WNL, Elbow Regional Examination Observation

Total Page:16

File Type:pdf, Size:1020Kb

WNL, Elbow Regional Examination Observation Elbow Regional Examination Patient:____________________________________ date: ______ Check normal, circle & describe abnormal (dd/mm/yr) CC & signifi cant history: ____________________________________________________ Insurance: ______________________________________ __________________________________________________________________________ Date of birth: ____________________________________ M/F Fracture screen (tuning fork, percussion, torsion test, grip strength): □ WWNLNL, □ RReferefer fforor XX-ra-ray: _________________________________________ Observation: □ WWNLNL Palpation: □ WWNL,NL, texture, tenderness, pain referral Development: □ ggood,ood, □ ffair,air, □ ppooroor RRightight LLefteft □ AAntalgia:ntalgia: __________________________________________________ Palpation L R Palpation L R □ SSkinkin ((bruising,bruising, sscars):cars): ______________________________ Medial epicondyle Common exten. tendon □ AAsymmetry:symmetry: ______________________________________________ Ulnar groove Anconeus Observation □ WNL L R Med. collateral ligament Brachioradialis Common fl exor tendon Extensor carpi ulnaris Head tilt Flexor carpi ulnaris Extensor carpi rad longus Head rotation Palmaris longus Extensor carpi rad brevis Shoulder high Flexor carpi radialis Extensor digitorum Shoulder rounded Pronator teres Supinator Humerus rotated Biceps tendon Triceps tendon Elbow fl exed Head of radius Triceps muscle Elbow hyperextended Radial tunnel Olecranon Valgus forearm Lateral epicondyle Olecranon bursa Varus forearm Lat. collateral ligament Cubital fossa Forearm pronated Lat. supracondylar ridge Brachialis Forearm supinated ________________________________________________________________________________________________________________________________________________________________ Hand/fi nger deformity ________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ____________________________________________________________________________________ Neurologic: □ WWNLNL Orthopedic: □ WWNLNL Refl exes (0-5), □ WNL L R Instability L R Lateral epicondylitis LR Vascular Screen: □ WWNLNL Biceps (C5) Valgus stress (0°) Book lift test Pulses (0-4) L R Brachioradialis (C6) Valgus stress (30°) Cozen’s Brachial pulse Triceps (C7) Varus stress (0°) Mill’s Radial pulse General grip strength Varus stress (30°) Kaplan’s test Ulnar pulse Motor (0-5), □ WNL L R Blanch test Medial epicondylitis LR Neuropathy L R Shoulder fl exors Allen’s test Reverse Cozen’s Tinel’s (elbow) Shoulder extensors Temperature Reverse Mill’s Tinel’s (wrist) Biceps brachii (musc.) Reverse book lift Elbow fl exion test Brachialis (musc.) Pronator stretch test ROM & Joint Play: □ WWNLNL Brachioradialis (radial) □ PPainain aatt eendnd RROM:OM: ____________________________________ Triceps brachii (radial) Dynamometer L R L R L R □ AAbnormalbnormal mmotion:otion: ____________________________________ Wrist extensors (radial) Repeat 3 times Wrist fl exors (median/ulnar) Active Passive Serial #_______________________ Setting: ________________ ROM Wrist abductors (median/radial) __________________________________________________________________________________________ LRLR Wrist adductors (ulnar/radial) __________________________________________________________________________________________ Flexion (150°) Pronator teres (median) ________________________________________________________________________________________________ Extension (0°) Supinator (radial) ______________________________________________________________________________________________ Supination (90°) Finger fl exors (median/ulnar) __________________________________________________________________________________________ Pronation (90°) Finger extensors (radial) NNeckeck eevaluation:valuation: ____________________________________________________________________ SShoulderhoulder eeval:val: ________________________________________________________________________ Joint Play L R Girth*, □ WNL L R WWrist/handrist/hand eeval:val: ________________________________________________________________ Ulnohumeral Mid arm Elbow Radiohumeral DDx: _____________________________________ Proximal radioulnar Mid forearm _____________________________________________ Carrying angle ______________________________________________________________________ _______________________________________________ ______________________________________________________________________ **Atrophy,Atrophy, sswelling,welling, ddominantominant vvs.s. nnon-dominanton-dominant ______________________________________________ ***General*General seensationnsation iiss ddoneone tthroughhrough ppalpationalpation This form is a comprehensive checklist of examination procedures. Each item should be utilized as a diagnostic option based on the patient’s presenting symptoms and the clinical discretion of the examiner. Every procedure does not have to be performed on every patient. Some procedures may be Signature: Date: contraindicated in certain situations. Patient information contained within this form is considered strictly confi dential. Reproduction is permitted for personal use, not for resale or redistribution. www.prohealthsys.com ©2005 by Professional Health Systems Inc. All rights reserved. “Dedicated to Clinical Excellence.”.
Recommended publications
  • HEENT EXAMINIATION ______HEENT Exam Exam Overview
    HEENT EXAMINIATION ____________________________________________________________ HEENT Exam Exam Overview I. Head A. Visual inspection B. Palpation of scalp II. Eyes A. Visual Acuity B. Visual Fields C. Extraocular Movements/Near Response D. Inspection of sclera & conjunctiva E. Pupils F. Ophthalmoscopy III. Ears A. External Inspection B. Otoscopy C. Hearing Acuity D. Weber/Rinne IV. Nose A. External Inspection B. Speculum/otoscope C. Sinus areas V. Throat/Mouth A. Mouth Examination B. Pharynx Examination C. Bimanual Palpation VI. Neck A. Lymph nodes B. Thyroid gland 29 HEENT EXAMINIATION ____________________________________________________________ HEENT Terms Acuity – (ehk-yu-eh-tee) sharpness, clearness, and distinctness of perception or vision. Accommodation - adjustment, especially of the eye for seeing objects at various distances. Miosis – (mi-o-siss) constriction of the pupil of the eye, resulting from a normal response to an increase in light or caused by certain drugs or pathological conditions. Conjunctiva – (kon-junk-ti-veh) the mucous membrane lining the inner surfaces of the eyelids and anterior part of the sclera. Sclera – (sklehr-eh) the tough fibrous tunic forming the outer envelope of the eye and covering all of the eyeball except the cornea. Cornea – (kor-nee-eh) clear, bowl-shaped structure at the front of the eye. It is located in front of the colored part of the eye (iris). The cornea lets light into the eye and partially focuses it. Glaucoma – (glaw-ko-ma) any of a group of eye diseases characterized by abnormally high intraocular fluid pressure, damaged optic disk, hardening of the eyeball, and partial to complete loss of vision. Conductive hearing loss - a hearing impairment of the outer or middle ear, which is due to abnormalities or damage within the conductive pathways leading to the inner ear.
    [Show full text]
  • Musculoskeletal Ultrasound Technical Guidelines II. Elbow
    European Society of MusculoSkeletal Radiology Musculoskeletal Ultrasound Technical Guidelines II. Elbow Ian Beggs, UK Stefano Bianchi, Switzerland Angel Bueno, Spain Michel Cohen, France Michel Court-Payen, Denmark Andrew Grainger, UK Franz Kainberger, Austria Andrea Klauser, Austria Carlo Martinoli, Italy Eugene McNally, UK Philip J. O’Connor, UK Philippe Peetrons, Belgium Monique Reijnierse, The Netherlands Philipp Remplik, Germany Enzo Silvestri, Italy Elbow Note The systematic scanning technique described below is only theoretical, considering the fact that the examination of the elbow is, for the most, focused to one quadrant only of the joint based on clinical findings. 1 ANTERIOR ELBOW For examination of the anterior elbow, the patient is seated facing the examiner with the elbow in an extension position over the table. The patient is asked to extend the elbow and supinate the fore- arm. A slight bending of the patient’s body toward the examined side makes full supination and as- sessment of the anterior compartment easier. Full elbow extension can be obtained by placing a pillow under the joint. Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint, a Pr perpendicular to the humeral shaft. Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis mu- Br scles. Alongside and medial to these muscles, follow the brachial artery and the median nerve: * the nerve lies medially to the artery. * Legend: a, brachial artery; arrow, median nerve; arrowheads, distal biceps tendon; asterisks, articular cartilage of the Humerus humeral trochlea; Br, brachialis muscle; Pr, pronator muscle 2 distal biceps tendon: technique The distal biceps tendon is examined while keeping the patient’s forearm in maximal supination to bring the tendon insertion on the radial tuberosity into view.
    [Show full text]
  • Structure of the Flexor Digitorum Superficialis
    Okajimas Folia Anat. Jpn., 56(5) : 277-288, December 1979 Structure of the Flexor Digitorum Superficialis By OSAMU OHTANI Department of Anatomy, Okayama University Medical School, Okayama 700, Japan (Director : Prof. Dr. H. Outi) —Received for Publication, March 9, 1979— Key Words: Flexor digitorum superficialis, Striated muscle, Forearm musculature. Summary. Fifty-two forearms of 26 Japanese adult cadavers were examined. The flexor digitorum superficialis can be separated into two layers: a superficial layer and a deep layer. The superficial layer is composed of the radial head and the superficial part of the humeroulnar head. It forms two muscle bellies which give rise to the tendons for the third and fourth digits, respectively. The deep layer is composed of the deep part of the humeroulnar head. After forming an inter- mediate tendon, the deep layer also divides into two fleshy bellies which give rise to the tendons for the second and fifth digits, respectively. Based on the mode of occurrence of the communicating muscle fasciculi between the superficial layer and the deep layer, the flexor digitorum superficialis can be classified into four types. Type I muscle has no communicating fasciculus (4/52, 7.7%). Type II muscle has a communicating muscle fasciculus between the intermediate tendon and the muscle belly for the fourth digit (muscle fasciculus A) (29/52, 55.8%). Type III muscle has the muscle fasciculus A as well as another communicating muscle fasciculus between the intermediate tendon and the belly for the third digit (muscle fasciculus B) (18/52, 34.6%). Type IV muscle has the muscle fasciculus B only (1/52, 1.9%).
    [Show full text]
  • Advanced Interpretation of Adult Vital Signs in Trauma William D
    Advanced Interpretation of Adult Vital Signs in Trauma William D. Hampton, DO Emergency Physician 26 March 2015 Learning Objectives 1. Better understand vital signs for what they can tell you (and what they can’t) in the assessment of a trauma patient. 2. Appreciate best practices in obtaining accurate vital signs in trauma patients. 3. Learn what teaching about vital signs is evidence-based and what is not. 4. Explain the importance of vital signs to more accurately triage, diagnose, and confidently disposition our trauma patients. 5. Apply the monitoring (and manipulation of) vital signs to better resuscitate trauma patients. Disclosure Statement • Faculty/Presenters/Authors/Content Reviewers/Planners disclose no conflict of interest relative to this educational activity. Successful Completion • To successfully complete this course, participants must attend the entire event and complete/submit the evaluation at the end of the session. • Society of Trauma Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Vital Signs Vital Signs Philosophy: “View vital signs as compensatory to the illness/complaint as opposed to primary.” Crowe, Donald MD. “Vital Sign Rant.” EMRAP: Emergency Medicine Reviews and Perspectives. February, 2010. Vital Signs Truth over Accuracy: • Document the true status of the patient: sick or not? • Complete vital signs on every patient, every time, regardless of the chief complaint. • If vital signs seem misleading or inaccurate, repeat them! • Beware sending a patient home with abnormal vitals (especially tachycardia)! •Treat vital signs the same as any other diagnostics— review them carefully prior to disposition. The Mother’s Vital Sign: Temperature Case #1 - 76-y/o homeless ♂ CC: 76-y/o homeless ♂ brought to the ED by police for eval.
    [Show full text]
  • Disclosures Flexor Pronator Strain
    11/19/2018 Flexor Pronator Strain, Epicondylitis, Avulsions Lee Kaplan, MD Director, UHealth Sports Medicine Institute Professor, Department of Orthopaedics, Kinesiology & Sports Science, Biomedical Engineering Medical Director and Head Team Physician, University of Miami Athletics Medical Director and Head Team Physician, Miami Marlins Josue Acevedo, MD Orthopaedics Sports Medicine fellow Disclosures • I have no conflicts of interest in relation to this presentation 2 Flexor Pronator Strain • Anatomy • Function • Forces • Clinical Presentation • Imaging Studies • Treatment 3 1 11/19/2018 Anatomy • Common Flexor Tendon origin - Medial Epicondyle Pronator Teres FCR Palmaris Longus FDS FCU 4 Function • Provides dynamic support to valgus stress during throwing motion • Contraction during early arm acceleration resists valgus and flexes wrist during ball release 5 Elbow Forces • Elbow valgus torque peaks at late cocking phase - during maximal shoulder external rotation (MER) • Can approach torque up to 120 N.m • Significantly higher torque in pitchers who enduring an injury Sawbick et al. JSES, 2004 Adam WA. AJSM, 2010. 6 2 11/19/2018 • Fastballs caused the greatest torque • Curveballs produced the greatest arm speed . • Predictors of increased elbow torque • Increased ball velocity • Higher BMI • Decreased arm slot • Protectors against elbow torque. • Increasing age • longer arm length • greater elbow circumference were independent 7 • VAS fatigue scores increased 0.72 points per inning • Medial elbow torque increased beyond inning 3, increase of 0.84 N·m each inning. • Pitch velocity decreased (0.28 mph per inning) • There were no differences in arm rotation or arm speed as the game progressed. • Arm slot decreased with each successive inning (0.73° on average per inning) ***These findings signify a possible relationship between fatigue and injury risk.
    [Show full text]
  • Blood Pressure Year 1 Year 2 Core Clinical/Year 3+
    Blood Pressure Year 1 Year 2 Core Clinical/Year 3+ Do Do • Patient at rest for 5 minutes • Measure postural BP and pulse in patients with a • Arm at heart level history suggestive of volume depletion or • Correct size cuff- bladder encircles 80% of arm syncope • Center of cuff aligns with brachial artery -Measure BP and pulse in supine position • Cuff wrapped snugly on bare arm with lower -Slowly have patient rise and stand (lie them down edge 2-3 cm above antecubital fossa promptly if symptoms of lightheadedness occur) • Palpate radial artery, inflate cuff to 70 mmHg, -Measure BP and pulse after 1 minute of standing then increase in 10 mmHg increments to 30 mmHg above point where radial pulse disappears. Know Deflate slowly until pulse returns; this is the • Normally when a person stands fluid shifts to approximate systolic pressure. lower extremities causing a compensatory rise in • Auscultate the Korotkoff sounds pulse by up to 10 bpm with BP dropping slightly -place bell lightly in antecubital fossa • Positive postural vital signs are defined as -inflate BP to 20-30mmHg above SBP as determined symptoms of lightheadedness and/or a drop in by palpation SBP of 20 mmHg with standing -deflate cuff at rate 2mmHg/second while auscultating • Know variations in BP cuff sizes -first faint tapping (Phase I Korotkoff) = SBP; • A lack of rise in pulse in a patient with an Disappearance of sound (Phase V Korotkoff)=DBP orthostatic drop in pressure is a clue that the Know cause is neurologic or related or related to -Korotkoff sounds are lower pitch, better heard by bell medications (eg.
    [Show full text]
  • Patient Assessment: 3 Techniques of Physical Examination: 2
    Patient Assessment: 3 Techniques of Physical Examination: 2 W4444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444 UNIT TERMINAL OBJECTIVE 3-2 At the completion of this unit, the EMT-Critical Care Technician student will be able to explain the significance of physical exam findings commonly found in emergency situations. COGNITIVE OBJECTIVES At the completion of this unit, the EMT-Critical Care Technician student will be able to: 3-2.1 Define the terms inspection, palpation, percussion, auscultation. (C-1) 3-2.2 Describe the techniques of inspection, palpation, percussion, and auscultation. (C-1) 3-2-3 Review the procedure for taking and significance of vital signs (pulse, respiration, and blood pressure.) (C-2) 3-2.4 Describe the evaluation of mental status. (C-1) 3-2.5 Evaluate the importance of a general survey. (C-3) 3-2.6 Describe the examination of skin and nails. (C-1) 3-2.7 Differentiate normal and abnormal findings of the assessment of the skin. (C-3) 3-2.8 Distinguish the importance of abnormal findings of the assessment of the skin. (C-3) 3-2.9 Describe the normal and abnormal assessment findings of the head (including the scalp, skull, face and skin). (C-1) 3-2.10 Describe the examination of the head (including the scalp, skull, face, and skin). (C-1) 3-2.11 Describe the examination of the eyes. (C-1) 3-2.12 Distinguish between normal and abnormal assessment findings of the eyes. (C-3) 3-2.13 Describe the examination of the ears. (C-1) 3-2.14 Differentiate normal and abnormal assessment findings of the ears.
    [Show full text]
  • 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.
    [Show full text]
  • Abdominal Palpation/Auscultation of Fetal Heart Rate
    Shared Maternity Care Program Guidelines Abdominal Palpation/Auscultation of Fetal Heart Rate Introduction Abdominal palpation and auscultation of the fetal heart rate is recommended as part of routine examination in pregnancy to assist in assessing fetal wellbeing. Requirements Sonicaid to identify the fetal heart rate. Aqueous gel Tape measure Recommendations for Abdominal Palpation Palpation is not performed during a contraction Only perform a GENTLE abdominal palpation for any woman with: History of ante partum hemorrhage Premature labour Severe (acute) abdominal pain Documentation of fundal height is advised from 24/40 A clinical estimate followed by a symphyso-fundal height using a tape measure should also be used A consistent approach to measurement increases accuracy Palpate the fundus first to identify the upper limit . Measure from the top of the fundus to the top of the pubic symphysis . The tape measure should stay in contact with the skin. It is not recommended to repeat the measurement. If the fundal height is more than 2cm below or above expected height, an obstetric opinion advised. Refer Antenatal Clinic 9784 2626 or if unavailable contact the obstetric registrar via switchboard 9784 7777 Fundal height measurement is of little value in a twin pregnancy. Recommendations for Intermittent Auscultation of fetal Heart Rate Is recommended from 20 weeks gestation It is important to identify maternal pulse before locating the fetal heart. Using intermittent auscultation the normal heart rate range is >110bpm and < 160bpm If fetal heart rate or fetal movements are not present after 24 weeks gestation immediately, contact the Women’s Health Unit on 9784 7959 SMCP GPLU 2018 Shared Maternity Care Program Guidelines Abdominal Palpation/Auscultation of Fetal Heart Rate Leopold’s manoeuvres:[1] a) Fundal palpation- to locate the upper pole of the fetus and note if cephalic or breech b) Lateral palpation- to locate the fetal back, anterior shoulder and limbs c) Pawlick’s grip- to assess the presentation and station.
    [Show full text]
  • Tug Endotracheal Tube to Assess Tube Location; a Randomized Clinical Trial William P
    Protocol: Tug Endotracheal Tube to assess tube location; a randomized clinical trial William P. McKay Introduction Correct endotracheal tube (ETT) placement is important. Ideal ETT position is achieved when the distal tip is in mid-trachea with the head in neutral alignment. Unrecognized tube misplacement is an uncommon but significant cause of hypoxemia and death during general anesthesia and emergency intubation of critically ill patients. It is commoner in out-of-hospital intubations, where it is reported to occur in 1 to 15% of cases, often with disastrous results. 1, 2 Three types of malpositioning can occur: one outside the trachea (esophageal), and two within the trachea: too shallow (hypopharyngeal), or too deep (endobronchial). Esophageal intubation results in rapid hypoxemia, hypercarbia, and inflation of the stomach as the patient receives no ventilation at all. 3 Too-shallow placement of the ETT can result in inadvertent extubation, especially with manipulation of head and neck. 4 Endobronchial intubation occurs when the ETT is advanced into a mainstem bronchus, which results in hypoxia and the potential for barotrauma in the hyperventilated lung. 5, 6 Confirmation of correct ETT depth is currently performed by several methods. In the operating room, simple measurement of the length of the tube at the corner of the mouth is rapid but not reliable. One study improved on this by using additional anatomical landmarks to determine ETT tube length as measured at the mouth.7 It enabled a reduction in the incidence of too-deep placement of the ETT from 58.8% to 24%. Cuff ballottement at the level of the suprasternal notch is a technique that has been studied with cuffed tubes in adults.
    [Show full text]
  • Anatomical Considerations of Fascial Release in Ulnar Nerve Transposition: a Concept Revisited
    LABORATORY INVESTIGATION J Neurosurg 123:1216–1222, 2015 Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited Mark A. Mahan, MD,1 Jaime Gasco, MD,2 David B. Mokhtee, MD,3 and Justin M. Brown, MD4 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; 2Division of Neurological Surgery, University of Texas Medical Branch, Galveston, Texas; 3Tulsa Bone and Joint Associates, Tulsa, Oklahoma; and 4Division of Neurosurgery, University of California, San Diego, La Jolla, California OBJECT Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. METHODS The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region. RESULTS An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in angulation of the nerve during elbow flexion when this fascial septum was not released. The proximal site at which the nerve began to traverse this fascial structure was found to be an average of 3.9 cm (SD 0.7 cm) from the medial epicondyle.
    [Show full text]
  • Physical Examination and Chronic Lower-Extremity Ischemia a Critical Review
    ORIGINAL INVESTIGATION Physical Examination and Chronic Lower-Extremity Ischemia A Critical Review Steven R. McGee, MD; Edward J. Boyko, MD, MPH Objective: To determine the clinical utility of physical cians diagnose the presence of peripheral arterial dis- examination in patients with suspected chronic ische- ease: abnormal pedal pulses, a unilaterally cool extrem- mia of the lower extremities. ity, a prolonged venous filling time, and a femoral bruit. Other physical signs help determine the extent and dis- Data Sources: MEDLINE search (January 1966 to tribution of vascular disease, including an abnormal fem- January 1997), personal files, and bibliographies of oral pulse, lower-extremity bruits, warm knees, and the textbooks on physical diagnosis, surgery, and vascular Buerger test. The capillary refill test and the findings of surgery. foot discoloration, atrophic skin, and hairless extremi- ties are unhelpful in diagnostic decisions. Mathematical Study Selection: Both authors independently graded formulas, derived from 2 studies using multivariate analy- the studies as level 1, 2, or 3, according to predeter- sis, allow clinicians to estimate the probability of periph- mined criteria. Criteria deemed essential for analysis of eral arterial disease in their patients. sensitivity, specificity, and likelihood ratios were (1) clear definition of study population, (2) clear definition of Conclusion: Certain aspects of the physical examination physical examination maneuver, and (3) use of an ac- help clinicians make accurate judgments about
    [Show full text]