general musculoskeletal exam
motion, tone, and strength
Rotational limb profiles for torsional deformities
gait lab analysis
plantigrade feet
stiff knee gait
spine exam
presence and flexibility of scoliosis
spinal balance and shoulder height
pelvic obliquity
resting head posture
hamstring contractures (lead to decreased lumbar lordosis)
hip contractures
flexion contracture (lead to excessive lumbar lordosis)
adduction contracture
hip instability and dislocations are common, may be looked over as a contracture alone
observe thigh length in sitting, leg length when supine, or galleazzi test
adductor contracture can make examination difficult
foot and ankle
equinovarus and planovalgus deformities common
observe wear patterns, callouses
note hypertonicity
toe walking or absent heel strike during gait secondary to gastrosoleus spasticity and contracture
may hyperextend knee to obtain heel contact
provacative Silverskiold test to differentiate gastrocnemius contracture vs achilles contracture