Transcript Meridians and Acupoint Examination Methods for Tuina

I.
Knowing the concept of Meridians and Acupoints.
II. Learning the composition of Meridians.
III. Understanding the formation of Meridians.
Use of Meridians and Acupoints in Tuina:
Point “点”
Clinical use
Line; Route“线”
Surface; Range“面”
Acupoint
Meridians
Twelve sinews/ skin division
Concept of Meridians:
Consists of meridians and collaterals which are the essential component parts of human body
structure.
It serves as the pathway for the transportation of qi and blood throughout the body, thus
connecting the viscera with extremities, the interior with the exterior as well as the upper
with the lower.
The interconnection of meridians with collaterals throughout the body integrates the viscera,
limbs and orifices, muscles and tendons into an organic whole, thus ensuring the normal
performance of body activities.
Meridians: longitudinal trunk parts of the meridians, run deeply inside and follow certain routes.
Collaterals: branches of meridians running reticular over the body.
Lung meridian of hand-Taiyin
Composition of meridians system
Three Yin meridians of
hand
Pericardium meridian of hand-Jueyin
Heart meridians of hand-Shaoyin
Large Intestine meridian of handYangming
Twelve regular meridians
Three Yang meridians of
hand
Triple Energizer meridian of handShaoyang
Small Intestine meridian of hand-Taiyang
Stomach meridian of foot-Yangming
Three Yang meridians of
foot
Gallbladder meridian of foot-Shaoyang
Bladder meridian of foot-Taiyang
Three Yin meridians of
foot
Governor Vessel
Meridians
Conception Vessel
Thoroughfare Vessel
Eight extraordinary meridians
Belt Vessel
Yang-Heel Vessel
Yin-Heel Vessel
Meridians
system
Yin-Link Vessel
Yang-Link Vessel
Twelve divergent channels
Subsidiary part of meridians
Fifteen main collaterals
Collaterals
Superficial collaterals
Minute collaterals
Twelve cutaneous regions
Twelve sinews regions
Spleen meridian of foot-Taiyin
Liver meridian of foot-Jueyin
Kidney meridian of foot-Shaoyin
The flow of Qi in cyclical order:
(1)Hand-taiyin (Lung)
(2)Hand-yangming (Large Intestine)
(4)Foot-taiyin (Spleen)
(3)Foot-yangming (Stomach)
(5)Hand-shaoyin (Heart)
(6)Hand-taiyang (Small Intestine)
(8)Foot-shaoyin (Kidney)
(7)Foot-taiyang (Bladder)
(9)Hand-jueyin (Pericardium)
(10)Hand-shaoyang (Triple Energizer)
(12)Foot-jueyin (Liver)
(11)Foot-shaoyang (Gallbladder)
Acupoints, “acupuncture points”
Places for acupuncture and moxibustion .
Locations where Qi and blood from the viscera and meridians effuse and infuse in the
body surface.
Acupoints
Channel Points
-points distributed along the course of the fourteen channels
Extra points
-points that have definite locations not in fourteen channels
have specific names and effective indications
Ashi-Points
-refers to the site which neither a point of the fourteen channels
nor an extra point but solely the tender spot
Head and Face
Chest and abdomen
Spine
Shoulder
Examination of:
The upper limbs
Elbow
Wrist, palm and fingers
Hip
The lower limbs
Knees
Malleolus
Examination methods used:
Inspection
Palpation
Motor examination
Special examination
Importance of Examination methods:
determine whether a patient is eligible for Tuina.
Use the correct manipulation for a certain disease.
Perform the right mechanism of Tuina for the treatment on a disease.
Coordinate with other therapies like acupuncture and moxibustion.
Judgment of prognosis.
The spirit
(1)Keen and bright
(2)Quick response and
normal speech
Spirit is normal
Visual expression
(1)Dull and sleepy
(2)Weak breathe and slow response
Spirit is lost
(3)floccillation
(4)Involuntary discharge of urine
The facial expressions
Bright and lustrous
Qi and blood not impaired
Favorable prognosis
Mild disease
Color and luster
Dull and lusterless
Impairment of disease
Unfavorable prognosis
Serious disease
The shape of the head and face
(1)Rickets
-Protrusion of frontal bone and temporal
bone at both sides and flat vertex
Rickets:
a disease of children caused by vitamin D deficiency, characterized by
imperfect calcification, softening, and distortion of the bones typically
resulting in bow legs.
The shape of the head and face
(2)Myogenic touticollis
-Head turns to the affected side and face to the
healthy side
(3)Stiff neck
Cervical spondylosis
-Mild anterior bending of the head with rigidity
The shape of the head and face
(5)Facial paralysis
-inability to close the eye of one side
-disappearance of wrinkles
-deviation of mouth corner to the healthy side
-disappearance of nasolabial groove
(6)Central neural facial distortion
-Paralysis of the lower part of the body and
deviation of the mouth corner to the affected side
The tongue
Normal- slightly red
Mild white tongue
-weakness of Qi and blood
-insufficiency of Yang Qi
accompanied by cold
Deep red tongue
-excess heat syndrome
-Yin deficiency
-fever, infection, trauma, operation
Bluish and purplish tongue
-unsmooth flow of Qi and blood
-blood stasis
The tongue coating
Scanty, no coating
-weakness of spleen
and stomach
Normal- thin, white and slippery
Thick and greasy coating
-Excessive dampness
White coating
Red tongue no coating
-deficiency of
stomach Qi and body
fluid
-Cold dampness or cold phlegm
Yellow coating
-external heat syndrome
-heat dampness
Palpation methods:
Purpose of palpation to differentiate:
-pulse taking
-cold
-touch and feel
-warmth
-moisture
-dryness
-distension
-pain
Infantile fontanel
Steps:
(1)doctor may put his palm at both sides of the temple
(2)examine the fontanel with the middle finger and index
finger
(the artery fontanel can be felt pulsating)
(3)anterior fontanel is at same level with cranium
Protrusion of anterior fontanel
Depression of anterior fontanel
-high fever
-bleeding inside cranium
(Increased of intracranial pressure)
-vomiting and diarrhea
-loss of body fluid
Retard closure of anterior fontanel
-rickets
Length of mouth opening
Traumatic Injury
Normal length:
Steps:
-the length of upper teeth to the lower teeth is about
the width of middle, index and the fourth fingers
putting together
-depression in cranium
-fracture in deep region of subcutaneous
hematoma
-cranial depression or deformity
Disorder of mandible
Dislocation of mandible
-length narrow
-lockjaw
-marked by emptiness of
articular fossa
-condyle anterior to it
Chest
Steps:
-local redness
-swelling
-mass and visible veins
-changes of thoracic and abdominal shapes
Mastitis
-hardness of breast
-obvious tenderness and fever
Portal hypertension in liver
-protrusion of veins
-ascites
-splenomegaly
Malnutrition
-infantile emaciation with swollen abdomen
-visible veins
Emphysema
-barrel chest
Tuberculosis
-flat chest
Rickets
-chicken breast
Bronchial asthma
Abdominal
Gastroptosis
-abdominal depression and protrusion of navel
Emaciation
Pyloric obstruction/ Intestinal obstruction
-Abdominal peristaltic wave can be seen
Thoracic
Tracheal rupture
-cutaneous emphysema
Costal fracture
Pinching or Extrusion Test
Steps:
-patient is asked to sit or stand
-the doctor pinch the thorax of the patient from both sides
-pain will be felt if there is costal fracture
Abdominal
Extrapyramidal bundle injury
Abdominal wall reflex test
Indications:
Steps:
-upper abdominal wall T7-T8
-middle abdominal wall T9-T10
-lower abdominal wall T11-T12
-patient lies in supine position, with knees bent
-relax the abdominal muscle
-the doctor quickly and mildly draw a line from hypochondrium
to the navel and abdomen with a stick
-observe for muscular reflex
*loss of abdominal wall reflex at certain horizontal level suggest
injury of spinal cord at the corresponding section
Cremasteric reflex test
Indications:
Steps:
-contraction of scrotum L1-L2
-used a stick of match to draw the skin over the inner
thigh
-draw from lower thigh to upper thigh
-to induce the contraction of scrotum
Physiological curvature and spinal deformity
Physiological curve of Spine:
Pathological abnormal changes:
-Cervical curvature (lordosis)
-Scoliolosis
-Thoracic curvature (kyphosis)
-humpback
-Lumbar curvature (lordosis)
-lumbar lordosis
-Sacral curvature (kyphosis)
-wry pelvis
Scoliosis- Functional
Functional scoliolosis test
(1)Steps:
-asked the patient to pull the horizontal bar with both hands
-the spinal curve disappear
(2)Steps:
-asked the patient to bent anteriorly for 80°
-functional curve disappear
*shows no structural deformity
Scoliosis- Structural
Characteristics:
-irreversible
-server curve and fixated
-appears prominent
-accompanied by deformity of thorax
-caused by disorders of vertebrae, ligaments, intervertebral disc, nerve and muscles
*not allowed to rectify through posture adjustment
Scoliosis- Structural
Pathological factors:
-improper posture
-non-symmetry of the lower limbs
-deformity of the shoulders
-breaking of the lumbar intervertebral fibers
-infantile paralysis
-chronic thoracic diseases
*deformity due to improper posture disappears in supination or when waist is bent
Neurofibroma
Proliferative fivrosis
-different size coffee spots over the
waist and back
Congenital fissure of sacral vertebrae
-long body hair, thick skin color over the
lumbosacral region
Spinal meningocele
-swollen and distending soft tissues
around middle waist
Wandering abscess
Swelling in the triangular region at
one side of the waist
Tenderness
Shallow tenderness
Tenderness
Superficial disorders in supraspinal and
interspinal ligament
Deep tenderness
Deep disorders of vertebrae, small
joints and intervertebral discs
Intermittent tenderness
Tenderness- Sprained of lumbar soft tissue
Interspinal ligament injury
-interspinal tenderness
Supraspinal ligament injury
-supraspinal tenderness
Lumbar myositis
-lumbar tenderness
Neck movement
Physiological motion
•
bends anteriorly for 35°-45°
•
posteriorly for 35°-45°
•
moves left and right sides respectively 45°
•
turns to the left and right 60°-80°
Lumbar movement
Physiological motion:
•
bending anteriorly for 90 °
•
posteriorly for 30°
•
moves left and right sides respectively 30°
•
turns to the left and right 30°
*fracture lest spinal cord, nerves or vessels be impaired
should avoid motor examination.
Vertex percussion test
Impairment of nerve root
Steps:
-the patient is asked to sit straight with the head
turning to he affected side
-doctor put his left palm on the vertex of the patient
-performs percussion with his right hand
* Positive: patients will feel pain or radiating pain due to
foramina stenosis
Brachial plexus pulling test
Compression on brachial plexus
Steps:
-the patients bends his neck anteriorly
-the doctor supports one side of the patient’s head with
one of this hand
-grasps the wrist of the patient with other hand
-pulling towards the opposite direction
*positive: arm is painful or numb  pressure on the
brachial plexus
Neck rotation test
Vertebral artery
Neck bending test
Protrusion of lumbar
intervertebral disc
Steps:
Steps:
-the patient is asked to raise his head slightly
to the posterior side
-and turns the neck automatically to the right
and left sides
-the patient lies supination
-the doctor puts one of his hands at the occipital
side
-the other over the chest of the patient
-then bending the patient’s head anteriorly
*positive: dizziness, vomiting or faint (suggest
insufficient of blood in basilar artery)
*positive: appear lumbago and sciatica (radiating
pain occured)
Abdomen straightening test
Pressure of the lumbar nerve roots
Steps:
-the patient lies in supination
-tries to straighten the abdomen by raising
the waist and pelvis over the bed
-ask the patient to cough at the same time
*positive: radiating pain in the waist and lower
limbs
Leg raising and foot dorsum test
Steps:
Leg raising  Tension of iloitibial tract and hamstring muscle
-the patient lies supination with both legs stretched straight,
then raising the legs
-the doctor examines the range of rising without pain (the angle
between the raised leg and the bed)
*Positive:
-pain occurs in the range of 60° and below when the respective
nerve roots are compressed (5°-10° the pain will disappear)
Foot dorsum  Intervertebral fiber breaking syndrome
-foot dorsum bent upwards
*Positive:
-sciatica appears
Femoral nerve pulling test
Compression of femoral nerve
Steps:
-the patient lies in prone position
-the doctor fixates the pelvis of the patient with one hand
-holds the affected shank of the patient with the other hand
-then pulling the leg of the patient with great strength
*Positive: Radiating pain in the anterior part of the thigh
Pelvis rotating test
Lumbar soft tissue injury, lumbosacral vertebral disorder
Steps:
-the patient lies in a supination
-the doctor bends the hips and knees of the patient as much as
possible
-raise the buttocks of the patient over the bed
-enable the waist of the patient to bend passively to the anterior
direction
*Positive: pain appears in the lumbosacral part
Pelvis separating and pressing test
Disorder of articulatio sacro-iliaca, pelvic fracture
Steps:
-the patient lies in a supination
-the doctor pressing the wing of iliac crest of the patient from
the opposite sides (pelvis separating test)
-the doctor presses the wing of ilium with both hands towards
the central (pelvis pressing test)
*Positive: pain appears
4-shaped test
Disorder of articulatio sacro-iliaca, Sciatica
Steps:
-the patient lies supination
-stretching the healthy lower limb straight
-laterally bending the affected limb to put the foot over
the knee of the healthy limb
-the doctor presses the knee of the affected limb of the
patient with the other hand to rotate the articulatio
sacro-iliaca
*Positive: pain appears
Bed side test
Disorder of articulatio sacro-iliaca
Steps:
-the patient lies supination
-turns the buttock against the side of the bed
-bending the knee of the healthy limb to fixate the pelvis
-the doctor moves the affected limb of the patient to the
edge of the bed
-pulls as much as possible in order to move the the
articulatio sacro-iliaca
*Positive: pain appears
Heel-buttock test
Disorder in lumbosacral joint
Steps:
-the patient lies in prone position and stretch the lower
limb
-the doctor grasps the heel of the patient
-to bend the knee till the heel touches the buttock
*Positive: pain appears in lumbosacral region, pelvis or
waist
Essentials
•
symmetry between the two shoulders
•
development of the deltoid muscle, superclavicular and infraclavicular fossae at
both sides
•
the symmetry between both sides of scapular
•
distance between the medial border of scapular and the spinal vertebrae
Congenital tall scapular disease
Dislocation of shoulder joint
-scapular is prominent
-the back of shoulder is swollen with acute injury
-bulge of deltoid muscle
Paralysis of serratus anterior muscles
-the medial border of the scapular is
protruding
Fracture of scapular
Dislocation of clavicular joint
-prominence of the lateral side of clavicle
Tenderness
Steps:
-the doctor uses the thumb to seek for tenderness around the shoulder
joint
-trials to be made to exclude fractures
-examine the functions and mobility of the joint
*Positive: Tenderness appears at certain examined region
Disorder of lesser tuberosity of humerus
Disorder of greater tuberosity of humerus
-tenderness anterior and inferior to
acromion
-tenderness lateral to acromion
Anteflexion movement
Steps:
-range of movement can reach 90°.
-the doctor fixates the shoulder with one hand and ask the patients to
raise the upper limb anteriorly
-muscles involved: anterior of deltoid muscle and coracobrachial muscle
Retro-extension movement
Steps:
-range of movement can reach 45°.
-the doctor asks the patient to raise the upper limb posteriorly
-abduct the upper limb
-muscles involved: musculus teres major
Abduction movement
Steps:
-range of movement can reach 90°
-the patient is asked to abduct the upper limb
-muscles involved: deltoid muscle and supraspinous muscle
Endoduction movement
Steps:
-range of movement can reach 45°
-the patient is asked to bend the elbows and move the upper limbs
medially
-muscles involved: greater pectoral muscle
Extorsion movement
Steps:
-range of movement can reach 30°
-the patient is asked to bend the elbow for 90°
-the doctor holds the elbow with one hand, and wrist with the other
hand
-to rotate the upper arms laterally
-muscles involved: infraspinous muscle and musculus teres minor
Adduction movement
Steps:
-range of movement can reach 80°
-the patient is asked to bend the elbow for 90°
-adduct the forearm to the front of the chest
-or to touch the subscapular muscle with the forearm from the back
-muscles involved: subscapular muscle
Rotation movement
Steps:
-to rotate the upper arms around the acromiobrachial joint
-muscles involved: subscapular muscle
Dugas syndrome test
Dislocation of shoulder joint
Steps:
-the patient bends the elbow
-puts the hand at the affected side on the shoulder at the opposite side
-touches the elbow against the chest
*Positive: pain appears, unable to complete the movement
Arm drop test
Injury of supraspinous muscle
Steps:
-the patient stands up
-passively abducts the affected limb for 90° and then slowly put it down
*Positive: arm suddenly drops to the side of the body
Pain circle test
Myotenositis
Steps:
-the patient is asked to abduct the affected shoulder
-when it is abducted to 60°-120°, the tendon of
supraspinous muscle will cause friction below the acromion
*Positive: pain appears in the shoulder
• Within the joints
• Outside the joints
• Whole joints swelling
Swelling
• Regional swelling (medial, external condyle of humerus, olecranon)
• Traumatic swelling
• Pathological swelling (suppurative infection)
Inspection
•
Fracture
•
Dislocation
Deformity
Tenderness
• External humeral condyles  extensor muscle group of forearm
(external humeral epicondylitis)
Elbow joint
• Internal humeral condyles  flexor muscle group of forearm (inflammation)
• Olecranons  (fracture orbursitis)
• Humeral joint
Flexion
(140°)
Extension
(0°-10°)
• Ulnar joint
• Upper and lower joints of ulna
Pronation 90°
Rotation of forearm
• Upper and lower joints of radius
Supination 90°
• Interosseous membraneand
Mill test
External humeral epicondylitis, “Tennis elbow”
Steps:
-the patient is asked to slightly bend the forearm, slightly clench
the fist
-flex the wrist joint as much as possible
-completely turn the forearm anteriorly and straighten the elbow
*Positive: pain appears in the lateral side of the humeral and
radial joint
Forearm flexion and extensor tension test
Steps:
-the patient is asked to clench the fist and flex the wrist
-the doctor presses the hand dorsum of the patient with his
hand
-ask the patient to stretch the wrist under the pressure
*Positive: pain appears in the lateral side of the elbow
Steps:
-or the doctor may press the palm of the patient
-ask the patient to flex his wrist under pressure
*Positive: pain appears in the medial side of the elbow
Physiological
•
The hand maintains in natural clenching pose and tension of all antagonistic
muscles is balanced
•
The dorsiflexion of the wrist ia about 15°
•
The thumb touches the index finger and the rest four fingers are in flexion
•
Rapidly clenching and stretching fingers
Oesteonosus and traumatism
Distal fracture of radius
Injury of radial nerve
-Silver fork deformity
-or bayonet shaped deformity
-cause drop of wrist
Distal fracture of ulnar joint
Damage of the median nerve
-protrusion of styloid process of
ulna at the dorsal side
-failure of thumb to oppose to the palm and abduct
-inability of the thumb and index finger to flex and
stretch
-atrophy of major thenar
-monkey paw deformity
Tenovaginitis
-swelling along the tendons
Tenderness
Tenovaginitis of the short/long extensor muscle of great toe
-tenderness at the styloid process of radius
Carpal tunnel syndrome
-tenderness in the central region of wrist crease at the palmar side
-radiating pain and numbness
Normal range of wrist joint movement
•
Dorsal extension (80°-90°)
•
Palmar flexion (60°-70°)
•
Radial deviation (25°-30°)
•
Ulnar deviation (30°-50°)
Fist clenching test
Tenosynonitis of radial styloid
Steps:
-when the affected hand clenches into a fist (thumb maintains
inside while the rest four fingers outside)
-ulnar deviation of the wrist joint
*Positive: pain in the styloid process of radius
Wrist flexion test
Carpal tunnel syndrome
Steps:
-when the wrist joint of the patient is extremely flexed
*Positive: numbness and pain
Frontal
Rear
Swelling of hip joint
Chronic disease of the hip joint
-the anterior superior iliac spine are not at the
same level
-disuse atrophy of gluteal muscle
(dyskinesia)
Severe injury of head femur
-the groin is asymmetrical in order
Lateral
Dislocation of the hip joint
-anterior protrusion of the waist
-posterior protrusion of the buttocks and
flexion of hip
Unilateral congenital dislocation of
the hip joint
-transverse crease at one side is thickened,
deepened and elevated
Tenderness
Inflammation of groin
-pain occurs when pressing the point 2cm below
the middle of inguinal ligament
-local swelling, distension or tenderness
Disorder of hip joint
-pain appears when percussion on the greater
trochanter of femur is performed with the fist
Bursitis
-superficial tenderness in the ateral greater
trochanter of femur
Normal range of hip joint movement
•
Flexion (110-130°)
•
Posterior extension (30°)
•
Abduction (35°-45°)
•
Adduction (20°-30°)
•
Extorsion (45°)
•
Intorsion (40°)
Palm-heel test
Dislocation or fracture of hip joint, paraplegia
Steps:
-the patient lies in supination with the lower limbs extended
-heel put on the palm of the doctor
-the lower limbs appear in a vertically median position
*Positive: heel will appear in extorsion
Heel percussion test
Disorder of hip joint
Steps:
-the patient lies in supination with the lower limbs extended
-the doctor lift the affected limb with one hand and knocks the
heel of the patient with the other
*Positive: pain in the hip joint
Excessive extension of the hip joint
Disorder in hip joint or sacral and iliac joint
Steps:
-the patient lies in pronation with the lower limbs extended
-the doctor presses the posterior part of the sacrum of the patient
-to fixate the pelvis with one hand
-lift the affected shank with the other hand to force the hip joint to extend excessively
*Positive: pelvis will be raised, pain appears in the sacral and iliac joint
Flexion of the hip joint
Disorder in hip joint or sacral and iliac joint
Steps:
-the patient lies in supination with the pelvis in anteversion and excessive
flexion of the hip and knee joint of the healthy side
*Positive: Flexion deformity appears; the angle between the tigh and the
bed is the deformity angle
Swelling and deformity
Extorsion or intorsion deformity
Bone tumor
-exceeding of a mild extorsion about 5°-8° in
the thigh and shank
-swelling of the condyle and epiphysis of the
tibia and femur
Bursitis and hydrarthrosis
Dyscinesia of the knee
-mass and swelling
above synovial bursa
-atrophy of the inner end of the quadriceps
muscle of thigh
Tenderness
Chondromalacia patellae
Hypertrophy of subpatellar fat pad
-pressure will lead to slight shift of the
patella and cause pain
-hard mass can be sensed in both sides of
patellar ligaments
Epiphysitis of tibial tubercle
Injury of meniscus
-hard mass can be palpated and obvious
tenderness appears
-tenderness between the interspace of the
knee joint
Normal range of knees joint movement
•
Flexion (130°) Hamstring muscles
•
Extension (10°) Quadriceps muscle of the thigh
Patella floating test
Retention fluid in the knee joint
Steps:
-the patient lies horizontal position extends the affected limb
-the doctor presses the suprapatellar bursal fluid above the patella into the cavity of
the joint with one hand
-repeatedly press the patella with the thumb of the other hand
*Positive: wave motion in the cavity of the joint indicates retention of fluid
Lateral pressure of the knee joint test
Ligament injured or broken
Steps:
-the patient lies in supination with the affected limb extended
-the quadriceps muscle of thigh relaxed
-perform intorsion and extorsion of the knee joint
*Positive: lateral motion and pain appears
Drawer test
Injury of ligament
Steps:
-the patient lies in supination and flexes the knee about 90° and feet put on bed
horizontally
-the doctors holds the shanks of the patient to push and pull repeatedly
*Positive: lateral motion and pain appears.
Rotation and pinching test of knee joint
Injury of meniscus
Steps:
-the patients lies supination with both limbs extended
-the doctor holds the ankle of the patient with one hand to flex the
knee joint as much as possible
-performing extorsion and of the knee and intorsion of the shank
-gradually extending the knee joint to induce crush and friction in the
interspace of the knee joint
*Positive:
Grounding, lifting and pulling test
Injury of collateral ligament and breaking of meniscus
Steps:
-the patients lies a prone position with the patellar joint extended and the knee flexed to 90°
-the doctor fixates the thigh of the patient and holds the affected foot with both hands
-press the knee joint and rotate the shank
-lift the shank and rotate
*Positive: (pressing) pain suggests injury of meniscus; (lifting) pain indicates injury of collateral
ligament
Signs of deformity
Traumatism injury
•
Drops
•
Swelling
•
Intorsion of foot
•
Distension
•
Extorsion of foot
•
Subcutaneous blood stasis
•
Flat foot
•
Carvus foot
Tenderness
•
Interspace of the joint
•
The end bone
•
The attaching point of tendons
Tenderness
Bursitis of the Achilles tendon
Spur or fat pad
-tenderness in the terminating point of the
arhilles tendon
-tenderness median and posterior to the
calcaneus
Normal range of knees joint movement
•
Dorsal extension (20°-30°)
•
Flexion (40°-50°)
•
Intorsion (30°)
•
Extorsion (20°)
Intorsion and extorsion of foot test
Steps:
-the doctor fixates the shank of the patient with one hand and
-holds the foot of the patient with the other to perform excessive intorsion and extorsion of foot
*Positive:
pain on the same side  fracture of medial or external malleolus
pain at opposite side  injury of collateral ligament
Dorsal flexion of foot test
Deep vein thrombosis
Steps:
-the patients lies supination with both limbs extended
-the doctor use one hand to push the patients foot with
dorsal flexion excessive
*Positive: pain in the calf muscle
Babinski’s sign test
Injury of extrapyramidal bundle
Steps:
-the doctor uses a stick with a blunt point to stroke the
lateral edge of the sole from back to front
*Positive: appears slow dorsal flexion of big toes and mild
extorsion of the rest of toes