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Upper Extremities
With the patient seated comfortably and appropriately undressed, begin the examination
of the upper extremities.
Inspect for deformity, visible swelling, muscle atrophy or abnormal joint range of
motion.
HANDS
Observe the dorsal and palmar surfaces and the intrinsic muscles.
WRISTS
ELBOWS
SHOULDERS
Observe shoulder flexion by asking the patient to bring the arms forward and raise them
overhead.
Observe shoulder internal rotation by having the patient place both hands behind the
back. Then assess shoulder external rotation by asking the patient to place both hands
behind the head.
Lower Extremities
Inspect for deformity, visible swelling, muscle atrophy or abnormal joint range of
motion.
HIPS
Assess hip flexion by grasping the ankle and moving the thigh up toward the chest.
Return the thigh to a position perpendicular to the exam table while holding the shin
parallel to the exam table.
Now, move the ankle medially to assess hip external rotation. Move the ankle laterally to
assess hip internal rotation.
KNEES
ANKLES
FEET
ALIGNMENT
Now with the patient standing, begin the examination of the spine.
Assess neck flexion by instructing the patient to place his chin on the chest.
Observe right and left rotation by asking the patient to place his chin on each shoulder.
Assess lateral flexion (or lateral bending) by asking the patient to incline his ear toward
each shoulder.
Now, while observing the patient from behind, inspect the thoracic and lumbar spine.
Observe lumbar flexion by instructing the patient to bend forward at the waist.
Assess thoracolumbar lateral flexion (or lateral bending) by asking the patient to bend to
the right and to the left.
Gait