Download Guidelines for Extremity Examination

Guidelines for Extremity Examination
(To be completed by the Trainer)
Place a
in case box if step/task is performed satisfactorily, and
N/O if not observed.
if it is not performed satisfactorily, or
Satisfactory: Performs the step or task according to the standard procedure or guidelines
Unsatisfactory: Unable to perform the step or task according to the standard procedure or guidelines
Not Observed: Step or task or skill not performed by participant during evaluation by clinical trainer
PARTICIPANT________________________ Date Observed___________
Guidelines FOR Extremity (Limb) Examination
STEP/TASK
CASES
GETTING READY
1. Greet the patient respectfully and with kindness.
2. Tell the patient that he/she is going to be examined.
3. Explain to the patient that he/she will undress from the umbilicus
upwards or downwards according to the limb examined
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4. Wash hands thoroughly and dry them. If necessary, put on new
examination or high-level disinfected surgical gloves on both hands.
General considerations:
- History Taking (CGL No..?)
-For assessment of limb follow the same general scheme of inspection, palpation,
percussion and auscultation.
-Some portions of the examination may not be appropriate depending on the clinical
situation( performing a range of movement on a fractured leg for example)
-Examine the back and pelvis with the lower limb examination.
- Examine the neck and chest with upper limb problems.
A-General Examination:
(Guidelines No.?…..)
B-Local examination:
1) Inspection:
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Look for scares, pigmentations , ulcers, edema ,varicose veins,trophic changes
Look for asymmetry , deformity ,or atrophy
Compare with the other side
2)Palpation:
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Examine each major joint and muscle grouping in turn (look CGL No?)
Identify any area of tenderness
Identify any areas of deformity
Compare with the other side
Evaluate the vascular tree ( arterial, venous and lymphatic)
Examine the draining lymph nodes; comment on location, size in cm,
tenderness, texture, and degree of fixation of the lymph nodes
Evaluated the nerve supply (look CGL no?)
Range of movement: (CGL No?)
- Start by asking the patient to move through an active range of motion.
- Proceed to passive range of motion, if active range motion is abnormal.
Arterial pulse:
All accessible arteries are palpated
The femoral artery:
Ask the patient to lie supine, make the leg partially flexed; abducted and externally
rotated the hip and feel pulse below the mid-inguinal point.
The popliteal artery:
Ask the patient to lie supine, make knee partially flexed, and feel the pulse with the
fingers encircling and supporting the knee from both sides.
Alternate method; turn the patient into the prone position; and feel along the line of the
artery with the tips of the thumbs of both hands against the femur.
The posterior tibial artery:
Ask the patient to lie supine ,and feel the pulse in the groove, midway between the
medial malleolus and the heel( tendo-achilles)
The dorsalis pedis artery:
Feel the pulse lateral to the extensor hallucis longus tendon and proximal to the first
metatarsal space.
The radial artery: (look at CGL no?)
Semipronate the forearm ,flex the wrist and feel the pulse near the wrist.( just lateral to
the flexor carpi radialis tendon
The brachial artery:
Partially flex the elbow, and feel the pulse over the elbow just medial to the biceps
tendon) with the thumb or other fingers.
Lymph Nodes in The Inguinal Region;
1-Make the patient lie supine with contra lateral thigh flexed
2-Expose the inguinal region well
3-Palpate above and below the inguinal ligament
4-Examine both sides and comment as mentioned above.
Lymph Nodes in the Axilla:
1-Examine the patient from the front
2- Insert his/her right hand into the patient's left axilla
3-The patients arms are adducted and his/her forearm rests on the examiner's forearm
4-Make the patient's opposite shoulder steady
5-Slide the fingers against the chest wall
6- Palpate the anterior axillary fold
7-Palpate the lateral axillary wall( used the left hand for the left side; the palm directed
laterally against the upper end of the humerus)
8- Palpate the posterior axillary fold ( from behind)
9- Examine both sides and comment as mentioned above.
Epitrochlear nodes;
Make the patient's elbow semiflexed.
Place his/her right palm over the posterior aspect of the patient's right elbow and vice
versa.
The epitrochlear lymph nodes are felt under thumb.
Move the thumb in an anteroposterior direction for better appreciation.
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