Abductor Pollicis Brevis 5, 66, 68 Acetabular Dysplasia 199 Achilles
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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]. -
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 -
Policy on Infant Hip Screening
Policy on Infant Hip Screening COMMITTEE ON CHIROPRACTIC PAEDIATRIC DIAGNOSTIC AND THERAPEUTIC PROCEDURES January 2020 Note: This policy is relevant to infant ages only. A policy on hip screening in the post-infantile paediatric patient will be covered separately. BACKGROUND Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions of infancy.1 DDH is the result of abnormal relationship between the femoral head and the acetabulum. It can range in severity from instability to dislocation (requiring surgical intervention), with varying degrees of acetabular dysplasia in between.2–4 In Australia, there is a reported incidence of seven per 1000 live births.5 The incidence of late- detection (clinically detected DDH after 3 months of age) and diagnosis has increased from 0.22 per 1000 live births in 1988-2003 to 0.7 per 1000 in 2003-2009.6,7 SCREENING In Australia, it is recommended that General Practitioners (GP) and Maternal and Child Health Nurses (MCHN) screen for DDH by performing Ortolani, Barlow, Abduction and Allis tests, as well as observing for leg length and thigh crease asymmetry.8–11 This follows guidelines established by the American Academy of Orthopaedic Surgeons.12 Regular screening is important as early detection of DDH has better outcomes and requires less aggressive management with reduced risks: bracing and non-surgical intervention compared to potential surgical intervention for those older than 6 months of age.5 Clinical hip examination by the infants’ GP and MCHN remains the primary -
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. -
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. -
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 ................................... -
Mcmaster Musculoskeletal Clinical Skills Manual 1E
McMaster Musculoskeletal Clinical Skills Manual Authors Samyuktha Adiga Dr. Raj Carmona, MBBS, FRCPC Illustrator Jenna Rebelo Editors Caitlin Lees Dr. Raj Carmona, MBBS, FRCPC In association with the Medical Education Interest Group Narendra Singh and Jacqueline Ho (co-chairs) FOREWORD AND ACKNOWLEDGEMENTS The McMaster Musculoskeletal Clinical Skills Manual was produced by members of the Medical Education Interest Group (co-chairs Jacqueline Ho and Narendra Singh), and Dr. Raj Carmona, Assistant Professor of Medicine at McMaster University. Samyuktha Adiga and Dr. Carmona wrote the manual. Illustrations were done by Jenna Rebelo. Editing was performed by Caitlin Lees and Dr. Carmona. The Manual, completed in August 2012, is a supplement to the McMaster MSK Examination Video Series created by Dr. Carmona, and closely follows the format and content of these videos. The videos are available on Medportal (McMaster students), and also publicly accessible at RheumTutor.com and fhs.mcmaster.ca/medicine/rheumatology. McMaster Musculoskeletal Clinical Skills Manual S. Adiga, J. Rebelo, C. Lees, R. Carmona McMaster Musculoskeletal Clinical Skills Manual TABLE OF CONTENTS General Guide 1 Hip Examination 3 Knee Examination 6 Ankle and Foot Examination 12 Examination of the Back 15 Shoulder Examination 19 Elbow Examination 24 Hand and Wrist Examination 26 Appendix: Neurological Assessment 29 1 GENERAL GUIDE (Please see videos for detailed demonstration of examinations) Always wash your hands and then introduce yourself to the patient. As with any other exam, ensure adequate exposure while respecting patient's modesty. Remember to assess gait whenever doing an examination of the back or any part of the lower limbs. Inspection follows the format: ● S welling ● E rythema ● A trophy ● D eformities ● S cars, skin changes, etc. -
Abdominal Distension
2003 OSCE Handbook The world according to Kelly, Marshall, Shaw and Tripp Our OSCE group, like many, laboured away through 5th year preparing for the OSCE exam. The main thing we learnt was that our time was better spent practising our history taking and examination on each other, rather than with our noses in books. We therefore hope that by sharing the notes we compiled you will have more time for practice, as well as sparing you the trauma of feeling like you‟ve got to know everything about everything on the list. You don‟t! You can‟t swot for an OSCE in a library! This version is the same as the 2002 OSCE Handbook, except for the addition of the 2002 OSCE stations. We have used the following books where we needed reference material: th Oxford Handbook of Clinical Medicine, 4 Edition, R A Hope, J M Longmore, S K McManus and C A Wood-Allum, Oxford University Press, 1998 Oxford Handbook of Clinical Specialties, 5th Edition, J A B Collier, J M Longmore, T Duncan Brown, Oxford University Press, 1999 N J Talley and S O‟Connor, Clinical Examination – a Systematic Guide to Physical Diagnosis, Third Edition, MacLennan & Petty Pty Ltd, 1998 J. Murtagh, General Practice, McGraw-Hill, 1994 These are good books – buy them! Warning: This document is intended to help you cram for your OSEC. It is not intended as a clinical reference, and should not be used for making real life decisions. We‟ve done our best to be accurate, but don‟t accept any responsibility for exam failure as a result of bloopers…. -
Journal Pre-Proof
Mayo Clinic Proceedings Telemedicine Musculoskeletal Examination The Telemedicine Musculoskeletal Examination Edward R. Laskowski, MD; Shelby E. Johnson, MD; Randy A. Shelerud, MD; Jason A. Lee, DO; Amy E. Rabatin, MD; Sherilyn W. Driscoll, MD; Brittany J. Moore, MD; Michael C. Wainberg, DO; Carmen M. Terzic, MD, PhD All authors listed are members of the Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, and additionally, Dr. Laskowski and Dr. Lee are members of the Division of Sports Medicine of the Department of Orthopedics, Mayo Clinic Rochester. Corresponding Author: Edward R. Laskowski, MD Physical Medicine and Rehabilitation Mayo Clinic 200 First Street SW Rochester, MN 55905 [email protected] Abstract Telemedicine uses modern telecommunication technology to exchange medical information and provide clinical care to individuals at a distance. Initially intended to improve health care to patients in remote settings, telemedicine now has a broad clinical scope with the generalJournal purpose of providing Pre-Proofconvenient, safe, time and cost-efficient care. The Corona Virus Disease 2019 (COVID-19) pandemic has created significant nationwide changes to health care access and delivery. Elective appointments and procedures have been cancelled or delayed, and multiple states still have some degree of shelter-in-place orders. Many institutions are now relying more heavily on telehealth services to continue to provide medical care to individuals while also preserving the © 2020 Mayo Foundation for Medical Education and Research. Mayo Clin Proc. 2020;95(x):xx-xx. Mayo Clinic Proceedings Telemedicine Musculoskeletal Examination safety of healthcare professionals and patients. Telemedicine can also help reduce the surge in health care needs and visits as restrictions are lifted. -
Rheumatology and Rehabilitation
Basics of Rheumatology and Rehabilitation STAFF OF Rheumatology and Rehabilitation Department Mansoura Faculty of Medicine 2020- 2021 1 Preface This book is written by the staff members of Rheumatology, Physical Medicine and Rehabilitation Department, Faculty of Medicine, Mansoura University. It has been made to provide, in brief, the basic knowledge of this specialty in a systemic, concisely written, well- illustrated and comprehensive manner to be easily memorized by the undergraduate students. We hope that this book provides our students with adequate basic rheumatological knowledge to make accurate clinical observations, arrive at a diagnosis and be aware of relevant differential diagnosis. We hope that this book can also provide our students with different modalities of physical medicine and role of interdisciplinary rehabilitation program in different medical conditions. Also we hope that this book will be beneficial to general practitioner helping them to diagnose and manage some medical disease with rheumatological manifestation (how to deal with! And when to consult!). STAFF OF Rheumatology and Rehabilitation Department Mansoura Faculty of Medicine 2 STAFF MEMBERS of Rheumatology, Physical Medicine and Rehabilitation Department Faculty of Medicine Mansoura University Prof. Mona Mohsen Dr. Reham Magdy Prof. Atif El.Ghaweet Dr. Rehab Abd-Elraof Prof. Seif Eldein Farag Dr. Abeer Fekry Prof. Amir Abd-Elrahman Dr. Amany El.Bahnasawy Prof. Salah Hawas Dr. Iman Abd-Elrazik Prof. Ibraheem El.Boghdady Dr. Ola Gharbia Prof. Basma El.Kady Dr. Sherein Gaafar Prof. Manal Awad Dr. Yasmin Adel Prof. Adel Abd-Elsalam Dr. Eman Bakr Prof. Abd-Elmoety Afify Dr. Dena Abdel Ghafar Prof. Mohammed Kamal Dr. Doaa Mosaad Prof. -
Developmental Dysplasia of the Hip in Children with Down Syndrome: Comparison of Clinical and Radiological Examinations in a Local Cohort
European Journal of Pediatrics (2019) 178:559–564 https://doi.org/10.1007/s00431-019-03322-x ORIGINAL ARTICLE Developmental dysplasia of the hip in children with Down syndrome: comparison of clinical and radiological examinations in a local cohort Anouk F.M. van Gijzen1 & Elsbeth D.M. Rouers 2,3 & Florens Q.M.P. van Douveren4 & Jeanne Dieleman5 & Johannes G.E. Hendriks4 & Feico J.J. Halbertsma1 & Levinus A. Bok 1 Received: 24 August 2018 /Revised: 27 December 2018 /Accepted: 10 January 2019 /Published online: 1 February 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Guidelines for children with Down syndrome (DS) suggest to perform an annual hip screening to enable early detection of developmental dysplasia of the hip (DDH). How to perform this screening is not described. Delayed detection can result in disabling osteoarthritis of the hip. Therefore, we determined the association between clinical history, physical, and radiological examination in diagnosing DDH in children with DS. Referral centers for children with DS were interviewed to explore variety of hip examination throughout the Netherlands. Clinical features of 96 outclinic children were retrospectively collected. Clinical history was taken, physical examination was performed, and X-ray of the hip was analyzed. All the referral centers performed physical examination and clinical history; however, 20% performed X-ray. Following physical examination according to Galeazzi test 26.9% and to limited abduction 10.8% of the outclinic-studied children were at risk for DDH. Radiological examination showed moderate or severe abnormal deviating migration rate of 14.6% resp. 11.5% in the right and left hip. -
Orthopaedic Examination Spinal Cord / Nerves
9/6/18 OBJECTIVES: • Identify the gross anatomy of the upper extremities, spine, and lower extremities. • Perform a thorough and accurate orthopaedic ORTHOPAEDIC EXAMINATION examination of the upper extremities, spine, and lower extremities. • Review the presentation of common spine and Angela Pearce, MS, APRN, FNP-C, ONP-C extremity diagnoses. Robert Metzger, DNP, APRN, FNP - BC • Determine appropriate diagnostic tests for common upper extremity, spine, and lower extremity problems REMEMBER THE BASIC PRINCIPLES OF MUSCULOSKELETAL EXAMINATION Comprehensive History Comprehensive Physical Exam THE PRESENTERS • Chief Complaint • Inspection • HPI OLDCART • Palpation HAVE NO CONFLICTS OF INTEREST • PMH • Range of Motion TO REPORT • PSH • Basic principles use a goniometer to assess joint ROM until you can • PFSH safely eyeball it • ROS • Muscle grading • Physical exam one finger point • Sensation to maximum pain • Unusual findings winging and atrophy SPINAL COLUMN SPINAL CORD / NERVES • Spinal cord • Begins at Foramen Magnum and • Consists of the Cervical, Thoracic, continues w/ terminus at Conus Medullaris near L1 and Lumbar regions. • Cauda Equina • Collection of nerves which run from • Specific curves to the spinal column terminus to end of Filum Terminale • Lordosis: Cervical and Lumbar • Nerve Roots • Kyphosis: Thoracic and Sacral • Canal is broader in cervical/ lumbar regions due to large number of nerve roots • Vertebrae are the same throughout, • Branch off the spinal cord higher except for C1 & C2, therefore same than actual exit through