<p>Extremity/Neuro/MuscularSkeletal</p><p>Tenderness and Facial signs of Distress</p><p>Head & Neck Temporal Mandibular Joint Tip of index finger Inspect Neck SternoMastoid muscle Traps Rhomboids ROM Chin to Chest Side to side Bend to shoulders Back Hand & Wrists ROM Fist Extend & Spread Flex / Extend wrists Side to side wrists Inspect Hands & Wrists Palpate the joints on the fingers Squeeze hand Examine knuckles Examine Wrist</p><p>Elbow ROM – Flex/Exten Supination / Pronation Examine/Palpate – Elbow Groves Lateral & Medial Epicondyles</p><p>Shoulders Raise Arms above head Hands behind Neck (elbows out) Hands behind small of back Examine SternoClavicular Joint ArcomialClavicular Joint Bicep Tendon Head</p><p>Feet & Ankles Inspect Feet & Ankles Palpate anterior surface of each ankle Feel on the Achilles tendon Squeeze foot Palpate Joints ROM –Flex/Extend Invert/Evert (holding Ankle, holding Leg) Knee Inspect Knees Palpate Suprapatella pouch Palpate side of patella Check for Knee Bulge (Milk knee and press on side of Patella)</p><p>Flex 90 degrees Palpate Patella Palpate Patella Ligaments</p><p>Hips Hip Mobility - Knee to chest Hip Rotation – Hold Knee and rotate leg (leg up at time) Patient Stands – inspect feet & Knees (Inspect)</p><p>Spine Spine Profile Inspect for lateral Curves Bend forward touch toes (Inspect again) Bend left and right / back / twist left & right (Hips stable) Palpate Spine process Paravetebra Muscles</p><p>Neurological Inspect Muscle Bulk Muscle tone – passive stretch Squeeze fingers Fingers apart (try to push together) Thumb (pull) Legs Lift leg Push down leg Abduction / Adduction Knee (90 degree) Lift foot (straiten) Keep on table Ankle</p><p>Coordination Rapid Alternating movement Point to point movement Tap hand with bottom of feet Point to point with feet (heal from knee to big toe) Observe Gait Heal to Toe (strait line) Tip toes (planter Flexion) Heals (dorsal Flexion) Hop (one leg then the other) Knee bends (one leg at a time) Romberg Test (Feet together – stand still then close eyes) Pronator Drift (arms forward palms up – close eyes) Tap arms downward Deep Tendon Reflexes Ankle - Sacral 1 Knee - Lumbar 2, 3 & 4 Bracioradialis - Cervical 5 &6 Biceps - Cervical 5 & 6 Triceps - Cervical 6 & 7</p><p>Babinski Response</p><p>Abdominal Reflex</p><p>Meningeal Signs (Chin to Chest) (watch hips and knees)</p><p>Cranial Nerves I – Sense of Smell II – Eyes (Visual acuity) & Fundus III, IV, VI – Extra Ocular Movement (Nastagmus) V – Sensory - Forehead, Cheek, Chin Muscles – Jaw clinch VII – Raise Eyebrows – puff cheeks VIII – Ears IX & X – Movement of Uvula, Gage reflex XI – Motor (Turn head – shoulder shrug) XII – Tongue Protrusion</p><p>Inspect ROM Strength</p><p>5 – No break of resistance 4 – Slight break of resistance 3 – Move against gravity 2 – Muscle movement 1 – Twitch of Muscle 0 – no movement</p><p>DTR – Deep Tendon Reflex</p>