DOCSLIB.ORG

Examination of the Knee

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

5/25/2016 George J. Davies, DPT, MED, PT, SCS, ATC, LAT, CSCS, NASM-PES, NASM-CES, ACSM-CET, APTA-CCI, SMAC, (REMT), FAPTA Thank You Professor of Physical Therapy, AASU, Savannah, GA. (2004- ) z Thanks to RUSH 2016 SPORTS Professor Emeritus UW-LaCrosse, WI. (1975-2004) Consultant, Clinician, Co-Director Clinical and Research Services– MEDICINE SYMPOSIUM for the Sports PT Residency Program , GLSM, La Crosse, WI. (1995-present) kind invitation to present at this Sports PT, Coastal Therapy, Savannah, GA. (2004- present) course Past President Sports Physical Therapy Section – APTA (1992-1998) JOSPT - Co-Founder & Co-Editor, 1979 JOSPT - GJD-JAG Excellence in Clinical Research Award, 2004 Fellow, APTA, 2005, Hall of Fame Award, SPTS-APTA, 2006 NATA, President’s Award, 2007, NATA, Most Distinguished Athletic Trainer, 2009 z It is indeed an honor and privilege Sports Health - Co-Founder & Co-Editor, 2009 to be invited to participate and AOSSM – Hall of Fame Award, 2013 share information. Disclosures: Disclosures: The following companies have Disclosures: provided research equipment support to Biodynamics & Human Associate Editor, Performance CenterCenter--AASU:AASU: ArthrometricsArthrometrics,, Atlanta, GA. Sports Health Editor Biodex, Shirley, N.Y. PUBMED CDM Sport/Monitored Rehab Elsevier-Book Royalties Systems, Fort Worth , TX. INDEX MEDICUS Human KineticsKinetics--BookBook Royalties ElsevierElsevier-- DS2 Rehab Systems, Missouri City, 2015 Williams & Wilkins-Wilkins-BookBook Royalties Book Royalties TX North American SeminarsSeminars--DVDDVD ERMI, Atlanta, GA. Royalties ExerToolsExerTools,, Petaluma, CA. Innovative Sports Inc, Chicago, IL. Conflicts TheraBandTheraBand,, Hygenic Corporation, No Conflicts Akron, OH. No Conflicts 2015 Disclosures: Casual interest in the “Gladly accept knee money from Examination anyone for for the last Institutional 51 years since I Research of the Support….” started as a student Knee athletic trainer in 1965 !!! No Conflicts 1 5/25/2016 Examination of the Knee Examination of z This is an article that we published the Knee: 38 years ago in the Physician and SportsMedicine that was used for CME’ s for physicians. How do we do z At that time it was ““statestate of the artart”,”, and it’s interesting how much it? of that that art has stayed the same, with of course, some changes! P & SM, 1978 Subjective Examination Knee Subjective, and History of the Knee Mechanism of Injury Complex Objective & Functional Examination Subjective Exam Subjective Differential Diagnosis Components Exam Components z Diagnostic tests & Imaging Studies z Demographic information z Lab tests z Location of symptoms z DiDominan t arm z Medical systems review: questionnaire Systems review z MOI and interview (Differential DX.) and differential z History: present & past z Meds z Previous treatments z Behavior of symptoms: rest, ADL’s, diagnosis work, sports, AM/PM z Previous functional status z Patient’s goals 2 5/25/2016 Functional Testing Algorithm – Functional Testing Algorithm FTA Specific Guidelines Knee -2016 kSports Specific Tests z LEFT ––MM--1:30;1:30; FF--2:002:00 minutes z Sport Specific Testing Competitive kLower Extremity Functional Tests z HOP - < 10%Ht.; < 10% bilat.bilat. Comp.; z Lower Extremity Functional Norms/various hops Athletes kFunctional Hop Tests Tests z JUMP - < 15%/Ht.; Norms z Functional Hop Tests kFunctional Jump Tests z OKC Isokinetics - < 25% bilateral z Functional Jump Tests Recreational kOKC Isokinetic Tests comparison/other criteria z OKC Isokinetic testing Athletes kCKC Isokinetic Tests z CKC Isokinetics - < 30% bilateral comparison z CKC Isokinetic Testing kKinesthetic/Balance Tests z Sensorimotor System Testing: General z Kinesthetic/Balance Testing – Bilat Balance/Proprioceptive Orthopaedic kKT 1000 Tests comp Testing Patients kSpecial Tests – ONLY 175 + 1 z KT 1000 - < 3 mm bilateral comparison z KT 1000/2000 kBasic Measurements z Basic Measurements - < 10% bilateral z Basic Measurements comparison Basic Measurements Basic Measurements zTime/soft tissue healing z MD Clearance & Approval zVAS (0(0--1010 scale) z Time/soft tissue healing zAnthropometric z VAS (0(0--1010 scale) measurements z Anthropometric measurements zAROM, PROM z AROM, PROM z Special Tests zSpecial Tests z Qualitative & Quantitative zQualitative & Quantitative Movement Assessment Movement Assessment z Knee Rating scales: IKDC, etc. zKnee Rating scales: IKDC, etc. Functional Testing Algorithm ACL Quad Tendon Dark Quad We still have not Tendon PrePre-- Graft Healing answered this Question? TIME: Op Soft tissue healing from zBiologics and “mother nature” the inj ury or anddth the: from a zNeoangiogenesis zMaturation post-surgical condition Time Zero 1 month PO 6 months PO zLigamentization 3 5/25/2016 Functional Testing Algorithm Clinical Decision Making Clinical Decision Making TIME: Soft tissue healing We need similar types of outcomes regarding the biology of healing We can’t hurry “mother nature”; Although we are trying with all the biologics!!! Clinical Decision Making Clinical Decision Making Basic Measurements zPerhaps wait for 3-6 z Hamstrings more months to allow Time/soft the biologics to “do their job”…. tissue BTB healing ACL Quad Tendon Dark Quad Clinical Decision Making Tendon PrePre-- Graft Healing Op Then we return him back to sports Time Zero 1 month PO 6 months PO 1 year PO 4 5/25/2016 Physical Examination/ Physical Examination of the Physical Tests & Measurements Knee z Observation/ z Physiological PROM posture z Gait Evaluation z Accessory/Jt. Play 1) Most physical exam tests should PROM Q & Q Movement be referenced back to the original ((ObjectiveObjective)) z KT 1000 Assessment z Flexibility Tests description z Referral/related joints z RROM (MMT/HHD) z 2) Sensitivity z Neurological Exam z Special Tests EitiExamination z Computerized z Sensation, reflexes z 3) Specificity isokinetic testing z Kinesthetic/ proprioceptive z Functional Testing z 4) Likelihood ratios z Imaging Studies Balance z 5) PPV of the Knee z Lab Studies Neural TT z Palpation z 6) NPV z AROM Functional Testing Algorithm – Functional Testing Algorithm – Functional Testing Algorithm – Knee -2016 Knee Knee z Progression to the next higher level of z Sport Specific Testing Competitive zObjective, quantitative (and z Lower Extremity Functional Athletes qualitative), systematic testing difficulty is predicated upon Tests passing the prior test in the series… z Functional Hop Tests testing and rehabilitation z Functional Jump Tests Recreational method to safely and rapidly z Each successive test and its associated z OKC Isokinetic testing Athletes progress a patient from training regimen places increasing z CKC Isokinetic Testing stress on the patient while at the same General immediate post injury/post-injury/post- z Sensorimotor System Testing: time decreasing clinical control Balance/Proprioceptive Orthopaedic op to return to full functional Testing Patients z KT 1000/2000 activities and return to play in z So how does it really work? z Basic Measurements sports DC to Focused Within NOT Sports Functional Testing Algorithm – 30%30%--YESYES Within RehabRehab-- CKC 30% NOT Focused Knee Exercises Within Within Specificity 10%10%--YESYES CKC Power Norms Rehab zWe can rehabilitate patients Testing Specificity NOT Focused Testing faster than ever because by Within Within Focused RehabRehab-- NOT 10%10%--YESYES 10% Within RehabRehab-- testing themthem, we always know Balance Within NormsNorms-- Functional YES Norms Jump/Jump/HopHop whthtitiithhere the patient is in the SensoriSensori-- Exercises motor Functional rehab program and can focus testing Testing NOT Within the interventions specifically on Within Focused NOT Focused 10%10%--YESYES Rehab Within 25%25%-- Within 10% YES RehabRehab-- the patient’s particular 25% OKC Basic Exercises condition and status MeasureMeasure-- OKC ments Testing 5 5/25/2016 Physical Examination/ Tests & Measurements KT 1000 Tests z Observation/ posture z Physiological PROM Gait Evaluation z Accessory/Jt. Play PROM Q & Q Movement Assessment z KT 1000 Observation z Flexibility Tests z Referral/related joints z RROM (MMT/HHD) z Neurological Exam z Special Tests z Sensation, reflexes z Computerized & Posture isokinetic testing z Kinesthetic/ proprioceptive z Functional Testing Balance z Imaging Studies Neural TT z Lab Studies z Palpation z AROM Gait Evaluation Q & Q Movement AtAssessment Qualitative Movement Analysis of the Entire Kinematic Chain in all Planes of Motion Regional Interdependency Basic Measurements Performance Tests z Qualitative & Quantitative Single Leg Step TOTAL BODY INTERDEPENDENCY Movement Assessment: Down Analysis If movement is one integrated z Step Down Tests: pattern, regardless of its complexity, then we must evaluate and treat z The TOTAL PATIENT 6 5/25/2016 Axial Spinal “Clearing” Appendicular Peripheral Joint “Clearing” Tests Tests • Lumbar Spine Hip • AROM • PROM – End ROM • MMT – Mid ROM Proximal Tib-Fib Joint • Special Tests Ankle • SI Joint Foot Neurological Exam-Exam-SensorimotorSensorimotor System Testing Knee Kinesthetic Testing •Balance •Sensation – dermatomes etc. •Balance •Reflexes •Angular Joint Replication •Neurodynamic testing •End ROM Reproduction •MMT •Threshold to Sensation of •Kinesthesia/Proprioception Movement Biodex Clinical Balance It has been my clinical Biomechanics Stabilometer 17:55117:551--554,554, observation (performance 2002 motion assessment) that after a LE injury, individuals do not bear weight equally during double-double-legleg exercises, especially on
Recommended publications
  • Effusion =S Fluid in Pleural Space (Outside of Lung) Fremitus - Pathophysiology • Fremitus: – Increased W/Consolidation (E.G

    Effusion =S Fluid in Pleural Space (Outside of Lung) Fremitus - Pathophysiology • Fremitus: – Increased W/Consolidation (E.G

    General Part Head and Neck Cardiovascular Abdomen Lung Muscles Lung Exam • Includes Vital Signs & Cardiac Exam • 4 Elements (cardiac & abdominal too) – Observation – Palpation – Percussion – Auscultation Pulmonary Review of Systems • All organ systems have an ROS • Questions to uncover problems in area • Need to know right questions & what the responses might mean! Exposure Is Key – You Cant Examine What You Can’t See! Anatomy Of The Spine Cervical: 7 Vertebrae Thoracic: 12 Vertebrae Lumbar: 5 Vertebrae Sacrum: 5 Fused Vertebrae Note gentle curve ea segment Hammer & Nails icon indicates A Slide Describing Skills You Should Perform In Lab Spine Exam As Relates to the Thorax • W/patient standing, observe: – shape of spine. – Stand behind patient, bend @ waist – w/Scoliosis (curvature) one shoulder appears “higher” Pathologic Changes In Shape Of Spine – Can Affect Lung Function Scoliosis (curved to one side) Thoracic Kyphosis (bent forward) Observation • ? Ambulates w/out breathing difficulty? • Readily audible noises (e.g. wheezing)? • Appearance →? sitting up, leaning forward, inability to speak, pursed lips → significant compromise • ? Use of accessory muscles of neck (sternocleidomastoids, scalenes), inter-costals → significant compromise / Make Note of Chest Shape: Changes Can Give Insight into underlying Pathology Barrel Chested (hyperinflation secondary to emphysema) Examine Nails/Fingers: Sometimes Provides Clues to Pulmonary Disorders Cyanosis Nicotine Staining Clubbing Assorted other hand and arm abnormalities: Shape, color, deformity
  • Netter's Musculoskeletal Flash Cards, 1E

    Netter's Musculoskeletal Flash Cards, 1E

    Netter’s Musculoskeletal Flash Cards Jennifer Hart, PA-C, ATC Mark D. Miller, MD University of Virginia This page intentionally left blank Preface In a world dominated by electronics and gadgetry, learning from fl ash cards remains a reassuringly “tried and true” method of building knowledge. They taught us subtraction and multiplication tables when we were young, and here we use them to navigate the basics of musculoskeletal medicine. Netter illustrations are supplemented with clinical, radiographic, and arthroscopic images to review the most common musculoskeletal diseases. These cards provide the user with a steadfast tool for the very best kind of learning—that which is self directed. “Learning is not attained by chance, it must be sought for with ardor and attended to with diligence.” —Abigail Adams (1744–1818) “It’s that moment of dawning comprehension I live for!” —Calvin (Calvin and Hobbes) Jennifer Hart, PA-C, ATC Mark D. Miller, MD Netter’s Musculoskeletal Flash Cards 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 NETTER’S MUSCULOSKELETAL FLASH CARDS ISBN: 978-1-4160-4630-1 Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this book may be produced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from the publishers. Permissions for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing Department in Philadelphia PA, USA: phone 1-800-523-1649, ext. 3276 or (215) 239-3276; or e-mail [email protected].
  • Carpal-Instability-Slide-Summary.Pdf

    Carpal-Instability-Slide-Summary.Pdf

    Carpal Instabilities Definition by IFSSH Orthopaedic Hand Conference Wrist is unstable only if it exhibits • symptomatic dysfunction Bernard F. Hearon, M.D. inability to bear loads Clinical Assistant Professor, Department of Surgery • University of Kansas School of Medicine - Wichita May 7, 2019 • abnormal carpal kinematics Garcia-Elias, JHS 1999 Carpal Instability Mayo Classification CID - Dissociative Wright, JHS (Br) 1994 Instability within carpal row usually due to intrinsic ligament injury • Carpal Instability Dissociative (CID) • Carpal Instability Non-Dissociative (CIND) • Scapholunate dissociation • Carpal Instability Adaptive (CIA) • Lunotriquetral dissociation • Carpal Instability Complex (CIC) • Scaphoid fracture Carpal Instability Carpal Instability CIND - Nondissociative Instability between carpal rows due CIA - Adaptive to extrinsic ligament injury Extra-carpal derangement causing carpal malalignment • CIND - Volar Intercalated Segment Instability (VISI) Midcarpal instability caused by malunited • CIND - Dorsal Intercalated fractures of the distal radius Segment Instability (DISI) Taleisnik, JHS 1984 • Combined CIND Carpal Instability Carpal Instability CIC - Complex Instability patterns with qualities of both CID and CIND patterns • Dorsal perilunate dislocations (lesser arc) Perilunate • Dorsal perilunate fracture-dislocations (greater arc injuries) Instability • Volar perilunate dislocations • Axial dislocations, fracture-dislocations Carpal Instability Carpal Instability Perilunate Dislocations Mayfield Classification Progressive
  • Cervical Spine Injuries

    Cervical Spine Injuries

    Essential Sports Medicine Essential Sports Medicine Joseph E. Herrera Editor Department of Rehabilitation Medicine, Interventional Spine and Sports, Mount Sinai Medical Center New York, NY Grant Cooper Editor New York Presbyterian Hospital New York, NY Editors Joseph E. Herrera Grant Cooper Department of Rehabilitation Medicine New York Presbyterian Hospital Interventional Spine & Sports New York, NY Mount Sinai Medical Center New York, NY Series Editors Grant Cooper Joseph E. Herrera New York Presbyterian Hospital Department of Rehabilitation Medicine New York, NY Interventional Spine and Sports Mount Sinai Medical Center New York, NY ISBN: 978-1-58829-985-7 e-ISBN: 978-1-59745-414-8 DOI: 10.1007/978-1-59745-414-8 Library of Congress Control Number © 2008 Humana Press, a part of Springer Science + Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, 999 Riverview Drive, Suite 208, Totowa, NJ 07512 USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.
  • Disorders of the Knee

    Disorders of the Knee

    DisordersDisorders ofof thethe KneeKnee PainPain Swelling,Swelling, effusioneffusion oror hemarthrosishemarthrosis LimitedLimited jointjoint motionmotion Screw home mechanism – pain, stiffness, fluid, muscular weakness, locking InstabilityInstability – giving way, laxity DeformityDeformity References: 1. Canale ST. Campbell’s operative orthopaedics. 10th edition 2003 Mosby, Inc. 2. Netter FH. The Netter collection of Medical illustrations – musculoskeletal system, Part I & II. 1997 Novartis Pharmaceuticals Corporation. 3. Magee DJ. Orthopedic Physical assessment. 2nd edition 1992 W. B. Saunders Company. 4. Hoppenfeld S. Physical examination of the spine and extremities. 1976 Appleton-century-crofts. AnteriorAnterior CruciateCruciate LigamentLigament Tibial insertion – broad, irregular, diamond-shaped area located directly in front of the intercondylar eminence Femoral attachment Femoral attachment Figure 43-24 In addition to their – semicircular area on the posteromedial synergistic functions, cruciate aspect of the lateral condyle and collateral ligaments exercise 33 mm in length basic antagonistic function 11 mm in diameter during rotation. A, In external Anteromedial bundle — tight in flexion rotation it is collateral ligaments that tighten and inhibit excessive Posterolateral bundle — tight in extension rotation by becoming crossed in 90% type I collagen space. B, In neutral rotation none 10% type III collagen of the four ligaments is under unusual tension. C, In internal Middle geniculate artery rotation collateral ligaments Fat
  • Meniscus Injury

    Meniscus Injury

    Introduction Role of menisci • Medial meniscus lesions are more common than 01 lateral meniscus because it is attached to the improving articular capsule that make it less mobile thus it cannot congruency and increasing easily to accommodate the abnormal stresses. the stability of the knee • In increasing age – gradual degeneration and change in the material properties of the menisci Meniscus controlling the complex thus splits and tears are more likely that usually associated with osteoarthritic articular damage or rolling and gliding actions of chondrocalcinosis. Injury the joint • In younger people - meniscal tears are usually the result of trauma, with a specific injury identified in distributing load during the history. movement Tear of Meniscus Pathology Pathology • Usually, meniscus more likely to tear along its Vertical tear Horizontal tear length than across its width because the Bucket-handle tear usually ‘degenerative’ or due to repetitive minor trauma meniscus consists mainly of circumferential the separated fragment remains attached front complex with the tear pattern lying in many collagen fibres held by a few radial strands. and back planes The torn portion can sometimes displace towards may be displaced or likely to displace • The meniscus is usually torn by a twisting the centre of the joint and becomes jammed If the loose piece of meniscus can be displaced, it between femur and tibia acts as a mechanical irritant, giving rise to force with the knee bent and taking weight. This causes a block to movement with the patient recurrent synovial effusion and mechanical describing a ‘locked knee’ symptoms • In middle life, tears can occur with relatively posterior or anterior horn tears Some are associated with meniscal cysts little force when fibrotic change has the very back or front of the meniscus is It is also suggested that synovial cells infiltrate into the vascular area between meniscus and restricted mobility of the meniscus.
  • Analysis of Rehabilitation Procedure Following Arthroplasty of the Knee with the Use of Complete Endoprosthesis

    Analysis of Rehabilitation Procedure Following Arthroplasty of the Knee with the Use of Complete Endoprosthesis

    © Med Sci Monit, 2011; 17(3): CR165-168 WWW.MEDSCIMONIT.COM PMID: 21358604 Clinical Research CR Received: 2010.10.01 Accepted: 2010.12.23 Analysis of rehabilitation procedure following Published: 2011.03.01 arthroplasty of the knee with the use of complete endoprosthesis Authors’ Contribution: Magdalena Wilk-Frańczuk¹,²ACDEF, Wiesław Tomaszewski3ACDEF, Jerzy Zemła²ABDEF, A Study Design Henryk Noga4DEF, Andrzej Czamara3ADEF B Data Collection C Statistical Analysis 1 Andrzej Frycz Modrzewski Cracow University, Cracow, Poland D Data Interpretation 2 Cracow Rehabilitation Centre, Cracow, Poland E Manuscript Preparation 3 College of Physiotherapy, Wroclaw, Poland F Literature Search 4 Endoscopic Surgery Clinic and Sport Clinic Żory, Żory, Poland G Funds Collection Source of support: Departmental sources Summary Background: The use of endoprosthesis in arthroplasty requires adaptation of rehabilitation procedures in or- der to reinstate the correct model of gait, which enables the patient to recover independence and full functionality in everyday life, which in turn results in an improvement in the quality of life. Material/Methods: We studied 33 patients following an initial total arthroplasty of the knee involving endoprosthesis. The patients were divided into two groups according to age. The range of movement within the knee joints was measured for all patients, along with muscle strength and the subjective sensation of pain on a VAS, and the time required to complete the ‘up and go’ test was measured. The gait model and movement ability were evaluated. The testing was conducted at baseline and after com- pletion of the rehabilitation exercise cycle. Results: No significant differences were noted between the groups in the tests of the range of movement in the operated joint or muscle strength acting on the knee joint.
  • Knee Examination (ACL Tear) (Please Tick)

    Knee Examination (ACL Tear) (Please Tick)

    Year 4 Formative OSCE (September) 2018 Station 3 Year 4 Formative OSCE (September) 2018 Reading for Station 3 Candidate Instructions Clinical Scenario You are an ED intern at the Gold Coast University Hospital. Alex Jones, 20-years-old, was brought into the hospital by ambulance. Alex presents with knee pain following an injury playing soccer a few hours ago. Alex has already been sent for an X-ray. The registrar has asked you to examine Alex. Task In the first six (6) minutes: • Perform an appropriate physical examination of Alex and explain what you are doing to the registrar as you go. In the last two (2) minutes, you will be given Alex’s X-ray and will be prompted to: • Interpret the radiograph • Provide a provisional diagnosis to the registrar • Provide a management plan to the registrar You do not need to take a history. The examiner will assume the role of the registrar. Year 4 Formative OSCE (September) 2018 Station 3 Simulated Patient Information The candidate has the following scenario and task Clinical Scenario You are an ED intern at the Gold Coast University Hospital. Alex Jones, 20-years-old, was brought into the hospital by ambulance. Alex presents with knee pain following an injury playing soccer a few hours ago. Alex has already been sent for an X-ray. The registrar has asked you to examine Alex. Task In the first six (6) minutes: • Perform an appropriate physical examination of Alex and explain what you are doing to the registrar as you go. In the last two (2) minutes, you will be given Alex’s X-ray and will be prompted to: • Interpret the radiograph • Provide a provisional diagnosis to the registrar • Provide a management plan to the registrar You do not need to take a history.
  • Comparison of the Thesslay Test and Mcmurray Test: a Systematic

    Comparison of the Thesslay Test and Mcmurray Test: a Systematic

    py & Ph ra ys e i th c Alexanders et al.,Physiother Rehabil 2016, 1:1 a io l s R y e Journal of DOI: 10.4172/2573-0312.1000104 h h a P b f i o l i l t a ISSN:a 2573-0312 t n i r o u n o J Physiotherapy & Physical Rehabilitation Research Article Open Access Comparison of the Thesslay Test and McMurray Test: A Systematic Review of Comparative Diagnostic Studies Jenny Alexanders1*, Anna Anderson2, Sarah Henderson1 and Ulf Clausen3 1Sport, Health and Sciences Department, The University of Hull, Washburn Building, Cottingham Road, Hull, United Kingdom 2Leeds Teaching Hospitals, Beckett Street, Leeds, LS9 7TF, United Kingdom 3Dr Hill and Partners, Beverly Health Practice, Manor Road, Hull, HU17 7BZ, United Kingdom Abstract Background: The Thessaly test is a relatively recently developed meniscal test; therefore research compared to other meniscal tests is somewhat limited. In addition, a systematic review comparing the Thessaly’s test with a long standing test such as the McMurray test has not been previously conducted. Objective: To systematically identify and appraise all empirical studies comparing the diagnostic accuracy of the Thessaly test and McMurray test. Procedure: Eligible studies were identified through a rigorous search of ScienceDirect, CINAHL Plus, Pubmed, PEDro, EMBASE and Cochrane Library from January 2004 until August 2014. Full English reports of studies investigating the accuracy of the Thessaly test and McMurray test. Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) scores were completed on each selected article. Results: The Thessaly test reported to have higher diagnostic accuracy values (61-96%) compared to the McMurray test (56-84%).
  • Physical Esxam

    Physical Esxam

    Pearls in the Musculoskeletal Exam Frank Caruso MPS, PA-C, EMT-P Skin, Bones, Hearts & Private Parts 2019 Examination Key Points • Area that needs to be examined, gown your patients - well exposed • Understand normal functional anatomy • Observe normal activity • Palpation • Range of Motion • Strength/neuro-vascular assessment • Special Tests General Exam Musculoskeletal Overview Physical Exam Preview Watch Your Patients Walk!! Inspection • Posture – Erectness – Symmetry – Alignment • Skin and subcutaneous tissues – Swelling – Redness – Masses Inspection • Extremities – Size – Deformities – Enlargement – Alignment – Contour – Symmetry Inspection • Muscles – Bilateral symmetry – Hypertrophy – Atrophy – Fasciculations – Spasms Palpation • Palpate bones, joints, and surrounding muscles for the following: – Heat – Tenderness – Swelling – Fluctuation – Crepitus – Resistance to pressure – Muscle tone Muscles • Size and strength affected by the following: – Genetics – Exercise – Nutrition • Muscles move joints through range of motion (ROM). Muscle Strength • Compare bilateral muscles – Strength – Symmetry – Equality – Resistance End Feel Think About It!! • The sensation the examiner feels in the joint as it reaches the end of the range of motion of each passive movement • Bone to bone: This is hard, unyielding – normal would be elbow extension. • Soft–tissue approximation: yielding compression that stops further movement – elbow and knee flexion. End Feel • Tissue stretch: hard – springy type of movement with a slight give – toward the end of range of motion – most common type of normal end feel : knee extension and metacarpophalangeal joint extension. Abnormal End Feel • Muscle spasm: invoked by movement with a sudden dramatic arrest of movement often accompanied by pain - sudden hard – “vibrant twang” • Capsular: Similar to tissue stretch but it does not occur where one would expect – range of motion usually reduced.
  • Evaluation and Management of Sports Injuries in Children

    Evaluation and Management of Sports Injuries in Children

    2019 Frontiers in Pediatrics Sports Medicine Mini-Symposium Presented by MUSC Health Sports Medicine Sports Medicine Panel of Experts Michael J. Barr, PT, DPT, MSR Sports Medicine Manager MUSC Health Sports Medicine Alec DeCastro, MD Assistant Professor CAQ Sports Medicine Director, MUSC/Trident Family Medicine Residency MUSC Health Sports Medicine MUSC Department of Family Medicine Harris S. Slone, MD Associate Professor Orthopaedic Surgery and Sports Medicine MUSC Health Sports Medicine MUSC Department of Orthopaedics Sports Medicine Breakout Group Leaders Aaron Brown, ATC Athletic Trainer MUSC Health Sports Medicine Amelia Brown, MS, ATC Athletic Trainer MUSC Health Sports Medicine Brittney Lang, MS, ATC Athletic Trainer MUSC Health Sports Medicine Bobby Weisenberger, MS, ATC, PES Athletic Trainer MUSC Health Sports Medicine Sports Medicine Schedule Approximate Timeline: 2:00: Introduction – Michael Barr, PT, DPT, MSR – Sports Medicine Manager 2:05: Ankle Case Report – Harris Slone, MD 2:20: Knee Case Report – Harris Slone, MD 2:35: Shoulder Instability Case Report – Michael Barr, PT, DPT, MSR 2:50: Back Case Report – Alec DeCastro, MD 3:05: High BP Case Report – Alec DeCastro, MD 3:20: Hands On Practice of Exam Techniques – All + Athletic Trainers 3:50: Question/Answer Open Forum – All 4:00: End Sports Medicine Disclosers No relevant financial disclosers Sports Medicine Learning Objectives Learning Objectives: 1. Describe mechanisms of injury and clinical presentation for common pediatric sports related injuries of the ankle, knee, back and shoulder. 2. Demonstrate examination techniques to support the diagnosis of common pediatric sports related injuries of the ankle, knee, back and shoulder 3. Determine what imaging studies should be ordered and when to refer to a sports med/orthopaedic surgeon or to physical therapy 4.
  • Examination of the Knee

    Examination of the Knee

    Examination of the Knee The Examination For every joint of the lower extremity always begin with the patient in standing IN STANDING INSPECTION 1. Cutaneous Structures: Look for Erythema, scarring, bruising, and swelling in the following areas: a. Peripatellar grooves b. Suprapatellar bursa c. Prepatellar bursa d. Infrapatellar tendon e. Anserine bursa f. Popliteal fossa 2. Muscle & Soft Tissue: a. Quadriceps atrophy b. Hamstring atrophy c. Calf atrophy 3. Bones & Alignment: a. Patella position (Alta, Baha, Winking, Frog eyed), b. Varus or Valgus alignment c. Flexion contracture or Genu recurvatum RANGE OF MOTION - ACTIVE Standing is the best opportunity to assess active range of motion of the knee. 1. Ask the patient to squat into a deep knee bend. Both knees should bend symmetrically. 2. Ask the patient to then stand and extend the knee fully – lock the knee. The knee should straighten to 0 degrees of extension. Some people have increased extension referred to as genu recurvatum. GAIT 1. Look for a short stance phase on the affected limb and an awkward gait if a concomitant leg length discrepancy 2. Look for turning on block 3. Screening 1. Walk on the toes 2. Walk on the heels 3. Squat down – Active Range of Motion testing SPECIAL TESTS 1. Leg Length Discrepancy a. Look at patients back for evidence of a functional scoliosis b. Place your hands on the patients Iliac crests looking for inequality which may mean a leg length discrepancy IN SITTING NEUROLOGIC EXAMINATION 1. Test the reflexes a. L4 – Quadriceps reflex VASCULAR EXAMINATION 1. Feel for the posterior tibial artery SUPINE POSITION INSPECTION 1.