UPPER AND LOWER EXTREMITIES

Okay ma’am this is the last part of your physical assessment. I will be assessing your upper and lower
extremities po. Please let me know if you feel uncomfortable as I will be palpating some parts of your
body. Will that be, okay?

*Inspect and palpate shoulders, upper back, right arm, left arm.

Thank you po now i will be instructing you to do some movements po just follow my instructions.

*Both arms up side ward

*Arms down and rotate shoulder inwards then outwards
*Nakafist and flex elbow
* Extend elbow and pronate
*The supinate
*Put up fists only (wrist)
*Then open hands with fingers spread, then close fingers, then pronate hand
*Then supinate hand

Okay po thank you. Next, I will be assessing your strength on both arms.

*Start sa right (nakafist si patient with elbow flexed) Kindly resist my hand po. Then do sa left.
*Start sa right ulit. Kindly resist my hand. (nakahawak sa may wrist). Then do sa left
*Then sa fingers. right then left. Kindly resist my hand
Next po kindly grip both of my hands po, Thank you
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Upon assessment, the shoulders, elbows, and the upper arms and hands, have no lesions, it has the
same color with the skin tone of the patient. There are no palpated nodules, tenderness, and no pain
verbalized during palpation. The muscle strength of the elbows, wrist and the fingers are 5/5 bilaterally
and there are no limitations in her range of motion.
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Okay next po I’m going to let you feel some objects with your eyes closed. Please say now if you feel
the cotton touching your arms.
*Lagay cotton pababa sa arms til hands
Now please tell me if it is sharp or dull, this is sharp and this is dull.
*Lagay sa arms ulet
Please tell me if it’s warm or cold.
*Lagay sa arms
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The patient’s sensory function is intact. The patient is able to feel the cotton that I let her feel in her right
and left arm. She was also able to identify the difference between sharp and dull also the warm and cold
while her eyes were closed.
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Okay now I will be placing the tuning fork in your bony area and please say now if you can feel the
vibrations. Kindly close your eyes rin po.
- left Elbow
- right shoulder
- right knuckles
- left knuckles
Next, I will be positioning your upper extremities then tell me if it is up or down.
- Lift left arm (up) then down
- Lift left finger up then down
- Lift right finger up then down
- Lift right hand up then down
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The patient’s proprioception is intact because the patient can feel the vibration over the bony areas of
the upper and lower arms bilaterally and the patient is able to identify the direction of the movements
while her eyes are closed.
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Next, I will be putting some objects on your hand with your eyes closed. Kindly identify it.
: paperclip, pen, key

Next, I will draw capital letters on your hands and identify them po. Close your eyes.
: 3 letters on each hand

Next, I will be placing these instruments on your arms going down and you will identify if it is 2 point or
1 point. Close your eyes.
- Upper arm pababa til sa hands (2x)

Next, I will touch you po with you eyes closed and you will point where I will touch you.
*Touch touch sa arms
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Upon assessment, the client’s cortical sensation is intact because she was able to identify objects
placed over her hand which were _______________ (Items). The patient was also able to identify the
capital letters drawn over the palm. She was able to identify the numbers of points placed over the arms
and she was able to point the area where she was touched with eyes closed.
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Okay ma’am please stand. In this procedure, I’m going to check the reflexes of your arms. (Flat part of
reflex hammer)
- Left arm (Hit sa gitna elbow area), then sa may wrist, then Sa likod ng left arm (left and right)
Okay you may now sit down po.
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The reflexes elicited on the biceps, triceps, and the radial area, on both upper extremities are positive.
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Next po kindly follow what I will do po with eyes closed.
- Do this clap then touch anterior part sa legs
- Touch my finger then you nose (lipat lipat finger ni nurse)
- Touch thumb to other finger pads on both hands
- With eyes closed touch nose and point left and right
Okay po thank you.
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Upon assessment, the patient’s cerebellar function is intact because she was able to do the tasks in a
well-coordinated movement without any limitations and difficulty.
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Okay ma’am lastly, I will assess your lower extremities, I will be touching some parts of your body
again and just tell me if you feel uncomfortable. Kindly stand po.
- Touch hips let me know if there is pain
- Knees
- Ankles

Follow me po in these movements

- lift right leg flexed, move left and right, then extend
- lift left leg flexed, move left and right, then extend
- Fold inside right leg and labas
- Fold inside left leg and labas
- Point right foot outwards then taas the left and right and ikot
- Point left foot outwards then taas the left and right and ikot
Okay ma’am you can now sit.

Next, I will test the muscle strength of your lower extremities. Please resist my hand.
- Thighs
- Legs front and back
- Feet up and down
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Upon assessment, the hips, feet, ankles, knees, and legs of the patient, both right and left, have no
lesions and no palpable nodules and the patient did not complain of any pain upon palpation. The color
is the same with the rest of the body’s color, the muscle strength in the hip area, ankles, and knees is
5/5, its bilaterally equal, the patient also was able to perform the different range of motions without any
limitations and difficulties.
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Please say now if you feel the cotton touching your legs with your eyes closed.
- Touch the legs
Please say if it is sharp or dull with your eyes closed.
- Touch the legs
Please say now if you feel the vibration when I place this instrument on your bony parts.
- Knees
- ankles
Next please close your eyes and tell me if it is warm or cold.
- Thigh
- Legs
- Ankles
Please tell me if the movement is up or down
- Imove yong legs and feet
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Upon assessment, the sensory function of the lower extremities is normal because the client was able
to identify the light sensation, distinguish between hot or cold, able to differentiate sharp or dull, able to
feel the vibration and can distinguish the position if it is up or down while her eyes were closed.
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Next, I will be assessing your reflexes. (Flat end)
- Cross legs and relax, hit patella
- Stand up, raise leg on the chair, hit Achilles’ tendon
- Babinski, pababa, then pataas
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The patient has positive plantar reflex which is normal, reflexes on the patellar and Achilles tendon are
positive as well. Which is scored as 2 plus.
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Next Slide one foot and do this heel to shin pataas then do sa other foot.
Follow me, lakad with toes dikit sa heel look straight. Then close your eyes and put your hands on
your chest. Thank you so much sir.
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After assessment, the patient’s cerebellar function is intact as she was able to perform the different tasks
in coordinated movement, without limitation and without losing balance.
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Thank you so much ma’am. This ends your physical examination. Thank you for your cooperation!