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Can we have some cell phone ettiquette, please ?Can we have some cell phone ettiquette, please ?
CLINICAL EXAMCLINICAL EXAM
History TakingHistory Taking Keep the question simpleKeep the question simple Ask one at a timeAsk one at a time Get an answer before proceeding to next oneGet an answer before proceeding to next one Avoid putting words into patients mouthAvoid putting words into patients mouth Give equal value to awkward pointsGive equal value to awkward points
CLINICAL EXAMCLINICAL EXAM
MANDATORY QUESTIONSMANDATORY QUESTIONS
CERVICAL REGIONCERVICAL REGION ? VERTIGO,BLACKOUT,DROP ATTACK? VERTIGO,BLACKOUT,DROP ATTACK H/O URT INFECTION (IN JUNIORS)H/O URT INFECTION (IN JUNIORS) H/O RHTD.ARTHRITIS,STEROIDS,ANTICOAGULANTSH/O RHTD.ARTHRITIS,STEROIDS,ANTICOAGULANTS
CLINICAL EXAMCLINICAL EXAM
THORACIC REGIONTHORACIC REGION ? NEUROLOGICAL SIGNS IN LOWER ? NEUROLOGICAL SIGNS IN LOWER
LIMBSLIMBS
LUMBAR REGIONSLUMBAR REGIONS ? PERINEAL ANAESTHESIA? PERINEAL ANAESTHESIA ? CHANGE IN MICTURITION HABITS? CHANGE IN MICTURITION HABITS ? SPHINCTER TROUBLE? SPHINCTER TROUBLE
CLINICAL EXAM OF NECKCLINICAL EXAM OF NECK
SymptomsSymptoms
Pain-Neck itself / Ref. To shoulder & armsPain-Neck itself / Ref. To shoulder & arms Relation to PostureRelation to Posture StiffnessStiffness
Intermittent / continuousIntermittent / continuous DeformityDeformity
Neck fixed in flexionNeck fixed in flexion
CLINICAL EXAM OF NECKCLINICAL EXAM OF NECKCLINICAL EXAM OF NECKCLINICAL EXAM OF NECK
Numbness, tingling & weaknessNumbness, tingling & weakness Headache-suspect other causesHeadache-suspect other causes ““Tension”- ‘Try to read’ the patientsTension”- ‘Try to read’ the patients Target zone for psychosomatic illnessTarget zone for psychosomatic illness
TWO ARMS = ONE NECKTWO ARMS = ONE NECK (If both arms are affected suspect (If both arms are affected suspect
neck)neck)
CLINICAL EXAM OF NECKCLINICAL EXAM OF NECKCLINICAL EXAM OF NECKCLINICAL EXAM OF NECK
LookLook - Deformity- Deformity FeelFeel - Tender areas in muscles /front- Tender areas in muscles /front
- Cervical rib- Cervical rib MoveMove - Forw.flex / ext / lat.flex / rotation- Forw.flex / ext / lat.flex / rotation PulsesPulses - Radial - at rest – on traction- Radial - at rest – on traction NeuroNeuro - Mandatory in upper limbs- Mandatory in upper limbs X-rayX-ray - AP / Lateral- AP / Lateral
EXAMINATIONEXAMINATION
FLEXION / EXTENSION / ROTATION TILT / TESTING POWER ELBOW & WRIST
READING A LAT.FILM OF C.SPINEREADING A LAT.FILM OF C.SPINE
ALIGNMENT ALIGNMENT BONY INTEGRITYBONY INTEGRITY CARTILAGINOUS SPACESCARTILAGINOUS SPACES SURROUNDING SOFT TISSUESSURROUNDING SOFT TISSUES PRE VERTEBRAL SOFT TISSUE PRE VERTEBRAL SOFT TISSUE
SHADOWSHADOW BLOOD / FLUID / PUS / TUMOR MATERIALBLOOD / FLUID / PUS / TUMOR MATERIAL
ANATOMY OF C - SPINEANATOMY OF C - SPINE
TORTICOLLIS
NATURAL HISTORY
EARLY DEFORMITY
STERNOMASTOID DIVIDED
RESULT AFTER SURGERY
SPASMODIC TORTICOLLIS - NOTE THE MUSCLE IN SPASM
CERVICAL DISC LESIONCERVICAL DISC LESION
STRAIGHTENING OF LORDOSIS / MRI SCAN SHOWS C5/6 DISC
CERVICAL SPONDYLOSISCERVICAL SPONDYLOSIS
DISC DEGENERATION & OSTEOPHYTES
PYOGENIC INFECTIONPYOGENIC INFECTION
DESTRUCTION TAKES 2 TO 3 WEEKS
RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS
BEWARE OF ATLANTO - AXIAL SUBLUXATION
NEURALGIC AMYOTROTHYNEURALGIC AMYOTROTHY
WASTING – WEAKNESS MAY BE PERMANENT
CERVICAL RIB CERVICAL RIB
UNILATERAL / BILATERAL PULSATING LUMP / TEACH SHRUGGING EXCERCISES
MALIGNANT DEPOSITS MALIGNANT DEPOSITS
NOTE THE PAN - COAST TUMOUR
OTHER CAUSES OF NECK & ARM PAINOTHER CAUSES OF NECK & ARM PAIN
CARPAL TUNNEL SYNDROME
SUPRA SPINATUS TENDON LESION
CERVICAL TUMOURS
THORACIC OUTLET SYNDROME
THORACIC SPINETHORACIC SPINE
LOOK LOOK -- DEFORMITIESDEFORMITIES FEELFEEL - - TENDERNESSTENDERNESS NEUROLOGYNEUROLOGY -- TB / PYOGENIC TB / PYOGENIC
/ /
-- METASTASISMETASTASIS TRACKING OF COLD ABSCESSTRACKING OF COLD ABSCESS
CONGENITAL MYELODYSPLASIA
SCHEUERMANN’S THORACIC KYPHOSIS
SCHEUERMANN’S LUMBAR KYPHOSIS
PARALYTIC SCOLIOSIS
OTHER CAUSES OF SCOLIOSIS
CLINICALEVALUATION
ANATOMY OF SPINAL NERVES
NOTE THE RELATIONSHIP OF DISC TO THE ROOTS
YOU STAND ON S1 & SIT ON S3
PRIMARY MUSCLE ACTIONPRIMARY MUSCLE ACTION
HIP FLEXION – PSOAS / ILIACUS = L 2 / 3HIP FLEXION – PSOAS / ILIACUS = L 2 / 3
KNEE EXTEN – VAST INTER = L 3 / 4KNEE EXTEN – VAST INTER = L 3 / 4
ANKLE FLEX – SOLEUS = S 1 / 2ANKLE FLEX – SOLEUS = S 1 / 2
EXCEPTIONEXCEPTION E H L – L 5 ROOTE H L – L 5 ROOT
EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE
PAIN - SCIATICA / PAIN - SCIATICA / COUGH / SNEEZECOUGH / SNEEZE STIFFNESS – DISC / A S / ARTHRITISSTIFFNESS – DISC / A S / ARTHRITIS DEFORMITYDEFORMITY NUMBNESS & / PARAESTHESIANUMBNESS & / PARAESTHESIA ASK ASK WALKING / STANDING / WALKING / STANDING / REST REST ? URETHRAL DISCHARGE/ DIARRHOEA / ? URETHRAL DISCHARGE/ DIARRHOEA /
SORE EYESSORE EYES
EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE
LOOKLOOK – SKIN SCARS / PIGMENTATION – SKIN SCARS / PIGMENTATION
ABNORMAL HAIRS / UNUSUAL SKIN CREASEABNORMAL HAIRS / UNUSUAL SKIN CREASE
SHAPE & POSTURE AFFECTEDSHAPE & POSTURE AFFECTED FEELFEEL – BONYSTRUCTURES / I V TISSUE / PARA – BONYSTRUCTURES / I V TISSUE / PARA
MUSCLESMUSCLES MOVEMOVE – FLEX / EXTD / LAT. BEND / ROTATION – FLEX / EXTD / LAT. BEND / ROTATION
CHEST EXPANSIONCHEST EXPANSION MUSCLE POWERMUSCLE POWER – –
STAND ON TOES STAND ON TOES (PLANTAR FLEXION)(PLANTAR FLEXION)
ROCK BACK ON HEELS ROCK BACK ON HEELS (DORSIFLEXION)(DORSIFLEXION)
EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE
IMAGING – IMAGING – X – RAYSX – RAYS PLEASE PREPARE BOWEL PLEASE PREPARE BOWEL
AP / LATERAL / OBLIQUE & P A VIEW FOR S I Jt.AP / LATERAL / OBLIQUE & P A VIEW FOR S I Jt.
COMPUTED TOMOGRAPHYCOMPUTED TOMOGRAPHY BONE TUMOUR / Sp.CANAL STENOSISBONE TUMOUR / Sp.CANAL STENOSIS
MRI SCANMRI SCAN – FOR SOFT TISSUE – FOR SOFT TISSUE
BEWARE FALSE POSITIVE FINDINGS ( >30%)BEWARE FALSE POSITIVE FINDINGS ( >30%)
EXAMINATION
STANDS WITH A TILT / LTD FORW. FLEX / LAT. FLEX
EXAMINATION
METHOD OF MEASURING EXCURSION
LYING ON HIS BACK
SLRSTRETCH+
HIP & KNEE
EHL
SENSATION
REFLEX
HERNIATED LUMBAR DISC
CHARACTERISTIC POSTURE
L3/4 DISCL4 ROOT
L4/5 DISCL5 ROOT
L5/S1 DISCS1 ROOT
SPINE TUBERCULOSIS
SHOWING PROGRESSIVE DESTRUCTION
SPINE TUBERCULOSIS
PATHOLOGICAL DESTRUCTION & ABSCESS
PYOGENIC SPONDYLITIS
EVIDENCE OF BONE DESTRUCTION + +
MOBILE SCOLIOSIS
POSTURAL FLEXION
SHORTLEG SITTING
PROLAPSED DISC ON TTMT
FIXED SCOLIOSIS
INCREASING CURVE OVER THE YEARS
INFANTILE THORACIC
ADOLESCENT THORACIC
THORACO - LUMBAR
LUMBAR
COMBINED
IDIOPATHIC SCOLIOSIS
TRANSITIONAL LUMBO-SACRAL VERTIBRA
SPODYLOLYSIS & SPONDYLOLISTHESIS
ANKYLOSING SPONDYLITIS
REDUCED CHEST EXPANSION / OSSIFIED LIGAMENTS
DEGENERATIVE OSTEO ARTHRITIS
SPINAL CANAL STENOSIS
CLINICAL FEATURES
MECHANICAL CAUSES OF LOW BACK PAIN
GOOD POSTURE & POOR POSTURE
EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE
EXTENSIVE LAB TESTEXTENSIVE LAB TEST
WHEN CLINICIAN SUSPECTSWHEN CLINICIAN SUSPECTS
MALIGNANCY MALIGNANCY
METABOLIC DISTURBANCEMETABOLIC DISTURBANCE
CHRONIC INFECTIONCHRONIC INFECTION
TUMOURS OF SPINE
OSTEIOD OSTEOMA HEMANGIOMA
BENIGN LESIONS
MYELOMA
SECONDARY TUMOURS
EXTRA DURALFIBROBLASTOMA
EXTRAMEDULLARY MENINGIOMA
INTRA MEDULLARY EPENDYMOMA
CHRONIC BACKACHECHRONIC BACKACHE
TB OM DISCITIS
SI Jt. TB OST. CONDENS. ILII
PSYCHOSOMATIC MANIFESTATION
“ From the unreal lead me to the real ! From darkness lead me to light ! From death lead me to immortality ! Brihad – aranyaka Upanishad
Thank YouThank You
© Dept. of © Dept. of OrthopaedicsOrthopaedics,,Govt. Medical College, Govt. Medical College, ThrissurThrissur