SPINE & EXTREMITIES d.

Front view
e. Check midline position / torticollis

GENERAL RULES:
1. Wash hands before touching the patient
a. Introduce self
b. Check patient ID (identity)

 Show that you disinfect your hands by using

alcohol
 Good morning po I’m ____________, a 2nd year
medical student…
 May I know your name sir/mam?

2. Explain the purpose & obtain consent

 I will be your student Doctor for today who will

examine your Spine and Extremities to check if
there are any abnormalities.
 Is that okay for you?

CERVICAL SPINE: Inspection & Palpation

3. Position: Patient:
a. Upright

b. Side view
c. Check spinal profile (concave post)
 4. Palpate: 5. ACTIVE ROM: “SIR PAKIGAYA PO AKO”
a. Land mark: C7 ;
b. Tenderness

“Sir yuko po kayo”

a. Flexion: Patient  Chin to touch

“Bring your chin to your chest.”
Or
“Sir pakigaya po ang gagawin ko”

b. Extension: Patient  Tip head backward

“Look up at the ceiling.”
Or
“Sir pakigaya po ang gagawin ko”

6. ROTATION
a. Turn head to left & right with shoulder stationary
“Look over one shoulder, and then the other.”
Or
“Sir pakigaya po ang gagawin ko”

7. LATERAL BENDING of head to Left & Right of shoulders

“Bring your ear to your shoulder.”
Or
“Sir pakigaya po ang gagawin ko”

The patient was able to perform full Range of Motion in the

CERVICAL SPINE (such as flexion, extension, hyperextension,
rotation and lateral flexion without difficulty and is at ease)

HANDS/FINGERS: Inspection & Palpation

8. Position: Patient upright
a. Check dorsum of hand for:
 Deformities
The patient scapula is symmetrical and is on the midline.  Nodes
The cervical spine is concave in shape, thoracic is convex in  Bogginess
shaped and lumbar spine is concave in shape.  Tenderness with both thumbs
C7 is palpable on the cervical spine b. Volar aspect with index finger
No lesions no mass, no deformities
No tenderness noted (Sir/Mam may masakit po ba?)
 Schamroth’s Sign is Normal
Negative/No clubbing of fingers noted

10. ACTIVE ROM: “SIR PAKIGAYA PO AKO”

a. Flexion - Patient to  Clench fist

“Make a tight fist with each hand, thumb across the
knuckles.” Or
“Sir pakigaya po ang gagawin ko”

The patient hands and finger is brown/fair in color,

The nails is pinkish in color
Has no bony deformities,
No nodes palpated on each side of the fingers
No bogginess,
No mass, no lesions
No tenderness noted (Sir/Mam may masakit po ba?)

9. Abnormalities:
a. Check: b. Extension - Patient to  Open hand
 Color of fingers “Extend and spread the fingers.”
 Clubbing of fingers Or
“Sir pakigaya po ang gagawin ko”
11. Abduction & Adduction - “SIR PAKIGAYA PO AKO c. Apposition – thumb to finger tips of the
Ask the patient to spread the fingers apart same hand
(abduction from dorsal interossei) and back together
(adduction from palmar interossei).

a. Abduction - Spread fingers apart

The patient is able to perform full Range of Motion in the

THUMB (such as abduction, adduction and opposition
without difficulty and is at ease)

WRIST JOINT: Inspection & Palpation

13. Check for the ff. with the THUMB:
b. Adduction – Hold fingers together a. Deformities
b. Bogginess
c. Masses
d. Tenderness

The patient was able to perform full Range of Motion in

the HANDS AND FINGERS (such Flexion, Extension,
Abduction and Adduction without difficulty and is at
ease)

Upon checking the wrist joint, there is no deformities,

12. Thumbs in abduction, adduction and apposition
bogginess, masses and tenderness noted (Sir/Mam may
a. Abduction – up & outward from the palm
masakit po ba?)
b. Adduction – back to neural position

14. Palpate for:

a. Radial / Ulnar distal ends
 b. Wrist bones 15. Active ROM: “SIR PAKIGAYA PO AKO”
a. Dorsi-flexion

b. Palmar-flexion

c. Medial & lateral deviation

The patient was able to perform full Range of Motion on

WRIST JOINT (such as dorsiflexion, palmar flexion and
medial and lateral deviation without difficulty and is at ease)

Radius and Ulnar bones are palpable on both ends

FOREARM: Inspection & Palpation ELBOW: Inspection & Palpation
16. Check for: 18. Using thumb & Index finger, check and ID the landmarks:
a. Skin a. Olecranon Bursa
b. Muscle & Bone deformities
c. Tenderness
d. Swelling
e. Masses

b. Olecranon Process

c. Lateral Epicondyle
d. Medial Epicondyle

The skin is brown/fair in color

The forearms are symmetrical,
There is no muscle or bony deformities
No tenderness (Ask the patient if may masakit po ba?)
No swelling
No masses palpated

17. Active ROM: “SIR PAKIGAYA PO AKO”

a. Pronation

 For Nodules
 Swelling
 Tenderness

b. Supination

The patient was able to perform Full Range of Motion in the

FOREARM (such as Pronation and Supination without
difficulty and is at ease)
 The following landmarks of the elbow are palpable such 20. Deformities: Carrying angle
as the olecranon bursa, olecranon process, lateral and
medial epicondyle.
There are no nodules, swelling or tenderness (Masakit
po ba Sir/Mam?) noted

19. Measure size (circumference), to check for symmetry

between Left & Right forearm / upper arm

The patient has normal carrying angle of 170o

21. Active ROM: “SIR PAKIGAYA PO AKO”

a. Flexion

“Bend your elbow.” Or

“Sir pakigaya po ang gagawin ko”

b. Extension

“Straighten your elbow.” Or

“Sir pakigaya po ang gagawin ko”

The patient’s upper forearm circumference in both

forearm is ___ cm, while
the lower forearm circumference in both forearm is
___cm and is symmetrical and has no bony deformities
 23. Humerus:
c. Pronation a. Check for deformities
“Turn your palms up, as if carrying
a bowl of soup.” Or
“Sir pakigaya po ang gagawin ko”
d. Supination
“Turn your palms down.” Or
“Sir pakigaya po ang gagawin ko”

The humerus is symmetrical with no bony deformities

No swelling and tenderness (May masakit po ba Sir/Mam?)
noted.

Patient can perform Full Range of Motion in the ELBOW SHOULDER: Inspection & Palpation
(such as flexion, extension, pronation and supination
24. ID the landmarks:
without difficulty and is at ease)
a. Sternum
b. Sternoclavicular joint
UPPER ARM: Inspection & Palpation
22. Biceps & Triceps:
a. Check for symmetry
b. Tenderness

Biceps and triceps muscles are symmetrical.

No bony deformities, no swelling
No tenderness (Masakit po ba Sir/Mam?) noted

Palpate both sides simultaneously

 c. Acromion 26. Active ROM: Patient positioned UPRIGHT:
d. Coracoid process “SIR PAKIGAYA PO AKO”
e. Greater tuberosity of humerus
a. Flexion – patient to raise arm above the head
“Raise your arms in front of you and overhead.” Or
“Sir pakigaya po ang gagawin ko”

ACROMION
b. Extension – patient to swing arm towards
CORACOID
PROCESS OF back
SCAPULA “Raise your arms behind you.” Or
GREATER “Sir pakigaya po ang gagawin ko”
TUBERCLE

Palpate both sides simultaneously

25. Check with finger tips for:

a. Swelling
b. Tenderness
The sternum, sternoclavicular joint, acromion, coracoid
process of the scapula and greater tubercle are
symmetrical, there is no swelling, no tenderness noted
on (Masakit po ba Sir/Mam?) both sides of the shoulder.

27. Adduction & Abduction

a. Abduction – Patient to swing & raise arm
laterally away from the body at the level of the
shoulder
“Raise your arms out to the side and overhead.”
 b. Adduction – Patient to swing arm across the b. Palm facing the floor & forearm to rotate
shoulder anteriorly & posteriorly
“Cross your arm in front of your body”, Or “Raise your arm to shoulder level; bend your
“Sir pakigaya po ang gagawin ko” elbow and rotate your forearm toward the
ceiling.”
OR
“Place one hand behind your neck or head as if
you are brushing your hair.”
Or
“Sir pakigaya po ang gagawin ko”

28. External & Internal Rotation:

The patient was able to perform Full Range of Motion in the

SHOULDER (such as flexion, extension, abduction, adduction
and internal and external rotation without difficulty and is at
ease)

THORACO-LUMBAR SPINE
a. Patient’s elbow in Flex position, arm raise at
shoulder level,
“Place one hand behind your back and touch
your shoulder blade.” Or
“Sir pakigaya po ang gagawin ko”
29. Exposure & Position of patient:
a. Without the shirt
b. Patient upright
30. Curvature & Vertical alignment:
a. View patient from side to check for spinal
profile
 b. View patient from behind to check for 32. Active ROM: Patient in standing position
straightness a. Flexion – patient to bend forward to reach
toes / knees
“Bend forward and try to touch your toes.” Or
“Sir pakigaya po ang gagawin ko”

31. Palpation
a. To check for  Muscle spasm
b. Fist palp (ulnar aspect) for  Tenderness

b. Extension – patient to bend backward as far

as she can with the examiner at the back
“Bend back as far as possible.” Or
“Sir ibend nyo po ‘yung likod nyo habang
nakaalalay ako”

Throco-lumbar spine is symmetrical, no bony deformities.

The spine is in the midline position.
The Thoracic spine is convex-shaped, while the lumbar spine
is concave-shaped.
There is no muscle spasm and
No muscle tenderness (Masakit po ba Sir/Mam?)
 33. Lateral Bending – Patient to bend sideways to reach Right
& Left sides of the knees alternatively
“Bend to the side from the waist.” Or
“Sir ibend nyo po ‘yung tagiliran nyo habang
nakaalalay ako”
HIPS
35. Exposure & Position
a. Patient preferably with just his undergarment
& in supine position to lateral decubitus –
b. Palpate for the side of the iliac crest & greater
trochanter to check for
 Tenderness Right & Left alternatively

34. Spinal Rotation

a. Patient to turn head & shoulder as one unit to
the Right then to the Left holding the pelvis
stationary
“Rotate from side to side.” Or
“Sir iikot nyo po ‘yung tagiliran nyo habang
nakaalalay ako”

The iliac crest and greater trochanter is symmetrical,

no bony deformities, no tenderness (May masakit po ba
Sir/Mam?) noted on both sides

The patient was able to perform Full Range of Motion in the

THORACO-LUMBAR SPINE (such as flexion, extension, lateral
bending and spinal rotation without difficulty and is at ease)
36. Active ROM: “SIR PAKIGAYA PO AKO” WHEN PATIENT IS LYING DOWN:
ABDUCTION OF HIP:
a. Flexion – Patient on supine, to lift leg up

ADDUCTION OF HIP:

“Sir pakigaya po ako”

b. Extension – Patient on his side to bend the hip

backward

EXTERNAL & INTERNAL ROTATION:

“Sir pakigaya po ako”

37. Abduction & Adduction

a. Patient to move the leg sideways away from
the midline
b. Then back towards across the midline

The patient was able to perform Full Range of Motion in the

HIPS (such as flexion, extension, abduction and adduction
without difficulty and is at ease)

The patient was able to perform Full Range of Motion in

the HIPS (such as flexion, extension, abduction and
adduction without difficulty and is at ease)
SPECIAL TESTS: 40. Gaenlen’s Test
Evaluating Patient with back pains: a. Hyperflex hip & dangle the opposite leg to do
38. Straight leg Raising test passive hyperextension of the same hip joint
a. Patient on supine position b. Check for SI pain
b. Raise one leg at a time around 60-70 degrees
from the table, to check for shooting pain from
buttock down to the leg

The patient is normal for Gaenlen’s Test

EVALUATING PATIENT WITH HIP FLEXION CONTRACTURE &

LUMBAR LORDOSIS:
41. Thomas Test
a. Patient on supine position to flex the hip & pull
the knee in flexion to the chest

The patient is normal for Straight Leg Raising Test

39. Patrick’s Test

a. Patient’s heel on the opposite knee
b. The hip of the flex knee is externally rotated to
check for SI pain at SI joint, groin pain at the
hip joint

The patient is negative for Lordosis, Normal Thomas

The patient is normal for Patrick’s Test Test
KNEE JOINT: Inspection & Palpation The patient’s upper knee circumference in both leg is ___
42. Check for the location of the: cm, while
a. Patella the lower knee circumference in both leg is ___cm and is
b. Side dimples for effusion symmetrical and has no bony deformities
43. For Mobility, tenderness
44. Cysts: 46. Active ROM: “SIR PAKIGAYA PO AKO”
a. Bursitis
b. Deformities

The patella is symmetrical, no signs of effusions and is

Mobile and no tenderness noted (May masakit po ba
Sir/Mam?)
No cysts, bursitis or bony deformities noted.

45. Compare size (circumference) & Symmetry above and

below the knee a. Flexion
“Bend or flex your knee.” OR
“Squat down to the floor.”

b. Extension
“Straighten your leg.” OR
“After you squat down to the floor, stand up.”

The patient was able to perform Full Range of Motion in the

KNEE JOINT (such as flexion and extension without difficulty
and is at ease)
ANKLE JOINT & FOOT: Inspection & Palpation
47. ID Landmarks:
a. Lateral Malleoli
b. Medial Malleoli
c. Calcaneous
 Check for swelling & skin lesions
48. Deformities:
a. Pedal
b. Toes

The skin is brown in color,

The nails is pinkish in color, no lesions noted
The following landmarks of ankle joint and foot are
palpable such as lateral and medial malleoli and
calcaenous. It is symmetrical with no bony deformities
There is no swelling (May masakit po Sir/Mam?)
No bony deformities noted on pedal and toes

49. Edema
a. (+ / - ) Grading
Negative for edema
50. Active ROM: “SIR PAKIGAYA PO AKO” d. Eversion
“Bend your heel outward.”

The patient was able to perform Full Range of Motion in

the ankle joint such as dorsiflexion, plantarflexion,
inversion and eversion without difficulty and is at ease.

a. Dorsiflexion
“Point your foot toward the ceiling.”

b. Plantar Flexion
“Point your foot toward the floor.”

c. Inversion
“Bend your heel inward.”