ASSESSING ABDOMEN

 Memorize quadrants, regions and its parts

 Inspect – Auscultate – Palpate – Percuss
 Grey Turner sign – purple discoloration at the flanks indicates bleeding or trauma within
abdominal walls
 Ascites – abdominal swelling due to fluid accumulation
 Spider angioma – dilated surface arterioles and capillaries with a central star
 Cullen sign – bluish or purple discoloration around umbilicus indicating intra-abdominal bleeding
 6 F’s – Fat, Feces, Fetus, Fluid, Fibroids, Flatulence
 Hernia is seen as a bulge in the abdominal wall
 Hepatomegaly – enlarged liver
 Splenomegaly – enlarged spleen
 Enlarged kidney may be due to a cyst, tumor, or hydronephrosis
 Test for Ascites: Test for shifting dullness and fluid wave test
 Test for appendicitis: Rebound tenderness in LLQ, Psoas sign – hyperextend, Obturator sign –
rotate leg externally and internally, Hypersensitivity test
 Test for Cholecystitis: RUQ pain or tenderness
 Psoas sign – pain in RLG when hyperextended due to irritation of iliopsoas muscle due to
appendicitis
 Obturator sign – pain in RLG when legs are rotated externally and internally due to irritation of
obturator muscle due to appendicitis
 Murphy sign – pain when pressure is elicited on the right costal margin liver border, sign of
inflammation of gallbladder
 Rovsing sign – pain in RLQ when there is pressure on LLQ, sign of appendicitis
 Blumberg sign – sign of peritoneal irritation
 READ ON ABNORMALITIES
ASSESSING MUSCOSKELETAL

 Bones provide structure and protection

 206 bones make up the axial and appendicular skeleton
 Two types of bones: compact and spongy bone
 Periosteum – covers the bones; it contains osteoblasts and blood vessels
 Three types of muscle: skeletal, smooth, and cardiac
 Skeletal muscles are attached to bones via tendons
 Joints are where two bones meet
 Fibrous joints – immovable
 Cartilagous joints
 Synovial joints – contain synovial fluid that allow sliding movement
 Bones in synovial joints are joined by ligaments
 Bursae – small sacs filled with synovial fluid
 READ ON MAJOR JOINTS

Observe posture Posture is erect and comfortable

Observe gait Evenly distributed weight and movement
Inspect and Palpate TMJ Snapping and clicking may be heard
Test ROM Jaw has full ROM against resistance
While client is sitting, No visible bone overgrowth, swelling, redness, tenderness
inspect sternoclavicular
joint
Observe cervical, Cervical and lumbar are concave; thoracic is convex
thoracic, lumbar
curvature
Palpate spinous process Non tender spinous processes, well developed, firm, smooth, nontender
and paravertebral muscle
muscles
ROM of cervical spine Flexion and extension of cervical spine
Test lateral bending 40 degrees
Evaluate rotation 70 degrees
ROM of lumbar spine Flexion of 75-90 degrees, hyperextension of 30, lateral bend of 35,
rotation of 30
Test for back and leg
pain
Measure leg length Measure from anterior superior iliac spine upto medial malleolus crossing
the knee; normal is equal or 1 cm apart
Inspect and palpate the Symmetric, no swelling, redness, deformity
arms
ROM of shoulders Forward flexion of 180, hyperextension of 50, adduction of 50, abduction
of 180, internal and external rotation of 90
Inspect elbows Symmetric, no deformities, redness, or swelling
ROM of elbows Flexion of 160, hyperextension of 180, pronation and supination of 90,
hyperextension of 5-10
Inspect wrist Wrist are symmetric, no redness or swelling
Perform squeeze test Pain is tolerated
ROM of wrist Flexion of 90, hyperextension of 70, ulnar deviation of 55, radial
deviation of 20
Test for Carpal tunnel No tingling, numbness, or pain
syndrome:
Perform Phalen test
Perform Tinel test No tingling or shocking sensation
Observe for flick signal
Test for thumb
weakness
Inspect hand and
fingers
ROM of hands and Abduction of 20, full adduction of fingers, flexion of 90, hyperextension
fingers of 30. Normal thumb flexion is at 50 degrees
While client is standing,
inspect symmetry and
shape of hips
ROM of hips 90 hip flexion, 120 hip flexion with bent knees, 45-50 abduction, 20-30
adduction, 40 internal hip rotation, 45 external hip rotation, 15 hip
hyperextension
Inspect knees
Perform bulge test
Perform ballottement
test
ROM of knees
Inspect position,
alignment, shape, and
skin of ankles and feet
Palpate ankles and feet
Assess
metatarsophalangeal
joint
Perform squeeze test
ROM of feet Dorsiflexion of 20, eversion of 20, inversion of 30, abduction of 10,
adduction of 20, flexion and extension of 40
Chronic rheumatoid arthritis – swelling and thickening of carpal and phalanges joints

Osteoarthritis – nodules on dorsolateral aspect of phalanges joints

Boutonniere and swan neck deformities – flexion of proximal phalanges joint and hyperextension of
distal phalanges joint

Ganglion – fluid filled cyst commonly in dorsum of wrist

Tenosynovitis – painful flexion of fingers

Thenar atrophy – seen in CTS

Acute gouty arthritis – phalanges joint of great toe is swollen

Flat feet – has no arch and may cause pain and swelling of foot surface

Callus – non painful thickened skin occurring at pressure points

Hallux valgus – lateral deviation of great toe

Corn – painful thickening of skin

Hammer toe – hyperextension of metatarsophalangeal joint with flexion of proximal interphalangeal

joint

Plantar warts – painful warts usually under callus