View
249
Download
0
Category
Tags:
Preview:
Citation preview
Musculoskeletal Musculoskeletal ExaminationExamination
Todd Milbrandt, MD, MSTodd Milbrandt, MD, MS
Pediatric Orthopaedic SurgeonPediatric Orthopaedic Surgeon
Musculoskeletal ExamMusculoskeletal Exam
There are so many moving parts-how am I going to remember them all?
Musculoskeletal ExamMusculoskeletal Exam
I was once a first I was once a first year medical year medical student, too.student, too.
That may have That may have been a long time been a long time ago….butago….but
Consider yourself Consider yourself lucky.lucky.
Musculoskeletal ExamMusculoskeletal Exam
We never had We never had standardized standardized patients.patients.
MSK information MSK information was a big black was a big black box. box.
No one taught it No one taught it because no-one because no-one felt comfortable felt comfortable doing it.doing it.
Musculoskeletal ExamMusculoskeletal Exam
The best part The best part about the MSK about the MSK examination is examination is that you really that you really can touch all the can touch all the parts.parts.
And you have a And you have a “normal” to “normal” to compare it too compare it too (the other side).(the other side).
Musculoskeletal ExamMusculoskeletal Exam
We will divide the We will divide the examination into examination into regions:regions:
Spine, Upper Spine, Upper Extremity and Lower Extremity and Lower Extremity.Extremity.
We will progress We will progress through inspection, through inspection, palpation, range of palpation, range of motion, stability motion, stability testing, and finally testing, and finally “special” tests “special” tests
Musculoskeletal ExamMusculoskeletal Exam
Remember Anatomy?Remember Anatomy? This is where you This is where you
need it. need it. I have a list of I have a list of
students and I am not students and I am not afraid to use it!!afraid to use it!!
Ward learning=Active Ward learning=Active engagement of engagement of participants!participants!
Functional AnatomyFunctional Anatomy
Name the bones Name the bones of the upper of the upper extremityextremity
Functional AnatomyFunctional Anatomy
Name bones Name bones within the axial within the axial skeleton and skeleton and pelvispelvis
Functional AnatomyFunctional Anatomy
Name bones Name bones within the lower within the lower extremityextremity
SpineSpine
InspectionInspection– Shoulder Shoulder
asymmetryasymmetry– Prominent Prominent
scapulascapula– Hairy Hairy
patchespatches– Dimples Dimples
Spine examinationSpine examination
InspectionInspection– KyphosisKyphosis– LordosisLordosis
PalpationPalpation– Spinous Spinous
processesprocesses– Paravertebral Paravertebral
musclesmuscles– Percussion of Percussion of
spine (??)spine (??)
Spine examinationSpine examination
PalpationPalpation– Spinous Spinous
processesprocesses– Paravertebral Paravertebral
musclesmuscles– Percussion of Percussion of
spine (??)spine (??)
Spine examination-Spine examination-Range of MotionRange of Motion ModesModes
– Passive (all Passive (all planes) planes)
– Active (all Active (all planes)planes)
Anatomical Anatomical areasareas– Cervical, Cervical,
thoracic, thoracic, lumbarlumbar
Spine examination-Spine examination-Range of MotionRange of Motion Cervical Cervical
– FlexionFlexion– ExtensionExtension– RotationRotation– Side bendSide bend
Spine examination-Spine examination-Range of MotionRange of Motion ThoracicThoracic
– FlexionFlexion– ExtensionExtension– RotationRotation– Side bendSide bend
Spine examination-Spine examination-Range of MotionRange of Motion ThoracicThoracic
– FlexionFlexion– ExtensionExtension– RotationRotation– Side bendSide bend
Spine examination-Spine examination-Special testsSpecial tests Axial Axial
compressioncompression It called the It called the
Lhermites testLhermites test Don’t do if Don’t do if
suspect C-suspect C-spine injury!spine injury!
Spine examination-Spine examination-Special testsSpecial tests Axial Axial
compression compression with head with head tiltedtilted
Spurling’s Spurling’s maneuvermaneuver
Don’t do if Don’t do if suspect C-suspect C-spine injuryspine injury
Spine examination-Spine examination-Special examSpecial exam Adam’s Adam’s
forward bend forward bend testtest
Shoulder-Cartoon Shoulder-Cartoon AnatomyAnatomy
The Shoulder- X-ray The Shoulder- X-ray AnatomyAnatomy
Shoulder-InspectionShoulder-Inspection
Name those areas Name those areas when inspectingwhen inspecting
DeltoidDeltoid AcromionAcromion ClavicleClavicle AC jointAC joint Spine of the Spine of the
scapluascaplua
Shoulder-InspectionShoulder-Inspection
Name those Name those areas when areas when inspectinginspecting
DeltoidDeltoid AcromionAcromion ClavicleClavicle AC jointAC joint Look for Look for
muscle muscle wastingwasting
Shoulder: PalpationShoulder: Palpation
Acromioclaviular Joint
Shoulder: PalpationShoulder: Palpation
Acromion
Shoulder: PalpationShoulder: Palpation
Shoulder-Range of Shoulder-Range of MotionMotion Must do both Active Must do both Active
and Passive!!!and Passive!!! Must do each side Must do each side
separateseparate Flexion and Flexion and
ExtensionExtension Internal and Internal and
External rotationExternal rotation AbductionAbduction AdductionAdduction
Shoulder-Range of Shoulder-Range of MotionMotion Must do both Active Must do both Active
and Passive!!!and Passive!!! Must do each side Must do each side
separateseparate Flexion and Flexion and
ExtensionExtension Internal and Internal and
External rotationExternal rotation AbductionAbduction AdductionAdduction
Shoulder-Range of Shoulder-Range of MotionMotion Must do both Active Must do both Active
and Passive!!!and Passive!!! Must do each side Must do each side
separateseparate Flexion and Flexion and
ExtensionExtension Internal and Internal and
External rotationExternal rotation AbductionAbduction AdductionAdduction
Shoulder-Range of Shoulder-Range of MotionMotion Must do both Active Must do both Active
and Passive!!!and Passive!!! Must do each side Must do each side
separateseparate Flexion and Flexion and
ExtensionExtension Internal and Internal and
External rotationExternal rotation AbductionAbduction AdductionAdduction
Shoulder-Stability Shoulder-Stability TestingTesting Sulcus signSulcus sign Apprehension Apprehension
SignSign
Shoulder-Stability Shoulder-Stability testingtesting Sulcus signSulcus sign ApprehensioApprehensio
n signn sign
Elbow-Cartoon Elbow-Cartoon AnatomyAnatomy
Elbow-X-ray AnatomyElbow-X-ray Anatomy
Elbow-InspectionElbow-Inspection
Elbow-InspectionElbow-Inspection
Elbows: PalpationElbows: Palpation
Lateral epichondyle Medial epichondyle
Elbows: PalpationElbows: Palpation
Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and
ExtensionExtension Pronation and Pronation and
SupinationSupination
Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and
ExtensionExtension Pronation and Pronation and
SupinationSupination
Pronation
Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and
ExtensionExtension Pronation and Pronation and
SupinationSupination
Pronation
Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and
ExtensionExtension Pronation and Pronation and
SupinationSupination
Supination
Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and
ExtensionExtension Pronation and Pronation and
SupinationSupination
Supination
Elbow: Stability Elbow: Stability testingtesting Varus Varus ValgusValgus
Elbow: Stability Elbow: Stability testingtesting Varus Varus ValgusValgus
Wrists-Cartoon Wrists-Cartoon AnatomyAnatomy
Wrists-Cartoon Wrists-Cartoon AnatomyAnatomy
Wrists-Xray AnatomyWrists-Xray Anatomy
Wrist-PalpationWrist-Palpation
Distal radus and Distal radus and radial styloidradial styloid
Distal ulna and Distal ulna and ulnar styloidulnar styloid
Wrist-PalpationWrist-Palpation
Anatomical Anatomical “Snuffbox”“Snuffbox”
Wrist: Range of MotionWrist: Range of Motion
FlexionFlexion ExtensionExtension
Wrist: Range of MotionWrist: Range of Motion
Flexion Flexion ExtensionExtension
Wrist: Range of MotionWrist: Range of Motion
Radial-Radial-deviationdeviation
Ulnar Ulnar deviationdeviation
Wrist: Range of MotionWrist: Range of Motion
Radial-Radial-deviationdeviation
Ulnar Ulnar deviationdeviation
Wrist: Special TestWrist: Special Test
Tinel’s SignTinel’s Sign– This is a This is a
tapping over tapping over any area any area over any over any nerve.nerve.
– Most Most commonly commonly associated associated with wristwith wrist
Phalen’s signPhalen’s sign
Wrist: Special TestWrist: Special Test
Tinel’s SignTinel’s Sign Phalen’s signPhalen’s sign
– Hold wrists for Hold wrists for 30-60 seconds30-60 seconds
– What nerve are What nerve are we we compressing?compressing?
– What area will What area will become numb?become numb?
Hands-Carton AnatomyHands-Carton Anatomy
Profundus or superficialis?
Hands: InspectionHands: Inspection
Hands: InspectionHands: Inspection
Hands: PalpationHands: Palpation
Metacarpal Metacarpal Phalangeal Phalangeal joints (MCP joints (MCP joints)joints)
Proximal Proximal InterphalangeInterphalangeal Joints (PIP)al Joints (PIP)
Distal Distal InterphalangeInterphalangeal Joints (DIP)al Joints (DIP)
Hands: PalpationHands: Palpation
Metacarpal Metacarpal Phalangeal Phalangeal joints (MCP joints (MCP joints)joints)
Proximal Proximal InterphalangeInterphalangeal Joints (PIP)al Joints (PIP)
Distal Distal InterphalangeInterphalangeal Joints (DIP)al Joints (DIP)
Hand and Finger: Hand and Finger: Range of MotionRange of Motion
FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb
oppositionopposition
Hand and Finger: Hand and Finger: Range of MotionRange of Motion
FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb
oppositionopposition
Hand and Finger: Hand and Finger: Range of MotionRange of Motion
FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb
oppositionopposition
Hand and Finger: Hand and Finger: Range of MotionRange of Motion
FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb
oppositionopposition
Hand and Finger: Hand and Finger: Range of MotionRange of Motion
FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb
oppositionopposition
Hip-Cartoon anatomyHip-Cartoon anatomy
Hip: X-ray anatomyHip: X-ray anatomy
Hip: Gait patternHip: Gait pattern
Hip:Surface Hip:Surface AnatomyAnatomy
Hip:Hip:PalpatioPalpationn
Hip: Range of MotionHip: Range of Motion
FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction
Hip: Range of MotionHip: Range of Motion
FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction
Hip: Range of MotionHip: Range of Motion
FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction
Hip: Range of MotionHip: Range of Motion
FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction
Hip: Range of MotionHip: Range of Motion
FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction
One hand should be on leg and the other on the iliac crest
Hip: Stability Hip: Stability examinationexamination
Barlow testBarlow test Ortolani testOrtolani test
Hip: Stability Hip: Stability examinationexamination
Barlow testBarlow test Ortolani testOrtolani test
You cannot dislocate a normal child’s hip!!!!
Knees: Cartoon Knees: Cartoon anatomyanatomy
Knees: X-ray anatomyKnees: X-ray anatomy
Knees: X-ray Knees: X-ray anatomyanatomy
Knees: X-ray Knees: X-ray anatomyanatomy
Knees: Surface anatomy Knees: Surface anatomy and inspectionand inspection
Knees: Surface anatomy Knees: Surface anatomy and inspectionand inspection
Varus Valgus
Knees: PalpationKnees: Palpation
PatellaPatella Patella tendonPatella tendon Quad tendonQuad tendon Tibial TubercleTibial Tubercle
Knees: PalpationKnees: Palpation
PatellaPatella Patella tendonPatella tendon Quad tendonQuad tendon Tibial TubercleTibial Tubercle
Knees: PalpationKnees: Palpation
PatellaPatella Patella tendonPatella tendon Quad tendonQuad tendon Tibial TubercleTibial Tubercle
Knees: PalpationKnees: Palpation
PatellaPatella Patella tendonPatella tendon Quad tendonQuad tendon Tibial TubercleTibial Tubercle
Knees: PalpationKnees: Palpation
Medial joint lineMedial joint line Lateral joint lineLateral joint line
Knees: PalpationKnees: Palpation
Medial joint lineMedial joint line Lateral joint lineLateral joint line
Knees: Range of Knees: Range of MotionMotion
Flexion Flexion ExtensionExtension
Knees: Range of Knees: Range of MotionMotion
Flexion Flexion ExtensionExtension
Knees: Stability Knees: Stability Examination Examination
Varus Varus ValgusValgus
Knees: Stability Knees: Stability Examination Examination
Varus Varus ValgusValgus
Knees: Stability Knees: Stability Examination Examination
Anterior drawer Anterior drawer (at 90 degrees (at 90 degrees flexion)flexion)– Lachman’s Lachman’s
maneuvermaneuver Posterior drawerPosterior drawer
Knees: Stability Knees: Stability Examination Examination
Anterior drawer Anterior drawer (at 90 degrees (at 90 degrees flexion)flexion)– Lachman’s Lachman’s
maneuver (at 30 maneuver (at 30 degrees of degrees of flexion)flexion)
Posterior drawerPosterior drawer
Knees: Stability Knees: Stability Examination Examination
Anterior drawer Anterior drawer (at 90 degrees (at 90 degrees flexion)flexion)– Lachman’s Lachman’s
maneuver (at 30 maneuver (at 30 degrees of degrees of flexion)flexion)
Posterior drawerPosterior drawer
Knees: Special Tests Knees: Special Tests
Bulge sign or Bulge sign or Balloon signBalloon sign
Knees: Special Tests Knees: Special Tests
McMurray’s test-McMurray’s test-medialmedial– While Palpating While Palpating
medial joint line, medial joint line, axially load and axially load and externally rotate externally rotate the footthe foot
– This “loads” the This “loads” the medial meniscusmedial meniscus
Knees: Special Tests Knees: Special Tests
McMurray’s test-McMurray’s test-LateralLateral– While Palpating While Palpating
lateral joint line, lateral joint line, axially load and axially load and internally rotate internally rotate the footthe foot
– This “loads” the This “loads” the lateral meniscuslateral meniscus
Ankles and Feet: Ankles and Feet: Cartoon AnatomyCartoon Anatomy
Ankles and Feet: X-ray Ankles and Feet: X-ray AnatomyAnatomy
Ankles: palpation of Ankles: palpation of ankleankle
Palpate:Palpate: Anterior aspect Anterior aspect
of jointof joint Achilles tendonAchilles tendon Medial and Medial and
lateral malleolilateral malleoli
Ankles: palpation of Ankles: palpation of ankleankle
Palpate:Palpate: Anterior aspect Anterior aspect
of jointof joint Achilles tendonAchilles tendon Medial and Medial and
lateral malleolilateral malleoli
Ankles: palpation of Ankles: palpation of ankleankle
Palpate:Palpate: Anterior aspect Anterior aspect
of jointof joint Achilles tendonAchilles tendon Medial and Medial and
lateral malleolilateral malleoli
Ankles: palpation of Ankles: palpation of ankleankle
Palpate:Palpate: Plantar FasciaPlantar Fascia Anterior Talo-Anterior Talo-
Fibular LigamentFibular Ligament
Ankles: palpation of Ankles: palpation of ankleankle
Palpate:Palpate: Plantar FasciaPlantar Fascia Anterior Talo-Anterior Talo-
Fibular LigamentFibular Ligament
Foot: palpationFoot: palpation
Palpate:Palpate: Metatarsal headsMetatarsal heads
Foot and Ankle: Range Foot and Ankle: Range of Motionof Motion
FlexionFlexion ExtensionExtension InversionInversion EversionEversion
Foot and Ankle: Range Foot and Ankle: Range of Motionof Motion
FlexionFlexion ExtensionExtension InversionInversion EversionEversion
Whew!!!! You made Whew!!!! You made it!!!it!!! Thanks for listeningThanks for listening Watch the videos on the knee Watch the videos on the knee
exam and shoulder examinationexam and shoulder examination
My contact infoMy contact info
Phone 859 266 2101Phone 859 266 2101
Email: tmilbrandt@shrinenet.orgEmail: tmilbrandt@shrinenet.org
Recommended