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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. -
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. -
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 -
Physical Examination of Knee Ligament Injuries..Pdf
Review Article Physical Examination of Knee Ligament Injuries Abstract Robert D. Bronstein, MD The knee is one of the most commonly injured joints in the body. Joseph C. Schaffer, MD A thorough history and physical examination of the knee facilitates accurate diagnosis of ligament injury. Several examination techniques for the knee ligaments that were developed before advanced imaging remain as accurate or more accurate than these newer imaging modalities. Proper use of these examination techniques requires an understanding of the anatomy and pathophysiology of knee ligament injuries. Advanced imaging can be used to augment a history and examination when necessary, but should not replace a thorough history and physical examination. he knee joint is one of the most injuries because the current injury may Tcommonly injured joints in the be the sequela of a previous injury. body. Knee ligament injury and sub- Here, we present specific tech- sequent instability can cause consid- niques for the ligamentous exami- erable disability. Diagnosis of knee nation, including identifying injuries ligament injuries requires a thorough of the anterior cruciate ligament understanding of the anatomy and (ACL), the medial collateral liga- the biomechanics of the joint. Many ment (MCL), the lateral collateral specific examination techniques were ligament (LCL), the posterolateral cor- developed before advanced imaging, ner (PLC), and the posterior cruciate and several techniques remain as ligament (PCL), and describe the asso- accurate or more accurate than the ciated anatomy and biomechanics and From the Division of Sports Medicine, new imaging modalities. Advanced the methods that allow for increased Department of Orthopaedics, University of Rochester School of Medicine and imaging (eg, MRI) is appropriate to diagnostic sensitivity and accuracy. -
ENU Mutagenesis Identifies Mice Modeling Warburg Micro Syndrome
Experimental Neurology 267 (2015) 143–151 Contents lists available at ScienceDirect Experimental Neurology journal homepage: www.elsevier.com/locate/yexnr Regular Article ENU mutagenesis identifies mice modeling Warburg Micro Syndrome with sensory axon degeneration caused by a deletion in Rab18 Chih-Ya Cheng a, Jaw-Ching Wu a,b,c,Jin-WuTsaid,e, Fang-Shin Nian d,Pei-ChunWue,f, Lung-Sen Kao e,f, Ming-Ji Fann e,f, Shih-Jen Tsai g,h, Ying-Jay Liou g,h,Chin-YinTaii, Chen-Jee Hong d,g,h,⁎ a Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan b Institute of Clinical Medicine and Cancer Research Center, National Yang-Ming University, Taipei, Taiwan c Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan d Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan e Brain Research Center, National Yang-Ming University, Taipei, Taiwan f Department of Life Sciences and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan g Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan h Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan i Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan article info abstract Article history: Mutations in the gene of RAB18, a member of Ras superfamily of small G-proteins, cause Warburg Micro Syn- Received 21 December 2014 drome (WARBM) which is characterized by defective neurodevelopmental and ophthalmological phenotypes. Accepted 5 March 2015 Despite loss of Rab18 had been reported to induce disruption of the endoplasmic reticulum structure and neuro- Available online 13 March 2015 nal cytoskeleton organization, parts of the pathogenic mechanism caused by RAB18 mutation remain unclear. -
General Physical Examination
BLSA Operations Manual Volume I Section IV, page 1 GENERAL PHYSICAL EXAMINATION 1. Background and Rationale The physical examination is an important component of translational research. It yields noninvasive, inexpensive and informative data that contributes to clinically relevant diagnoses, prognosis, and assessment of risk. In addition, the physical examination is important to participants and promotes recruitment and retention in the study. 1.1 Objective The objectives of the physical examination are: 1) To document physical findings in the cardiovascular, musculoskeletal and nervous systems that are related to mobility in older adults 2) To screen participants for testing exclusion criteria to allow safe and meaningful completion of performance testing 1.1 Recommended Instrument(s) 1.2 Strengths and weaknesses of selected approach The strengths of the physical examination include ease of performance, non- invasive nature (i.e. low risk), and direct contact with participants. The weakness of the physical examination, in general, is related to the potential variation in assessment measures and the level of expertise of examiners, the lack of standardized assessment methods for research, and the subjective nature. These effects can be limited by implementing standardized protocols using published techniques when available, utilizing experienced nurse practitioners (NPs) and physicians, training the examiners in standardized fashion, and incorporating ongoing quality control programs that include direct observation and certification. 1.3 Analagous (past) measures used in the BLSA This is the first version of a fully standardized physical examination protocol that has undergone rigorous training, certification processes, monitoring and quality control checks. 1.4 Reliability/Validity Studies Limited studies are available on performing the physical examination for Version 1.0 BLSA Operations Manual Volume I Section IV, page 2 research purposes. -
Medical Student + Survival Skills
https://t.me/MBS_MedicalBooksStore Medical Student + Survival Skills History Taking and Communication Skills Medical Student + Survival Skills History Taking and Communication Skills Philip Jevon RN BSc(Hons) PGCE Academy Manager/Tutor Walsall Teaching Academy, Manor Hospital, Walsall, UK Steve Odogwu FRCS Consultant, General Surgery, Senior Academy Tutor Walsall Teaching Academy, Manor Hospital, Walsall, UK Consulting Editors Jonathan Pepper BMedSci BM BS FRCOG MD FAcadMEd Consultant Obstetrics and Gynaecology, Head of Academy Walsall Healthcare NHS Trust, Manor Hospital, Walsall, UK Jamie Coleman MBChB MD MA(Med Ed) FRCP FBPhS Professor in Clinical Pharmacology and Medical Education / MBChB Deputy Programme Director School of Medicine, University of Birmingham, Birmingham, UK 0004265133.INDDChapter No.: 7 Title 3 Name: Jevon3 03/07/2019 1:01:46 PM This edition first published 2020 © 2020 by John Wiley & Sons Ltd All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions. The right of Philip Jevon and Steve Odogwu to be identified as the authors in this work has been asserted in accordance with law. Registered Office(s) John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Office 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.