2-Day-Old Infant
History questions: Are the baby’s legs and arms symmetrical? Is there any tenderness in the abdomen?
Pertinent physical exam findings: Full hip abduction, equal gluteal folds, negative Barlow’s sign is normal (Tappero & Honeyfield, 2018).
Maneuvers to perform Palpation, reflex tests, congenital hip dysplasia assessment (Tappero & Honeyfield, 2018).
Normal findings: Feet and legs are symmetric in size, movement, and shape. Adequate capillary refill should be present in extremities (Tappero & Honeyfield, 2018). All pulses are strong and equal (radial, pedal, femoral, brachial, popliteal) (Tappero & Honeyfield, 2018).
Abnormal findings: Joints are hyper-extensible (Tappero & Honeyfield, 2018). Palmar simian crease is a sign of Down’s syndrome (Tappero & Honeyfield, 2018).
12-Year-Old Child
History questions: Are there any issues with muscles or skeleton that you are aware of? Is the problem symmetrical? Is the issue local? Have you experienced any musculoskeletal defects in the past? (Chiocca, 2019).
Pertinent physical exam findings: Fine precision pinch should be in place as it is an important functional ability (Chiocca, 2019). Both knees should be extensible and flexible, with no sign of crepitus. Power grip and strength should be adequate for the child’s age (Chiocca, 2019).
Maneuvers to perform: The patient should be asked to walk a few steps – this would help the care provider observe the patient’s ability to turn quickly and also assess the gait for symmetry (Chiocca, 2019).
Normal findings: The patient’s spine is aligned properly, iliac crests are equally leveled (Chiocca, 2019). The patient easily (painlessly) extends both knees and elbows.
Abnormal findings: Feet abnormalities – an arch profile that is either too low or too high (Chiocca, 2019). The hallux valgus is present. In some patients, toes could be retracted or clawed.
35-Year-Old Patient
History questions: What is your daily occupation? Do you practice any sports or work out? Do you have a history of musculoskeletal illnesses? Do you have any pains in your limbs or spine?
Pertinent physical exam findings: Elbow, wrist, finger, and arm movements are not accompanied by any kind of pain (Petty & Ryder, 2017). Movements of the spine are accurate, smooth, and do not generate any sounds. Flexion and extension are adequate for the patient’s limbs, spine, and cervical spine movements (Petty & Ryder, 2017).
Maneuvers to perform: The patient should rotate their body in all directions so that the examiner would be able to find any areas of discomfort (Petty & Ryder, 2017). Also, joints and fingers should be palpated for the examiner to identify unusual swellings.
Normal findings: Flexion and extension of all limbs is adequate and do not cause discomfort in the patient (Petty & Ryder, 2017). Bony prominences do not show any sign of tenderness (Petty & Ryder, 2017).
Abnormal findings: The patient fails the Trendelenburg test where they have to stand on one foot (Petty & Ryder, 2017). True leg length differences could hint at hip diseases (Petty & Ryder, 2017).
65-Year-Old Patient
History questions: What is your daily occupation? Do you exercise several times a week? Do you have a history of musculoskeletal illnesses? Do you have any chronic pains in your limbs or spine?
Pertinent physical exam findings: Feet deformation should be assessed to evaluate the grade of hallux valgus (Avers & Wong, 2019).
Maneuvers to perform: The patient should be asked to touch their toes while standing. The flexibility of joints should be tested (Avers & Wong, 2019). Knee reflex should be tested as well.
Normal findings: Limb length is symmetrical and no swellings in arms, legs, or spine are identified (Avers & Wong, 2019). Skin color is identical across the body and there are no ulcers or signs of the rash.
Abnormal findings: Excessive hallux valgus is present and causes pain and discomfort in the patient (Avers & Wong, 2019). Joints are swollen and the patient restricts their motion because of the overall health state. Arthritis and similar conditions are found in the patient.
References
Avers, D., & Wong, R. A. (2019). Guccione’s geriatric physical therapy (4th ed.). Elsevier.
Chiocca, E. M. (2019). Advanced pediatric assessment (3rd ed.). Lippincott Williams & Wilkins.
Petty, N. J., & Ryder, D. (2017). Musculoskeletal examination and assessment e-book: A handbook for therapists (5th ed.). Elsevier Health Sciences.
Tappero, E. P., & Honeyfield, M. E. (2018). Physical assessment of the newborn: A comprehensive approach to the art of physical examination (6th ed.). Springer Publishing Company.