint is moving – Plantarflexion, Dorsiflexion, Eversion, Inversion, Pronation, Supernation.
· Strength – Plantarflexion, Dorsiflexion, Eversion, Inversion, Pronation, Supernation.
· Palpation – Malleolus, Achilles tendon, Joint lines.
· Functional – Possible functional movements that may aggravate symptoms or display possible weaknesses in the joint – examples: tip toe, squatting.
· Special Tests
o Talar Tilt – Ligament Stress
o Anterior Draw – Ligament Stress
o Thompson’s test – Calf squeeze Achilles rupture
Cx SPINE
· Observation – check the patient’s symptoms now to gauge state at rest, severity and irritability.
· Clear Below - Clearing the shoulder will ensure that the symptoms aren’t referring from this area.
· AROM – Flexion, Extension, Side flexion right and left, Rotation right and left.
· PROM – More of a passive over pressure - Flexion, Extension, Side flexion right and left, Rotation right and left.
· Strength – Flexion, Extension, Side flexion right and left, Rotation right and left.
· Myotomes
o C1 – Cx Flexion
o C2 – Cx Extension
o C3 – Cx Lateral
o C4 – Shoulder elevation
o C5 – Shoulder Abduction
o C6 – Wrist Extension/Biceps
o C7 – Triceps
o T1 – Finger Adduction/Abduction
· Dermatomes – See diagram.
· Reflexes – Biceps, Triceps, Babinski, Clonus
· Palpation – AP Vertebrae, Transverse processes, Spinous processes
· Functional – Possible functional movements that may aggravate symptoms or display possible weaknesses in the joint – example: looking around.
· Special Tests
o Spurling’s
o Neurodynamic tests
Tx SPINE
· Observation – check the patient’s symptoms now to gauge state at rest, severity, and irritability.
· Clear Above - Clearing the Cx spine will ensure that the symptoms aren’t referring from this area.
· AROM – Flexion, Extension, Rotation left and right.
· PROM – More of a passive overpressure if needed- Flexion, Extension, Rotation left and right.
· Strength – Rarely needed -Flexion, Extension, Rotation left and right.
· Myotomes
o L2 – Hip Flexion
o L3 – Knee Extension
o L4 Ankle Dorsiflexion
o L5 great toe Extension
o S1 Plantar flexion
· Dermatomes – see diagram.
· Reflexes – Quadriceps, Achilles.
· Palpation – AP Vertebrae, Transverse processes, Spinous processes
· Functional – Possible functional movements that may aggravate symptoms or display possible weaknesses in the joint – example: twisting.
· Special Tests
o Slump
o Femoral Stretch
o SLR
o Tip toe/heel walk
Lx SPINE
· Observation – check the patient’s symptoms now to gauge state at rest, severity, and irritability.
· Clear Above - Clearing the Tx spine will ensure that the symptoms aren’t referring from this area.
· AROM – Flexion, Extension, Side flexion left and right.
· PROM – More of a passive overpressure – Flexion, Extension, Side flexion left and right.
· Strength – Rarely needed – Flexion, Extension, Side flexion left and right.
· Myotomes
o L2 – Hip Flexion
o L3 – Knee Extension
o L4 Ankle Dorsiflexion
o L5 great toe Extension
o S1 Plantar flexion
· Dermatomes – see diagram.
· Reflexes – Quadriceps, Achilles.
· Palpation – AP Vertebrae, Transverse processes, Spinous processes
· Functional – Possible functional movements that may aggravate symptoms or display possible weaknesses in the joint – examples: bending down, twisting.
· Special Tests
o Slump
o Femoral Stretch
o SLR
o Tip toe/heel walk
Dermatome Diagram
This is a map for testing dermatomes for a spinal assessment.