Normal Musculoskeletal Assessment Documentation
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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. -
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. -
Examination of the Spine
Page 1 of 7 Examination of the Spine Neck and back pain are common presentations in primary care. Many cases of neck and back pain are due to benign functional or postural causes but a thorough history and examination is essential to assess the cause (see articles Low Back Pain and Sciatica, Thoracic Back Pain and Neck Pain), any associated psychological difficulties (eg depression, anxiety or somatisation disorder), and any functional impairment, including restrictions with work, leisure and domestic activities. General examination of the spine The examination should begin as soon as you first see the patient and continues with careful observation during the whole consultation. It is essential to observe the patient's gait and posture. Inconsistency between observed function and performance during specific tests may help to differentiate between physical and functional causes for the patient's symptoms. Inspection Examination of any localised spinal disorder requires inspection of the entire spine. The patient should therefore undress to their underwear. Look for any obvious swellings or surgical scars. Assess for deformity: scoliosis, kyphosis, loss of lumbar lordosis or hyperlordosis of the lumbar spine. Look for shoulder asymmetry and pelvic tilt. Observe the patient walking to assess for any abnormalities of gait. Palpation Palpate for tenderness over bone and soft tissues. Perform an abdominal examination to identify any masses, and consider a rectal examination (cauda equina syndrome may present with low back pain, pain in the legs and unilateral or bilateral lower limb motor and/or sensory abnormality, bowel and/or bladder dysfunction with saddle and perineal anaesthesia, urinary dysfunction and bowel disturbances, and rectal examination may reveal loss of anal tone and sensation). -
Escharotomy Incisions 17
Emergency War Surgery Second United States Revision of The Emergency War Surgery NATO Handbook Thomas E. Bowen, M.D. Editor BG, MC, U.S. Army Ronald Bellamy, M.D. Co-Editor COL, MC, U.S. Army United States Department of Defense United States Government Printing Office Washington, D.C. 1988 Peer Review Status: Internally Peer Reviewed Creation Date: Unknown Last Revision Date: 1988 Contents Foreword Preface Prologue Acknowledgments Chapter I. General Considerations of Forward Surgery Part I. Types of Wounds and Injuries II. Missile-Caused Wounds III. Burn Injury IV. Cold Injury V. Blast Injuries VI. Chemical Injury VII. Mass Casualties in Thermonuclear Warfare VIII. Multiple Injuries Part II. Response of the Body to Wounding IX. Shock and Resuscitation X. Compensatory and Pathophysiological Responses to Trauma XI. Infection Part III. General Considerations of Wound Management XII. Sorting of Casualties XIII. Aeromedical Evacuation XIV. War Surgery Within the Division XV. Anesthesia and Analgesia XVI. Wounds and Injuries of the Soft Tissues XVII. Crush Injury XVIII. Vascular Injuries XIX. Wounds and Injuries of Bones and Joints XX. Wounds and Injuries of Peripheral Nerves XXI. Amputations Part IV. Regional Wounds and Injuries XXII. Craniocerebral Injury XXIII. Maxillofacial Wounds and Injuries XXIV. Wounds and Injuries of the Eye XXV. Laser Injury of the Eye XXVI. Wounds and Injuries of the Ear XXVII. Wounds and Injuries of the Neck XXVIII. Wounds and Injuries of the Chest XXIX. Wounds of the Abdomen XXX. Reoperative Abdominal Surgery XXXI. Wounds and Injuries of the Genitourinary Tract XXXII. Wounds and Injuries of the Hand XXXIII. Wounds and Injuries of the Spinal Column and Cord Appendixes A. -
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. -
Harbor Chiropractic, P.C
American Arbitration Association New York No-Fault Arbitration Tribunal In the Matter of the Arbitration between: Harbor Chiropractic, P.C. AAA Case No. 17-18-1084-8145 (Applicant) Applicant's File No. 113141 - and - Insurer's Claim File No. 0397235870 NAIC No. 19232 Allstate Insurance Company (Respondent) ARBITRATION AWARD I, James Hogan, the undersigned arbitrator, designated by the American Arbitration Association pursuant to the Rules for New York State No-Fault Arbitration, adopted pursuant to regulations promulgated by the Superintendent of Insurance, having been duly sworn, and having heard the proofs and allegations of the parties make the following AWARD: Injured Person(s) hereinafter referred to as: EIP 1. Hearing(s) held on 04/18/2019, 06/19/2019 Declared closed by the arbitrator on 04/18/2019 Michael Spector from The Odierno Law Firm P.C. participated in person for the Applicant Allison Lindsey from Law Offices Of Karen L Lawrence participated in person for the Respondent 2. The amount claimed in the Arbitration Request, $ 4,241.52, was AMENDED and permitted by the arbitrator at the oral hearing. At the hearing, the Applicant amended the amount in controversy to $2,778.45 to be in accordance with the Chiropractic Fee Schedule for both the CMT and physical medicine services provided on the 18 DOS, but also to be in accordance with the fee schedule for the range of motion testing and manual muscle testing. Stipulations WERE NOT made by the parties regarding the issues to be determined. 3. Summary of Issues in Dispute The EIP, a 27 year old female, was injured in a collision on 12/30/15. -
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. -
Knee Examination
Checklist for Physical Examination of the Knee Muscuoskeletal Block -- Chris McGrew MD, Andrew Ashbaugh DO This handout is for use as a “rough” guide and study aid. Your instructor may perform certain maneuvers differently than depicted here. I acknowledge that this may be frustrating, but please try to be understanding of this inter-examination variability. A. Inspection 1) Standing - alignment, foot structure, hip/pelvis 2) Gait – Observe (is there a limp?) 3) Supine – effusion, erythema, quadriceps muscle (atrophy?) “Var us my pig” B. Palpation 1) Warmth, Crepitus, Effusion 2) Tenderness – medial/lateral joint lines, MCL, LCL, patellar facets, quadriceps insertions, patellar tendon, IT Band, pes anserine bursa Milk test for effusion Start at inferior pole of patella, drop down and move medially and laterally to joint lines. Then condyles and plateuas, Then patellar tendon. For patella check poles and facets. C. Range of Motion --Need to check both hip and knee ROM as hip pathology can refer pain to the knee. 1) Hip ROM: flexion, internal and external rotation 120 degrees Int Rot: Ext Rot: 0 degrees 30-40 40-60 2) Knee flexion and extension (know difference between AROM and PROM) 3) Hamstring flexibility (compare to other side) Popliteal angle test: hip flexed to 90, knee flexed to 90, then examiner passively extends knee till it reaches it resistance. D. Manual Muscle Testing / Neurovascular exam 1) Knee Extension/Flexion (MMT of quadriceps and hamstrings) 2) Distal Neurovascular: pulses, gross sensation, capillary refill. Dorsalis pedis pulse found best in line with the second toe. E. Special Tests 1) Patellar Examination a) Q-angle, be able to visualize varus or valgus b) Patellar compression/grind c) Patellar glide/tilt d) Apprehension sign Patellar compression/grind test (PFPS, chondromalacia patellae) Have patients knee bent at 20-30 degrees, hold their patella in place and have them slowly activate their quadriceps muscles and to stop if it hurts. -
Knee Examination
Knee Examination Video.(Was done by the department) Objective: To be able to perform examination of the knee and to distinguish and identify an abnormal finding that suggests a pathology. Done By: Fahad Alabdullatif Edited & Revised By: Adel Al Shihri & Moath Baeshen. References: Department handout, Notes(by moath baeshen), Browse’s,433 OSCE Team. Look ❖ Standing: ➢ Expose both lower limbs from mid-thigh down. ➢ Comment on knee alignment while standing (varus/valgus /or neutral) and whither physiological or pathological). ➢ Look for abnormal motion of the knees while walking. ➢ Look for ankle and foot alignment and position. ➢ Gait. ❖ Supine ➢ Alignment ( physiological valgus, abnormal valgus, varus) ➢ Skin changes ➢ Varicose veins ➢ Swelling ➢ Muscle wasting (quadriceps) (Should be measured by a measuring tape guess) ➢ Inspect the back of the knee. (Baker’s cyst) Feel 1. Before touching the patient ask if he has any pain 2. Always compare to the other side ❖ Check and compare temperature ❖ Feel for any lumps or bumps in the soft tissue or bone around the knee – comment if present ➢ Baker's cyst (in popliteal fossa) ❖ Identify bony landmarks (femoral and tibial condyles, tuberosity, proximal fibula, patella and comment if tender) (Best done with the knees flexed. Keep looking at the patient’s face.) (Tenderness over the tibial tuberosity may indicate Osgood–Schlatter disease) ❖ Identify course of collateral ligaments and comment if tender ❖ Identify joint line in flexion of 80 - 90 degrees and comment if tender (Joint line tenderness = meniscus injury) (Identify the quadriceps tendon checking for a gap) ❖ You should know surface anatomy to localize the site of abnormality, in the exam the SP may points to an area that hurts, you should be able to identify it. -
Soldier's Manual and Trainer's Guide
STP 8-68W13-SM-TG 3 May 2013 SOLDIER’S MANUAL AND TRAINER’S GUIDE MOS 68W HEALTH CARE SPECIALIST SKILL LEVELS 1/2/3 HEADQUARTERS, DEPARTMENT OF THE ARMY DISTRIBUTION RESTRICTION: Distribution authorized to US Government agencies and their contractors only to protect technical and operational information from automatic dissemination under the International Exchange Program or by other means. This determination was made on 12 September 2011. Other requests for this documentation will be referred to MCCS-IN, 3630 Stanley Rd Ste 101 Ft Sam Houston, TX 78234-6100. DESTRUCTION NOTICE: Destroy by any approved method, i.e., shredding, pulping, or pulverizing, that will prevent disclosure of contents or reconstruction of this document.. This publication is available at Army Knowledge Online (https://armypubs.us.army.mil/doctrine/index.html). To receive publishing updates, please subscribe at http://www.apd.army.mil/AdminPubs/new_subscribe.asp. STP 8-68W13-SM-TG 1SOLDIER TRAINING PUBLICATION HEADQUARTERS No. 8-68W13-SM-TG DEPARTMENT OF THE ARMY Washington, DC 3 May 2013 SOLDIER’s MANUAL and TRAINER’S GUIDE MOS 68W Health Care Specialist Skill Levels 1, 2 and 3 TABLE OF CONTENTS PAGE Table of Contents………………………………….…………………………………………….i Preface………………………………………………………………..……………………….…..v Chapter 1. Introduction ........................................................................................................... 1-1 1-1. General .............................................................................................................. 1-1 1-2. -
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