Orthopaedic Examination Spinal Cord / Nerves
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Frequently Asked Questions
Frequently Asked Questions What are the requirements for license renewal? Licenses Expire Contact Hours Required Each three-year registration renewal period in the licensee’s month of birth. 36 contact hours How do I complete this course and receive my certificate of completion? On-Line Submission: Go to PT.EliteCME.com and follow the prompts.You will be able to print your certificate immediately upon completion of the course. Fax Submission: Fax to (386) 673-3563, be sure to include your credit card information. All completions will be processed within 2 business days of receipt and certificates e-mailed to the e-mail address provided.* Mail Submission: Use the envelope provided or mail to Elite, PO Box 37, Ormond Beach, FL 32175. All completions will be processed and certificates issued within 10 business days from the date it is mailed.* *Please note - providing a valid e-mail address is the quickest and most efficient way to receive your certificates when submitting via fax, e-mail or mail. Submissions without a valid e-mail address will be mailed to the address provided at registration. How much will it cost? Cost of Courses Course Title Contact Hours Price Acute Injury and Pain: A Strategy, Management and Rehabilitation Discussion for Physical 3 $18.00 Therapists An Overview of Oncology Rehabilitation 4 $24.00 Common Injuries and Therapy Management for Runners 4 $24.00 Lifestyle and Therapy Approaches to Osteoporosis 3 $18.00 Reducing and Eliminating Workplace Injuries Through Ergonomics 2 $12.00 Stroke: Risk Factor Assessment, Rehabilitation Protocols and Best Practices for Prevention 2 $12.00 BEST VALUE 18-HOUR COURSE BOOK PACKAGE SAVE $11.00 18 $97.00 Are you a department approved provider? Elite Professional Education, LLC is recognized by The New York State Education Department’s Board of Physical Therapy as an approved provider of physical therapy and physical therapist assistant continuing education. -
Telemedicine Management of Musculoskeletal Issues Nicole T
Telemedicine Management of Musculoskeletal Issues Nicole T. Yedlinsky, MD, University of Kansas Medical Center, Kansas City, Kansas Rebecca L. Peebles, DO, Ehrling Bergquist Family Medicine Residency Program, Offutt Air Force Base, Nebraska; Uniformed Services University of the Health Sciences, Bethesda, Maryland Telemedicine can provide patients with cost-effective, quality care. The coronavirus disease 2019 pandemic has highlighted the need for alternative methods of delivering health care. Family physi- cians can benefit from using a standardized approach to evaluate and diagnose musculoskeletal issues via telemedicine visits. Previsit planning establishes appropriate use of telemedicine and ensures that the patient and physician have functional telehealth equipment. Specific instructions to patients regard- ing ideal setting, camera angles, body positioning, and attire enhance virtual visits. Physicians can obtain a thorough history and perform a structured musculoskel- etal examination via telemedicine. The use of common household items allows physicians to replicate in-person clinical examination maneuvers. Home care instructions and online rehabilitation resources are available for ini- tial management. Patients should be scheduled for an in-person visit when the diagnosis or management plan is in question. Patients with a possible deformity or neuro- vascular compromise should be referred for urgent evaluation. Follow-up can be done virtually if the patient’s condition is improving as expected. If the condition is worsening or not improving, the patient should have an in-office assessment, with consideration for referral to formal physical therapy or spe- cialty services when appropriate. (Am Fam Physician. 2021;103:online. Copyright © 2021 American Academy of Family Physicians.) Illustration by Jennifer Fairman by Jennifer Illustration Published online January 12, 2021. -
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]. -
A Comparative Study on Immediate Effects of Traction Straight Leg And
International Jour nal of Applie d Rese arc h 2019; 5(4): 274-278 ISSN Print: 2394-7500 ISSN Online: 2394-5869 A comparative study on immediate effects of traction Impact Factor: 5.2 IJAR 2019; 5(4): 274-278 straight leg and bent leg raise on hamstring muscle www.allresearchjournal.com Received: 07-02-2019 flexibility in normal individuals Accepted: 09-03-2019 Pooja D Kapadia Intern at Late Shree Fakirbhai Pooja D Kapadia and Dr. Virendra K Meshram Pansare Education Foundation’s College Of Abstract Physiotherapy, Nigdi, Pune, Background: Muscular flexibility is an important aspect of normal human function. Limited flexibility Maharashtra, India has been shown to predispose a person to several musculoskeletal overuse injuries and significantly affect a person’s level of function. The objective of our study was to find out the effect of mulligan Dr. Virendra K Meshram Traction Straight Leg Raise (TSLR) on hamstring flexibility, to find out the effect of Mulligan bent Leg Associate Professor, Raise (BLR) on hamstring flexibility & Comparison of Mulligan TSLR & Mulligan BLR on hamstring Department of Cardiovascular and Respiratory flexibility in normal individuals. Physiotherapy, Late Shree Method: For the present study, a total of 124 physiotherapy students were screened; of which 50 adults Fakirbhai Pansare education with hamstring muscle tightness were recruited and randomly divided into two groups: Group A- given Foundation’s College Of Mulligan Traction Straight Leg Raise and Group B- given Mulligan Bent Leg Raise. Hamstring Physiotherapy, Nigdi, Pune, flexibility was measured before and after the application of each stretching technique with the use of sit Maharashtra, India and reach test. -
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. -
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
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 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. -
SIMMONDS TEST: Patient Is Prone Doctor Flexes the Patients Knee to 90 Degrees Doctor Squeezes the Patient’S Calf
Clinical Orthopedic Testing Review SIMMONDS TEST: Patient is prone Doctor flexes the patients knee to 90 degrees Doctor squeezes the patient’s calf. Classical response: Failure of ankle plantarflexion Classical Importance= torn Achilles tendon Test is done bilaterally ACHILLES TAP: Patient is prone Doctor flexes the patient’s knee to 90 degree Doctor dorsiflexes the ankle and then strikes the Achilles tendon with a percussion hammer Classical response: Plantar response Classical Importance= Intact Achilles tendon Test is done bilaterally FOOT DRAWER TEST: Patient is supine with their ankles off the edge of the examination table Doctor grasps the heel of the ankle being tested with one hand and the tibia just above the ankle with the other. Doctor applies and anterior to posterior and then a posterior to anterior sheer force. Classical response: Anterior or posterior translation of the ankle Classical Importance= Anterior talofibular or posterior talofibular ligament laxity. Test is done bilaterally LATERAL STABILITY TEST: Patient is supine Doctor grasps the tibia with one hand and the foot with the other. Doctor rotates the foot into inversion Classical response: Excessive inversion Classical Importance= Anterior talofibular ligament sprain Test is done bilaterally MEDIAL STABILITY TEST: Patient is supine Doctor grasps the tibia with one hand and the foot with the other Doctor rotates the foot into eversion Classical response: Excessive eversion Classical Importance= Deltoid ligament sprain Test is done bilaterally 1 Clinical Orthopedic Testing Review KLEIGER’S TEST: Patient is seated with the legs and feet dangling off the edge of the examination table. Doctor grasps the patient’s foot while stabilizing the tibia with the other hand Doctor pulls the ankle laterally. -
Sacroiliac Joint N Ischium N Ilium N Pubis James R
Pelvic Anatomy Evidence-Based Evaluation & Treatment n Innominates of the Sacroiliac Joint n ischium n ilium n pubis James R. Scifers, DScPT, LAT, ATC Moravian College n Sacrum Athletic Training Program Articulations Biomechanics of the Pelvis n Function of the SI Joint n transmit vertical forces n Sacroiliac Joints n transmit ground n Pubic Symphysis reaction forces n Lumbo-Sacral Joint Sacral Motions Arthrokinematics of the SI Joint n During trunk flexion… n Sacral Base (S1) n Initially, sacral flexion occurs (base of sacrum n Sacral Apex (S5) moves anterior) n Flexion (nutation) n Later, sacral extension occurs with continued trunk flexion (base of sacrum moves posterior) n occurs during exhalation n Extension (counternutation) n occurs during inhalation 1 Dysfunction Classification Ilio-Sacral (IS) Dysfunctions n Sacroiliac Joint (SIJ) n Named for motion at n Any injury to SIJ PSIS n Ilio-Sacral (IS) n anterior rotation n ilium (innominate) n posterior rotation moving on sacrum n up-slip n Sacro-Iliac (SI) n down-slip (rare) n sacrum moving on ilium n in-flare n Pubic Shear n out-flare n Pubic symphysis / Pubic shear lesion Sacro-Iliac (SI) Dysfunctions Pubic Shear Lesions n Sacral Rotations n Named for “direction facing on axis” n Named for any movement at pubic n Forward Rotations symphysis n right on right n Indicates injury to pubic n left on left symphysis n Backward Rotations n right on left n left on right SI Evaluation Evidence-Based Practice (EBP) n Reliability (k) is reproducibility of test results, can be n History* intra-tester (within one clinician) or inter-tester (between n Observation** multiple clinicians) n Palpation** n Sensitivity (sens) is the ability of test to RULE OUT a condition. -
Musculoskeletal Clinical Vignettes a Case Based Text
Leading the world to better health MUSCULOSKELETAL CLINICAL VIGNETTES A CASE BASED TEXT Department of Orthopaedic Surgery, RCSI Department of General Practice, RCSI Department of Rheumatology, Beaumont Hospital O’Byrne J, Downey R, Feeley R, Kelly M, Tiedt L, O’Byrne J, Murphy M, Stuart E, Kearns G. (2019) Musculoskeletal clinical vignettes: a case based text. Dublin, Ireland: RCSI. ISBN: 978-0-9926911-8-9 Image attribution: istock.com/mashuk CC Licence by NC-SA MUSCULOSKELETAL CLINICAL VIGNETTES Incorporating history, examination, investigations and management of commonly presenting musculoskeletal conditions 1131 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey Prof. John O'Byrne Mr. Iain Feeley Dr. Richie Downey Dr. Martin Kelly Mr. Iain Feeley Dr. Lauren Tiedt Dr. Martin Kelly Department of General Practice, RCSI Dr. Lauren Tiedt Dr. Mark Murphy Department of General Practice, RCSI Dr Ellen Stuart Dr. Mark Murphy Department of Rheumatology, Beaumont Hospital Dr Ellen Stuart Dr Grainne Kearns Department of Rheumatology, Beaumont Hospital Dr Grainne Kearns 2 2 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey TABLE OF CONTENTS Prof. John O'Byrne Mr. Iain Feeley Introduction ............................................................. 5 Dr. Richie Downey Dr. Martin Kelly General guidelines for musculoskeletal physical Mr. Iain Feeley examination of all joints .................................................. 6 Dr. Lauren Tiedt Dr. Martin Kelly Upper limb ............................................................. 10 Department of General Practice, RCSI Example of an upper limb joint examination ................. 11 Dr. Lauren Tiedt Shoulder osteoarthritis ................................................. 13 Dr. Mark Murphy Adhesive capsulitis (frozen shoulder) ............................ 16 Department of General Practice, RCSI Dr Ellen Stuart Shoulder rotator cuff pathology ................................... -
Sacroiliac Joint Dysfunction a Case Study
NOR200188.qxd 3/8/11 9:53 PM Page 126 Sacroiliac Joint Dysfunction A Case Study CPT William Murray Pain is a widespread issue in the United States. Nine of physical therapist. She was evaluated and her treatment 10 Americans regularly suffer from pain, and nearly every consisted of a transcutaneous electrical nerve stimula- person will experience low back pain at one point in their lives. tion unit while in the PT clinic, aqua therapy, and ice Undertreated or unrelieved pain costs more than and heat application. $60 billion a year from decreased productivity, lost income, After several weeks, Ms. T returned to the primary care and medical expenses. The ability to diagnose and provide ap- provider and informed her that the pain has not decreased and “feels like that it is getting worse.” She also informed propriate medical treatment is imperative. This case study ex- the provider that she was having difficulty sleeping and amines a 23-year-old Active Duty woman who is preparing to constantly feeling tired secondary to pain. Throughout the be involuntarily released from military duty for an easily cor- next several months, the primary care provider tried nu- rectable medical condition. She has complained of chronic low merous medication trials with no relief for the patient. Ms. back pain that radiates into her hip and down her leg since ex- T gives a history of being prescribed numerous medica- periencing a work-related injury. She has been seen by numer- tions within several drug classifications. She stated vari- ous providers for the previous 11 months before being referred ous side effects that are related to the medications and to the chronic pain clinic.