Saturday, 22 October 2022

LOCOMOTORY SYSTEM EXAMINATION

INTRODUCTION:

The locomotor system is also known as the musculoskeletal system. It is made up of

the skeleton, the skeletal muscles, tendons, ligaments, joints, cartilage and other
connective tissue. These parts work together to allow movement. 



The brain controls the movements of the body, using information from

• the eye
• the ears, including special canals which give us a three-dimensional sense of
motio
• the muscles themselves, called ‘muscle sense’ or kinaesthesia

Generally, muscles move the skeleton by working in opposite pairs. For instance, if
you bend your elbow, your biceps (muscles on the front of the upper arm) contract
and the triceps (muscles on the back of the upper arm) relax. It works the other way
if you straighten your arm – the triceps contract while the biceps relax

THE MUSCULOSKELETAL EXAMINATION

This screening examination is known by the acronym ‘GALS’, which stands for Gait,
Arms, Legs and Spine.

GAIT

• Ask the patient to walk a few steps, turn and walk back. Observe the patient’s gait
for symmetry, smooth- ness and the ability to turn quickly

• With the patient standing in the ana- tomical position, observe from behind, from
the side, and from in front for: bulk and symmetry of the shoulder, gluteal,
quadriceps and calf muscles; limb alignment; alignment of the spine; equal level of
the iliac crests; ability to fully extend the elbows and knees; popliteal swelling;
abnormalities in the feet such as an excessively high or low arch pro le, clawing/
retraction of the toes and/or presence of hallux valgus

GAIT CYCLE

The gait cycle is a repetitive pattern involving steps and strides

Phases of the Gait Cycle (8 phase model)

1. Initial Contact or Heel strik

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 2. Loading Response or foot a

3. Midstanc
4. Terminal Stance or heel of
5. Pre swing or toes of
6. Initial Swin
7. Mid Swin
8. Late Swing.
STANCE PHASE:

1. The heel strike (initial response, contact response, or weight acceptance). In this
subphase, the heel of the foot makes initial contact with the ground. It requires the
body’s weight to be accepted by the leg making contact with the ground.

2. The foot at (loading response) is the second subphase when the foot rolls
forward until the entire plantar surface is in contact with the ground.

3. The mid stance starts when the weight of the body is propelled forward, directly
over the lower extremity, so that the greater trochanter of the femur is directly above
the middle of the foot. At this stage, our entire body weight is being balanced over
one leg.

4. The heel-off includes lifting the heel off the ground. This is when we start to shift
the body weight onto the contralateral leg.

5. The toe-off is the nal stage of the stance phase and includes pushing the toes
into the ground while the ankle plantar exes, creating forward propulsion.



SWING PAHSE:

6. The early swing (acceleration phase) - the foot is lifted from the ground. The
ankle dorsi exes and the knee exes so that the foot and toes can be moved from
the ground. The hip exes to bring the leg forward, moving it directly under the body.

7. The mid-swing phase - the non-weight-bearing leg passes directly beneath the
body and past the weight-bearing leg. At the same time, the trunk is moved forward
so that the weight of the body is directly over the weight-bearing leg.

8. The late swing (deceleration phase) is the last subphase. The foot is moved to a
position in front of the body, the knee extends and momentum decelerates. The
lower limb is now ready for heel strike and prepares to accept the transfer of body
weight, for the start of the next stance phase

GAIT PATTERN:

- The gait pattern describes the gait characteristics of each individual. 

- These characteristics can depend on a number of individual variables such as age,
height, weight, sex, walking speed, strength, exibility and aerobic conditioning. 

- The gait patterns can be assessed by conducting a gait analysis.

- The alterations in normal gait can be caused by different deformities, injuries,
weakness, disease, or pain in any part of the body.



ATAXIC GAIT - is typically caused by cerebellar dysfunction. It is characterised by
wide step width and jerky, irregular, uncoordinated movements. The movements may
appear exaggerated and the person may appear to lurch or stagger

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 HEMIPLEGIC OR HEMIPARETIC GAIT - unilateral weakness on the affected side

with weakness in exion and dorsi exion. This causes the person to swing the
paraplegic leg outwards and in a circular motion in order to bring the leg forward.
The affected upper limb is exed, adducted, internally rotated and placed against or
across the trunk as a way of improving balance. Seen in stroke patients

PARKINSONIAN GAIT - characterised by the exion rigidity of the major joints and
bradykinesia. Seen in conditions that affect the basal ganglia

TRENDELENBURG GAIT - while standing on one leg, the free side of the pelvis
drops towards the oor. It is caused by the weakness of the gluteus medius and
minimus of the contralateral side.

HIGH STEPPING GAIT - neuropathic gait where weak or paralaysed dorsi exor
muscles prevent the person from dorsi exing the talocrural joint in the early swing
phase. The toes may point the ground but not touch the ground. To compensate this,
the person increases the knee exion and keeps a high step to clear the foot from
the ground. Seen in LMN lesions, L5 nerve compression or peripheral neuropathies

WADDLING GAIT - Movement of the trunk is exaggerated to produce a waddling,

duck-like walk. Progressive muscular dystrophy or hip dislocation present from birth
can produce a waddling gait

ARMS:

- Ask the patient to put their hands behind their head. Assess shoulder abduction and
external rotation, and elbow exion (these are often the rst movements to be
affected by shoulder problems).

- With the patient’s hands held out, palms down, ngers outstretched, observe the
backs of the hands for joint swelling and deformity.

- Ask the patient to turn their hands over. Look at the palms for muscle bulk and for
any visual signs of abnormality.

- Ask the patient to make a st. Visually assess power grip, hand and wrist function,
and range of movement in the ngers.

- Ask the patient to squeeze your ngers. Assess grip strength.

- Ask the patient to bring each nger in turn to meet the thumb. Assess ne precision
pinch (this is important functionally).

- Gently squeeze across the metacarpophalangeal (MCP) joints to check for
tenderness suggesting in ammatory joint disease. (Be sure to watch the patient’s
face for non-verbal signs of discomfort.

LEGS: 

- With the patient lying on the couch, assess full exion and extension of both knees,
feeling for crepitus

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 - With the hip and knee exed to 90 degree, holding the knee and ankle to guide
the movement, assess internal rotation of each hip in exion (this is often the rst
movement affected by hip problems).

- Perform a patellar tap to check for a knee effusion. Slide your hand down the
thigh, pushing down over the suprapatellar pouch so that any effusion is forced
behind the patella. When you reach the upper pole of the patella, keep your hand
there and maintain pressure. Use two or three ngers of the other hand to push
the patella down gently. Does it bounce and ‘tap’? This indicates the presence of
an effusion.

- From the end of the couch, inspect the feet for swelling, deformity, and callosities
on the soles.

- Squeeze across the matatarsophalangeal (MTP) joints to check for tender- ness
suggesting in ammatory joint disease. (Be sure to watch the patient’s face for
signs of discomfort.

SPINE:

- With the patient standing, inspect the spine from behind for evidence of scoliosis,
and from the side for abnormal lordosis or kyphosis.

- Ask the patient to tilt their head to each side, bringing the ear towards the shoulder.
Assess lateral exion of the neck (this is sensitive in the detection of early neck
problems).

- Ask the patient to bend to touch their toes. This movement is important functionally
(for dressing) but can be achieved relying on good hip exion, so it is important to
palpate for normal movement of the vertebrae. Assess lumbar spine exion by
placing two or three ngers on the lumbar vertebrae. Your ngers should move apart
on exion and back together on extension

ASPECTS TO BE NOTED DURING THE EXAMINATION:


1. Muscle tone - hypertonia, hypotonia

2. Muscle strength - power

3. Range of motion (ROM)

4. Re exes - super cial and deep

5. Tenderness in the muscles

6. Tremors - static, acting, intentional, apping tremors

7. Clonus

8. Temperature

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