SMALL GROUP SESSION 16 January 8 th or 10 th. Shoulder pain case/ Touch workshop/ Upper and Lower Extremity Examination

Size: px
Start display at page:

Download "SMALL GROUP SESSION 16 January 8 th or 10 th. Shoulder pain case/ Touch workshop/ Upper and Lower Extremity Examination"

Transcription

1 SMALL GROUP SESSION 16 January 8 th or 10 th Shoulder pain case/ Touch workshop/ Upper and Lower Extremity Examination Suggested Readings: Opatrny L. The Healing Touch. Ann Int Med 2002; 137: Complete the modules at the course web-site: Principles of Musculoskeletal Exam and the Upper Extremity Exam Lower Extremity Exam Optional: Mosby s Guide to Physical Diagnosis- Chapters on Upper & Lower Extremity Prepare by: Wearing clothing for examining each others shoulders and upper extremities and lower extremities (tank tops, loose T-shirts, gym shorts). Someone should bring anatomy text and atlas. It will be helpful! Brief Outline: Section 1: Section 2: Section 3: Touch Base (20 minutes) Case Discussion: A Patient with Shoulder Pain (60 minutes) Upper and Lower Extremity Exam (Discussion 25 minutes, Examination 60 minutes) Section 4: Evaluate Session (15 minutes). 1

2 Section 1: Touch Base (20 minutes) Welcome back from break! Section 2: A Patient with Shoulder Pain (Case Discussion 60 minutes) Objectives: 1. To begin to develop an approach to analyzing a clinical case. 2. To apply knowledge of shoulder anatomy Logistics: 1. Mentors hand out cases. One student should read the history. Stop and discuss. Then read the physical exam. Continue discussion. 2. One person the scribe will take notes on the board. We suggest that a mentor be scribe for this session, and that you write findings or questions in several columns: History Physical findings Anatomy Issues (physician, patient, ethical) Diagnostic possibilities Laboratory and test findings, if any 3. At the end of the discussion, choose learning objectives raised by your case discussion that you would like to research and report to the group next week. 2

3 Case Summary: A Patient with Shoulder Pain Chief Complaint: Shoulder pain HPI: The patient is a 40y/o old right-handed man who injured his right shoulder last weekend. He was skiing with his new girlfriend and fell and hurt his arm. He had planted his ski pole for a sharp turn just as he hit a patch of ice, and his arm was jerked upwards as he fell. He experienced immediate severe tearing pain in his right shoulder and wasn t able to move it fully due to the pain. He was not able to ski for the rest of the weekend. The pain is now aching, 8/10 in severity, radiating half way down the arm, worse when attempting to use the arm and worse when lying on the right side at night. The patient is 40 years old and works in an auto parts store. He played softball in high school and continued to pitch periodically in a community intramural softball league. The patient is back at work and rather frustrated due to the pain and limited shoulder mobility. His supervisor advised him to see a doctor. Begin Discussion What structures could be affected by this injury? What might you expect to see on physical exam? What affects might this injury have on this person s quality of life? 3

4 Physical examination: (from the examiner s perspective) His painful shoulder looks just like the other one. He has good muscle strength in his proximal (upper) arm muscles when his arm hangs at his side. He has tenderness at the lateral (outside) right shoulder. You can move his shoulder fully, but he winces when you raise his arm sideways from the body with the shoulder between 60 and 120 degrees. When you hold the arm raised at 90 degrees (straight out from the shoulder) and let go, it falls (a positive drop arm test). He says it isn t only pain that keeps him from holding his arm up; he just can t. A few suggested questions: 1. What could these physical findings mean? 2. What could have happened to his shoulder? Think of the specific bones, joints, ligaments and muscles that might have been injured. 3. How might you be able to find out what is the matter? 4. How might this injury affect him? 4

5 Case Summary: A Patient with Shoulder Pain Chief Complaint: Shoulder pain HPI: The patient is a 40y/o old right-handed man who injured his right shoulder last weekend. He was skiing with his new girlfriend and fell and hurt his arm. He had planted his ski pole for a sharp turn just as he hit a patch of ice, and his arm was jerked upwards as he fell. He experienced immediate severe tearing pain in his right shoulder and wasn t able to move it fully due to the pain. He was not able to ski for the rest of the weekend. The pain is now aching, 8/10 in severity, radiating half way down the arm, worse when attempting to use the arm and worse when lying on the right side at night. The patient is 40 years old and works in an auto parts store. He played softball in high school and continued to pitch periodically in a community intramural softball league. The patient is back at work and rather frustrated due to the pain and limited shoulder mobility. His supervisor advised him to see a doctor. Begin Discussion What structures could be affected by this injury? What might you expect to see on physical exam? What affects might this injury have on this person s quality of life? 5

6 Physical examination: (from the examiner s perspective) His painful shoulder looks just like the other one. He has good muscle strength in his proximal (upper) arm muscles when his arm hangs at his side. He has tenderness at the lateral (outside) right shoulder. You can move his shoulder fully, but he winces when you raise his arm sideways from the body with the shoulder between 60 and 120 degrees. When you hold the arm raised at 90 degrees (straight out from the shoulder) and let go, it falls (a positive drop arm test). He says it isn t only pain that keeps him from holding his arm up; he just can t. A few suggested questions: 1. What could these physical findings mean? 2. What could have happened to his shoulder? Think of the specific bones, joints, ligaments and muscles that might have been injured. 3. How might you be able to find out what is the matter? 4. How might this injury affect him? 6

7 Case Summary: A Patient with Shoulder Pain Chief Complaint: Shoulder pain HPI: The patient is a 40y/o old right-handed man who injured his right shoulder last weekend. He was skiing with his new girlfriend and fell and hurt his arm. He had planted his ski pole for a sharp turn just as he hit a patch of ice, and his arm was jerked upwards as he fell. He experienced immediate severe tearing pain in his right shoulder and wasn t able to move it fully due to the pain. He was not able to ski for the rest of the weekend. The pain is now aching, 8/10 in severity, radiating half way down the arm, worse when attempting to use the arm and worse when lying on the right side at night. The patient is 40 years old and works in an auto parts store. He played softball in high school and continued to pitch periodically in a community intramural softball league. The patient is back at work and rather frustrated due to the pain and limited shoulder mobility. His supervisor advised him to see a doctor. Begin Discussion What structures could be affected by this injury? What might you expect to see on physical exam? What affects might this injury have on this person s quality of life? 7

8 Physical examination: (from the examiner s perspective) His painful shoulder looks just like the other one. He has good muscle strength in his proximal (upper) arm muscles when his arm hangs at his side. He has tenderness at the lateral (outside) right shoulder. You can move his shoulder fully, but he winces when you raise his arm sideways from the body with the shoulder between 60 and 120 degrees. When you hold the arm raised at 90 degrees (straight out from the shoulder) and let go, it falls (a positive drop arm test). He says it isn t only pain that keeps him from holding his arm up; he just can t. A few suggested questions: 1. What could these physical findings mean? 2. What could have happened to his shoulder? Think of the specific bones, joints, ligaments and muscles that might have been injured. 3. How might you be able to find out what is the matter? 4. How might this injury affect him? 8

9 Case Summary: A Patient with Shoulder Pain Chief Complaint: Shoulder pain HPI: The patient is a 40y/o old right-handed man who injured his right shoulder last weekend. He was skiing with his new girlfriend and fell and hurt his arm. He had planted his ski pole for a sharp turn just as he hit a patch of ice, and his arm was jerked upwards as he fell. He experienced immediate severe tearing pain in his right shoulder and wasn t able to move it fully due to the pain. He was not able to ski for the rest of the weekend. The pain is now aching, 8/10 in severity, radiating half way down the arm, worse when attempting to use the arm and worse when lying on the right side at night. The patient is 40 years old and works in an auto parts store. He played softball in high school and continued to pitch periodically in a community intramural softball league. The patient is back at work and rather frustrated due to the pain and limited shoulder mobility. His supervisor advised him to see a doctor. Begin Discussion What structures could be affected by this injury? What might you expect to see on physical exam? What affects might this injury have on this person s quality of life? 9

10 Physical examination: (from the examiner s perspective) His painful shoulder looks just like the other one. He has good muscle strength in his proximal (upper) arm muscles when his arm hangs at his side. He has tenderness at the lateral (outside) right shoulder. You can move his shoulder fully, but he winces when you raise his arm sideways from the body with the shoulder between 60 and 120 degrees. When you hold the arm raised at 90 degrees (straight out from the shoulder) and let go, it falls (a positive drop arm test). He says it isn t only pain that keeps him from holding his arm up; he just can t. A few suggested questions: 1. What could these physical findings mean? 2. What could have happened to his shoulder? Think of the specific bones, joints, ligaments and muscles that might have been injured. 3. How might you be able to find out what is the matter? 4. How might this injury affect him? 10

11 Case Summary: A Patient with Shoulder Pain Chief Complaint: Shoulder pain HPI: The patient is a 40y/o old right-handed man who injured his right shoulder last weekend. He was skiing with his new girlfriend and fell and hurt his arm. He had planted his ski pole for a sharp turn just as he hit a patch of ice, and his arm was jerked upwards as he fell. He experienced immediate severe tearing pain in his right shoulder and wasn t able to move it fully due to the pain. He was not able to ski for the rest of the weekend. The pain is now aching, 8/10 in severity, radiating half way down the arm, worse when attempting to use the arm and worse when lying on the right side at night. The patient is 40 years old and works in an auto parts store. He played softball in high school and continued to pitch periodically in a community intramural softball league. The patient is back at work and rather frustrated due to the pain and limited shoulder mobility. His supervisor advised him to see a doctor. Begin Discussion What structures could be affected by this injury? What might you expect to see on physical exam? What affects might this injury have on this person s quality of life? 11

12 Physical examination: (from the examiner s perspective) His painful shoulder looks just like the other one. He has good muscle strength in his proximal (upper) arm muscles when his arm hangs at his side. He has tenderness at the lateral (outside) right shoulder. You can move his shoulder fully, but he winces when you raise his arm sideways from the body with the shoulder between 60 and 120 degrees. When you hold the arm raised at 90 degrees (straight out from the shoulder) and let go, it falls (a positive drop arm test). He says it isn t only pain that keeps him from holding his arm up; he just can t. A few suggested questions: 1. What could these physical findings mean? 2. What could have happened to his shoulder? Think of the specific bones, joints, ligaments and muscles that might have been injured. 3. How might you be able to find out what is the matter? 4. How might this injury affect him? 12

13 Case Summary: A Patient with Shoulder Pain Chief Complaint: Shoulder pain HPI: The patient is a 40y/o old right-handed man who injured his right shoulder last weekend. He was skiing with his new girlfriend and fell and hurt his arm. He had planted his ski pole for a sharp turn just as he hit a patch of ice, and his arm was jerked upwards as he fell. He experienced immediate severe tearing pain in his right shoulder and wasn t able to move it fully due to the pain. He was not able to ski for the rest of the weekend. The pain is now aching, 8/10 in severity, radiating half way down the arm, worse when attempting to use the arm and worse when lying on the right side at night. The patient is 40 years old and works in an auto parts store. He played softball in high school and continued to pitch periodically in a community intramural softball league. The patient is back at work and rather frustrated due to the pain and limited shoulder mobility. His supervisor advised him to see a doctor. Begin Discussion What structures could be affected by this injury? What might you expect to see on physical exam? What affects might this injury have on this person s quality of life? 13

14 Physical examination: (from the examiner s perspective) His painful shoulder looks just like the other one. He has good muscle strength in his proximal (upper) arm muscles when his arm hangs at his side. He has tenderness at the lateral (outside) right shoulder. You can move his shoulder fully, but he winces when you raise his arm sideways from the body with the shoulder between 60 and 120 degrees. When you hold the arm raised at 90 degrees (straight out from the shoulder) and let go, it falls (a positive drop arm test). He says it isn t only pain that keeps him from holding his arm up; he just can t. A few suggested questions: 1. What could these physical findings mean? 2. What could have happened to his shoulder? Think of the specific bones, joints, ligaments and muscles that might have been injured. 3. How might you be able to find out what is the matter? 4. How might this injury affect him? 14

15 Case Summary: A Patient with Shoulder Pain Chief Complaint: Shoulder pain HPI: The patient is a 40y/o old right-handed man who injured his right shoulder last weekend. He was skiing with his new girlfriend and fell and hurt his arm. He had planted his ski pole for a sharp turn just as he hit a patch of ice, and his arm was jerked upwards as he fell. He experienced immediate severe tearing pain in his right shoulder and wasn t able to move it fully due to the pain. He was not able to ski for the rest of the weekend. The pain is now aching, 8/10 in severity, radiating half way down the arm, worse when attempting to use the arm and worse when lying on the right side at night. The patient is 40 years old and works in an auto parts store. He played softball in high school and continued to pitch periodically in a community intramural softball league. The patient is back at work and rather frustrated due to the pain and limited shoulder mobility. His supervisor advised him to see a doctor. Begin Discussion What structures could be affected by this injury? What might you expect to see on physical exam? What affects might this injury have on this person s quality of life? 15

16 Physical examination: (from the examiner s perspective) His painful shoulder looks just like the other one. He has good muscle strength in his proximal (upper) arm muscles when his arm hangs at his side. He has tenderness at the lateral (outside) right shoulder. You can move his shoulder fully, but he winces when you raise his arm sideways from the body with the shoulder between 60 and 120 degrees. When you hold the arm raised at 90 degrees (straight out from the shoulder) and let go, it falls (a positive drop arm test). He says it isn t only pain that keeps him from holding his arm up; he just can t. A few suggested questions: 1. What could these physical findings mean? 2. What could have happened to his shoulder? Think of the specific bones, joints, ligaments and muscles that might have been injured. 3. How might you be able to find out what is the matter? 4. How might this injury affect him? 16

17 SECTION 3: UPPER AND LOWER EXTREMITY EXAMINATION AND TOUCH WORKSHOP (Discussion 25 minutes, Examination 60 minutes) Objectives: 1. To discuss the role of touch in physician-patient interactions 2. To discuss how to approach a patient from a different culture about issues related to the physical examination 3. To learn the upper and lower extremity examination 1. Touch workshop: In examining the upper and lower extremity, you will be touching each other in a medical context. Before doing this, take a few minutes to discuss touch. Long before physicians and modern medicine, touch has been associated with healing. It can be a literal way to make contact and express caring, as well as one of a physician s tools to diagnose disease. Touch also has different meanings in different cultures. For example: some of you may feel uncomfortable, for cultural or personal reasons, being touched by someone of opposite (or the same) gender. If so, tell your mentors! Some things you may want to discuss before you touch each other: 1. What is your own reaction to touch by a stranger? By a friend? By a doctor? 2. How do your family background, cultural context and individual personality contribute to your reaction to touch? 3. What potential issues might arise during examination of an individual from another culture? How should this be approached? 4. How do you feel about touching others when you are the examiner? Do particular situations make you more or less uncomfortable? 5. As you are examined during this session: how do you feel? Why? 17

18 EXTREMITY EXAMINATION Review the following characteristics assessed during a musculoskeletal exam: range of motion signs of inflammation (redness, warmth, swelling, pain) crepitus deformities condition of surrounding tissues muscular strength symmetry Review the techniques used to evaluate the joints and surrounding soft tissues: inspection active range of motion palpation passive range of motion strength testing special maneuvers UPPER EXTREMITY EXAMINATION: This will include: inspection, range of motion, palpation, and strength, as well as a few special tests. 1. The shoulder: inspect for symmetry, deformity and discoloration do range of motion: abduction, adduction, flexion, extension, internal rotation, external rotation palpate surface landmarks: the scapular spine, acromion, acromioclavicular joint, clavicle and bicipital groove assess strength: ask patient to shrug shoulders, flex shoulder and abduct shoulder against your resistance. 2. The elbow: inspect for symmetry, deformity and discoloration do range of motion: flexion, extension, pronation, supination palpate for swelling or tenderness; palpate for crepitus during motion assess strength: have patient flex and extend elbow against resistance Maneuvers of the elbow: palpate for tenderness at the lateral epicondyle (a sign of lateral epicondylitis tennis elbow ) and medial epicondyle. 18

19 3. The wrist and hand: inspect for symmetry, deformity and discoloration; assess thenar and hypothenar eminence do range of motion: flexion, extension, flexion toward the ulna and toward the radius, flexion and extension at metacarpophalangeal (MCP) joints, and make a fist palpate wrist, carpometacarpal (CMC), MCP and proximal interphalangeal (PIP) joints for swelling or tenderness assess strength: have patient flex and extend wrist against resistance, grip your fingers, abduct fingers and hold together thumb and small finger (opposition) against resistance Special maneuvers of the wrist (optional): Tinel s sign: tap on the palmar side of the wrist; in carpal tunnel syndrome, this elicits pain and tingling into the hand Phalen s sign: patient holds wrist flexed at 90 degrees for one minute. In carpal tunnel syndrome, this causes pain and tingling in the hand 19

20 LOWER EXTREMITY EXAMINATION Goal: To learn how to examine the lower extremity, with a special emphasis on the examination of the knee. Objectives: A. Describe and demonstrate the examination (inspection, palpation, range of motion) of normal joints of the lower extremity: foot and ankle: tibiotalar, subtalar, transverse tarsal and metatarsophalangeal joints knee hip, including assessment of proximal muscle strength through observation of standing from a sitting position B. Describe and demonstrate and know the significance of the following components of the knee exam: Lachman test and anterior drawer tests posterior drawer tests varus and valgus stress McMurray test Exam: 1. The hip and pelvis: assess strength: ask patient to stand from a sitting position inspect for symmetry, deformity and discoloration while standing palpate surface landmarks: palpate the iliac crest and greater trochanter do passive range of motion: abduction, adduction, flexion, extension, internal rotation, external rotation of the hip 2. The knee: inspect for symmetry, deformity and discoloration palpate for swelling or tenderness along the joint lines, the patella and the popliteal space. Palpate for crepitus during motion do range of motion: flexion and extension assess strength: have patient flex and extend knee against resistance Maneuvers of the knee o Assess mediolateral instability: support leg and stabilize knee. Apply a varus and valgus stress, and evaluate the lateral and medial collateral ligaments, respectively, for pain or laxity o Assess cruciate ligament: Flex knee to 30 (Lachmann) or to 90 (anterior drawer), stabilize the lower leg, and pull the lower leg towards you and watch for anterior movement of the tibia. With the leg flexed to 90 and while stabilizing the lower leg, push the 20

21 lower leg towards the patient while assessing for posterior movement of the tibia (posterior drawer). o Assess meniscal cartilage (McMurray test): flex knee and hip, support knee with one hand. With other hand internally rotate and extend knee, then flex knee and externally rotate and extend knee. Feel for pain and/or a popping sensation. 3. The foot and ankle: inspect for symmetry, deformity and discoloration palpate achilles tendon, lateral and medial malleoli and mid-foot and forefoot. do range of motion: extension (plantar flexion), flexion (dorsiflexion), inversion (adduction) and eversion (abduction). assess strength: have patient plantar flex, dorsiflex, evert and invert foot against resistance. SECTION 4: Evaluate Session (15 minutes) Continue the touch discussion. What was it like examining a classmate? Being examined by a classmate? How will examining a patient be different? 21

22 Physical Diagnosis Objective Structured Clinical Examination (OSCE) Upper Extremity Exam A = Attempted Satisfactory B = Attempted Below Satisfactory C = Did Not Attempt Procedure A B C Comments 1. SHOULDER Inspection: Assess symmetry, deformity and discoloration. (Ex states what they are inspecting for) 2. SHOULDER Range of motion: Examiner asks patient to flex, extend, abduct (full arc), internally rotate (elbow flexed, thumb at opposite scapula) and externally rotate (elbow flexed, hands out at sides or behind head) both shoulders. 3. SHOULDER Palpation: Ex. palpates scapular spine, acromion process, acromioclavicular joint and bicipital groove (one side OK). 4. SHOULDER Strength: Ex resists patient while patient shrugs shoulders, flexes shoulder forward and abducts shoulder. 5. ELBOW Inspection: Assesses symmetry, deformity and discoloration. (Ex states what they are inspecting for) 6. ELBOW Range of motion: Pt. flexes, extends, pronates, (elbow at 90, palm down) and supinates (elbow at 90, palm up) both elbows. 7. ELBOW Palpation: Ex. palpates lateral epicondyle, medial epicondyle and olecranon process (one side OK). 8. ELBOW Strength: Ex. resists patient while patient flexes and extends elbow. 9. WRIST and HAND Inspection: Assesses symmetry, deformity and discoloration. Assesses thenar and hypothenar eminence. (Ex states what they are inspecting for) 10. WRIST and HAND Range of motion: Pt flexes and extends wrist. Pt moves hand to ulnar and radial sides. Pt flexes and extends fingers at MCP joint with fingers straight, and makes fist. 11. WRIST and HAND Palpation: Ex. palpates wrist, CMC, MCP and PIP joints. 12. WRIST and HAND Strength: Ex. resists patient while patient flexes and extends wrist, assesses grip strength, resists finger abduction, and resists opposition of thumb and small finger. 22

23 Physical Examination Objective Structured Clinical Examination (OSCE) Lower Extremity Exam A = Attempted Satisfactory B = Attempted Below Satisfactory C = Did Not Attempt Procedure A B C Comments 1. INSPECTION: a. Examiner assesses strength of hip muscles by asking patient to rise from chair. b. Examiner assesses hips, knees, ankles and feet for symmetry, deformity and discoloration while patient is standing. 2. HIP Palpate: Ex palpates iliac crest and greater trochanter. 3. HIP Range of motion: (Passive) a. Flexion with the patient supine, Ex flexes the patient s hip with knee bent. b. Extension (prone or standing) Ex extends patient s hip. c. Adduction and abduction with patient supine, Ex adducts and abducts patient s hip. d. Internal and external rotation with patient supine and knee flexed to ~90, Ex internally and externally rotates patient s hip. 4. KNEE Inspect: Ex inspects knee with patient supine for swelling and discoloration. 5. KNEE Palpate: Ex palpates popliteal space, tibiofemoral joint space laterally and medially, and patella. 6. KNEE Range of motion: Ex asks patient to flex and extend knee. 7. KNEE Strength: Ex resists patient while patient flexes and extends knee. 8. KNEE Special maneuvers: a. Mediolateral instability Ex flexes knee to 30 and applies varus and valgus stress to knee, assessing for medial and lateral laxity. b. Cruciate ligament: Lachman test Ex flexes knee to 20 to 30, grasps the distal thigh above the patella with one hand (thumb should wrap over thigh just above patella), grasps proximal tibia with other hand and pulls tibia anteriorly. -or- Cruciate ligament: Drawer test Ex flexes knee to 90, stabilizes foot by lightly sitting on it, and pulls tibia anteriorly for anterior drawer test, and also pushes posteriorly for posterior test. (Ex may choose which cruciate test to perform) 23

24 c. McMurray test (included only for small group use, not for testing) Ex flexes knee completely, encircles joint space with thumb and index finger, rotates foot laterally, and extends knee. Maneuver should be repeated with medial rotation of foot. 9. ANKLE and FOOT Inspection: Ex inspects feet and ankles without shoes or socks for deformity or discoloration. 10. ANKLE and FOOT Palpation: Ex palpates Achilles tendon, lateral and medial malleoli and forefoot. 11. ANKLE and FOOT Range of motion: Ex asks patient to dorsiflex, plantar flex, evert and invert the ankle. 12. ANKLE and FOOT Strength: Ex resists patient while patient dorsiflexes and plantar flexes ankle. Ex also resists inversion and eversion. 24

SMALL GROUP SESSION 16 January 8 th or 10 th Shoulder pain case/ Touch workshop/ Upper and Lower Extremity Examination

SMALL GROUP SESSION 16 January 8 th or 10 th Shoulder pain case/ Touch workshop/ Upper and Lower Extremity Examination SMALL GROUP SESSION 16 January 8 th or 10 th Shoulder pain case/ Touch workshop/ Upper and Lower Extremity Examination Suggested Readings: Opatrny L. The Healing Touch. Ann Int Med 2002; 137:1003. http://www.annals.org/cgi/reprint/137/12/1003.pdf

More information

SMALL GROUP SESSION 21B February 10 th or February 12 th. Lower Extremity Examination and Ethics Case Discussion

SMALL GROUP SESSION 21B February 10 th or February 12 th. Lower Extremity Examination and Ethics Case Discussion SMALL GROUP SESSION 21B February 10 th or February 12 th Lower Extremity Examination and Ethics Case Discussion Suggested Readings: Opatrny L. The Healing Touch. Ann Int Med 2002; 137:1003. http://www.annals.org/cgi/reprint/137/12/1003.pdf

More information

Musculoskeletal Examination

Musculoskeletal Examination Musculoskeletal Examination Statement of Goals Know how to perform a complete musculoskeletal examination. Learning Objectives A. Describe the anatomy of the musculoskeletal system including the bony structures,

More information

SMALL GROUP SESSION 8 October 21st or October 23 rd. Narratives Discussion/ OSCE Practice

SMALL GROUP SESSION 8 October 21st or October 23 rd. Narratives Discussion/ OSCE Practice SMALL GROUP SESSION 8 October 21st or October 23 rd Narratives Discussion/ OSCE Practice Readings: Review your upper extremity, blood pressure and chest/lung OSCEs; Read Rita Charon s Narrative Medicine:

More information

Musculoskeletal Examination Benchmarks

Musculoskeletal Examination Benchmarks Musculoskeletal Examination Benchmarks _ The approach to examining the musculoskeletal system is the same no matter what joint or limb is being examined. The affected and contralateral region should both

More information

Sick Call Screener Course

Sick Call Screener Course Sick Call Screener Course Musculoskeletal System Upper Extremities (2.7) 2.7-2-1 Enabling Objectives 1.46 Utilize the knowledge of musculoskeletal system anatomy while assessing a patient with a musculoskeletal

More information

Examination of the Knee

Examination of the Knee Examination of the Knee Wash your hands & Introduce the exam to the patient Positioning & Draping With the patient supine, make sure both legs are exposed in order to compare each side be sure to use draping

More information

Copyright 2004, Yoshiyuki Shiratori. All right reserved.

Copyright 2004, Yoshiyuki Shiratori. All right reserved. Ankle and Leg Evaluation 1. History Chief Complaint: A. What happened? B. Is it a sharp or dull pain? C. How long have you had the pain? D. Can you pinpoint the pain? E. Do you have any numbness or tingling?

More information

Evidence-Based Examination of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs

Evidence-Based Examination of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs Evidence-Based Examination of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs Module Five: Movement Assessment of the Foot/Ankle (1 hour CEU Time) Skilled

More information

Types of Body Movements

Types of Body Movements Types of Body Movements Bởi: OpenStaxCollege Synovial joints allow the body a tremendous range of movements. Each movement at a synovial joint results from the contraction or relaxation of the muscles

More information

Elbow Anatomy, Growth and Physical Exam. Donna M. Pacicca, MD Section of Sports Medicine Division of Orthopaedic Surgery Children s Mercy Hospital

Elbow Anatomy, Growth and Physical Exam. Donna M. Pacicca, MD Section of Sports Medicine Division of Orthopaedic Surgery Children s Mercy Hospital Elbow Anatomy, Growth and Physical Exam Donna M. Pacicca, MD Section of Sports Medicine Division of Orthopaedic Surgery Children s Mercy Hospital Contributing Factors to Elbow Injury The elbow is affected

More information

RN(EC) ENC(C) GNC(C) MN ACNP *** MECHANISM OF INJURY.. MOST IMPORTANT *** - Useful in determining mechanism of injury / overuse

RN(EC) ENC(C) GNC(C) MN ACNP *** MECHANISM OF INJURY.. MOST IMPORTANT *** - Useful in determining mechanism of injury / overuse HISTORY *** MECHANISM OF INJURY.. MOST IMPORTANT *** Age of patient Sport / Occupation - Certain conditions are more prevalent in particular age groups (Osgood Schlaters in youth / Degenerative Joint Disease

More information

BIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY

BIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY BIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY B.Resseque, D.P.M. ARCH HEIGHT OFF WEIGHTBEARING Evaluate arch height by placing a ruler from the heel to the first metatarsal head Compare arch

More information

Terms of Movements by Prof. Dr. Muhammad Imran Qureshi

Terms of Movements by Prof. Dr. Muhammad Imran Qureshi Terms of Movements by Prof. Dr. Muhammad Imran Qureshi Three systems of the body work in coordination to perform various movements of the body. These are: A System of Bones (Osteology), A System of Muscles

More information

Movement Terminology. The language of movement is designed to allow us to describe how the body moves through space.

Movement Terminology. The language of movement is designed to allow us to describe how the body moves through space. Movement Terminology The language of movement is designed to allow us to describe how the body moves through space. In exercise it allows us to communicate with other movement professionals so we can describe

More information

Radiographic Positioning Summary (Basic Projections RAD 222)

Radiographic Positioning Summary (Basic Projections RAD 222) Lower Extremity Radiographic Positioning Summary (Basic Projections RAD 222) AP Pelvis AP Hip (Unilateral) (L or R) AP Femur Mid and distal AP Knee Lateral Knee Pt lies supine on table Align MSP to Center

More information

Physical Exam. Jared Van Der Beek. Basics To Remember. Know the anatomy and how the muscles function.

Physical Exam. Jared Van Der Beek. Basics To Remember. Know the anatomy and how the muscles function. Physical Exam Jared Van Der Beek Jared@physio-puncture.com 1 Basics To Remember Know the anatomy and how the muscles function. Know what the special tests are looking for and understand why they are positive.

More information

Physical Examination of the Knee

Physical Examination of the Knee History: Pain Traumatic vs. atraumatic? Acute vs Chronic Previous procedures done on the knee? Swelling, catching, instability General Setup Examine standing, sitting and supine Evaluate gait Examine hip

More information

Knee Injuries. PSK 4U Mr. S. Kelly North Grenville DHS. Medial Collateral Ligament Sprain

Knee Injuries. PSK 4U Mr. S. Kelly North Grenville DHS. Medial Collateral Ligament Sprain Knee Injuries PSK 4U Mr. S. Kelly North Grenville DHS Medial Collateral Ligament Sprain Result from either a direct blow from the lateral side in a medial direction or a severe outward twist Greater injury

More information

Module Eight. Application of Health Assessment NUR 225. Physical examination of Musculoskeletal System. King Saud University. Collage of Nursing

Module Eight. Application of Health Assessment NUR 225. Physical examination of Musculoskeletal System. King Saud University. Collage of Nursing King Saud University Collage of Nursing Medical Surgical Nursing depart Application of Health Assessment NUR 225 Module Eight Physical examination of Musculoskeletal System Obtaining a health history Ask

More information

Physical Examination of the Knee

Physical Examination of the Knee History: Pain Traumatic vs. atraumatic Acute vs Chronic Mechanism of injury Swelling, catching, instability Previous evaluation and treatment General Setup Examine standing, sitting and supine Evaluate

More information

General Procedure and Rules

General Procedure and Rules General Procedure and Rules PROCEDURE Description: This assessment is a measure of upper extremity (UE) and lower extremity (LE) motor and sensory impairment. Equipment: A chair, bedside table, reflex

More information

Physical Examination of the Shoulder

Physical Examination of the Shoulder General setup Patient will be examined in both the seated and supine position so exam table needed 360 degree access to patient Expose neck and both shoulders (for comparison); female in gown or sports

More information

King Saud University College of Nursing Medical-surgical Nursing

King Saud University College of Nursing Medical-surgical Nursing King Saud University College of Nursing Medical-surgical Nursing 1.Obtaining a health history: Ask about chief complain: History of presence of muscle pain (onset, location, Aggravating and alleviating

More information

Elbow. Chapter 2 LISTEN. Mechanism of Injury (If Applicable) Pain

Elbow. Chapter 2 LISTEN. Mechanism of Injury (If Applicable) Pain Chapter 2 Elbow LISTEN Mechanism of Injury (If Applicable) Patient usually remembers their position at the time of injury Certain mechanisms of injury result in characteristic patterns Fall on outstretched

More information

BATES VISUAL GUIDE TO PHYSICAL EXAMINATION. Vol. 16: Musculoskeletal System

BATES VISUAL GUIDE TO PHYSICAL EXAMINATION. Vol. 16: Musculoskeletal System BATES VISUAL GUIDE TO PHYSICAL EXAMINATION Vol. 16: Musculoskeletal System I m Dr. Bickley, it s very nice to meet you, Jason. Nice to meet you. Your learning objectives for mastering the examination of

More information

MLT Muscle(s) Patient Position Therapist position Stabilization Limb Position Picture Put biceps on slack by bending elbow.

MLT Muscle(s) Patient Position Therapist position Stabilization Limb Position Picture Put biceps on slack by bending elbow. MLT Muscle(s) Patient Position Therapist position Stabilization Limb Position Picture Put biceps on slack by bending elbow. Pectoralis Minor Supine, arm at side, elbows extended, supinated Head of Table

More information

CASE ONE CASE ONE. RADIAL HEAD FRACTURE Mason Classification. RADIAL HEAD FRACTURE Mechanism of Injury. RADIAL HEAD FRACTURE Imaging

CASE ONE CASE ONE. RADIAL HEAD FRACTURE Mason Classification. RADIAL HEAD FRACTURE Mechanism of Injury. RADIAL HEAD FRACTURE Imaging CASE ONE An eighteen year old female falls during a basketball game, striking her elbow on the court. She presents to your office that day with a painful, swollen elbow that she is unable to flex or extend

More information

The examination of the painful knee. Maja K Artandi, MD, FACP Clinical Associate Professor of Medicine Stanford University

The examination of the painful knee. Maja K Artandi, MD, FACP Clinical Associate Professor of Medicine Stanford University The examination of the painful knee Maja K Artandi, MD, FACP Clinical Associate Professor of Medicine Stanford University Objectives of the talk By the end of this talk you will know The important anatomy

More information

Connects arm to thorax 3 joints. Glenohumeral joint Acromioclavicular joint Sternoclavicular joint

Connects arm to thorax 3 joints. Glenohumeral joint Acromioclavicular joint Sternoclavicular joint Connects arm to thorax 3 joints Glenohumeral joint Acromioclavicular joint Sternoclavicular joint Scapula Elevation Depression Protraction (abduction) Retraction (adduction) Downward Rotation Upward Rotation

More information

The Language of Anatomy. (Anatomical Terminology)

The Language of Anatomy. (Anatomical Terminology) The Language of Anatomy (Anatomical Terminology) Terms of Position The anatomical position is a fixed position of the body (cadaver) taken as if the body is standing (erect) looking forward with the upper

More information

WEEKEND 2 Elbow. Elbow Range of Motion Assessment

WEEKEND 2 Elbow. Elbow Range of Motion Assessment Virginia Orthopedic Manual Physical Therapy Institute - 2016 Technique Manual WEEKEND 2 Elbow Elbow Range of Motion Assessment - Patient Positioning: Sitting or supine towards the edge of the bed - Indications:

More information

What is the most frequently sprained ligament with inversion ankle sprains? 1/30/2014

What is the most frequently sprained ligament with inversion ankle sprains? 1/30/2014 What is the most frequently sprained ligament with inversion ankle sprains? A. Anterior Talofibular B. Anterior Tibiofibular C. Calcaniofibular D. Posterior Talofibular E. Deltoid Lateral ligaments of

More information

Scar Engorged veins. Size of the foot [In clubfoot, small foot]

Scar Engorged veins. Size of the foot [In clubfoot, small foot] 6. FOOT HISTORY Pain: Walking, Running Foot wear problem Swelling; tingly feeling Deformity Stiffness Disability: At work; recreation; night; walk; ADL, Sports Previous Rx Comorbidities Smoke, Sugar, Steroid

More information

Anatomy and Physiology 2016

Anatomy and Physiology 2016 Anatomy and Physiology 2016 O = Temporal line I = coronoid process (Mandible) A = elevates mandible (chewing) O = galea aponeurotica (layer of dense fibrous tissue which covers the upper part of the cranium)

More information

MUSCULOSKELETAL PHYSICAL EXAMINATION GUIDE FOR GERIATRICIANS Dixie Aragaki, MD Daniel Estrada, MD Updated

MUSCULOSKELETAL PHYSICAL EXAMINATION GUIDE FOR GERIATRICIANS Dixie Aragaki, MD Daniel Estrada, MD Updated MUSCULOSKELETAL PHYSICAL EXAMINATION GUIDE FOR GERIATRICIANS Dixie Aragaki, MD Daniel Estrada, MD Updated 9-21-2017 To facilitate the physical examination for common musculoskeletal ailments, this guide

More information

Occupational Therapy Assessment Guidelines

Occupational Therapy Assessment Guidelines Occupational Therapy Assessment Guidelines DATA BASE Patient's Main Concerns and Goals Patient's problems. - pq!p"*q., Vancouver " i,'" ~;a ;i 5 r,:!. H e a Lt h Prontof~trg u~cllness Rnsurrng car? Mary

More information

Evaluation of the Knee and Shoulder

Evaluation of the Knee and Shoulder Evaluation of the Knee and Shoulder Karen J. Boselli, MD Northeast Regional Nurse Practitioner Conference May 2018 Knee Overview History Examination Top 5 diagnoses When to image When to refer Pain most

More information

BATES VISUAL GUIDE TO PHYSICAL EXAMINATION. OSCE 4: Knee Pain

BATES VISUAL GUIDE TO PHYSICAL EXAMINATION. OSCE 4: Knee Pain BATES VISUAL GUIDE TO PHYSICAL EXAMINATION OSCE 4: Knee Pain This video format is designed to help you prepare for objective structured clinical examinations, or OSCEs. You are going to observe and participate

More information

Hand Anatomy A Patient's Guide to Hand Anatomy

Hand Anatomy A Patient's Guide to Hand Anatomy Hand Anatomy A Patient's Guide to Hand Anatomy Introduction Few structures of the human anatomy are as unique as the hand. The hand needs to be mobile in order to position the fingers and thumb. Adequate

More information

Checklist for Physical Examination of the Knee Muscuoskeletal Block -- Chris McGrew MD, Andrew Ashbaugh DO

Checklist for Physical Examination of the Knee Muscuoskeletal Block -- Chris McGrew MD, Andrew Ashbaugh DO 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

More information

Evidence-Based Examination of the Elbow, Wrist, and Hand

Evidence-Based Examination of the Elbow, Wrist, and Hand Evidence-Based Examination of the Elbow, Wrist, and Hand Presented by Chad Cook, PT, PhD, MBA, FAAOMPT Practice Sessions/Skill Check-offs Chapter Five: Movement Examination of the Elbow, Wrist, and Hand

More information

THE LOWER EXTREMITY EXAM FOR THE FAMILY PRACTITIONER

THE LOWER EXTREMITY EXAM FOR THE FAMILY PRACTITIONER THE LOWER EXTREMITY EXAM FOR THE FAMILY PRACTITIONER Melinda A. Scott, D.O. Orthopedic Associates of Dayton Board Certified in Primary Care Sports Medicine GOALS Identify landmarks necessary for exam of

More information

Evidence- Based Examination of the Shoulder Presented by Eric Hegedus, PT, DPT, MHSC, OCS, CSCS Practice Sessions/Skill Check- offs

Evidence- Based Examination of the Shoulder Presented by Eric Hegedus, PT, DPT, MHSC, OCS, CSCS Practice Sessions/Skill Check- offs Evidence- Based Examination of the Shoulder Practice Session & Skills Check- offs Evidence- Based Examination of the Shoulder Presented by Eric Hegedus, PT, DPT, MHSC, OCS, CSCS Practice Sessions/Skill

More information

Clinical examination of the wrist, thumb and hand

Clinical examination of the wrist, thumb and hand Clinical examination of the wrist, thumb and hand 20 CHAPTER CONTENTS Referred pain 319 History 319 Inspection 320 Functional examination 320 The distal radioulnar joint.............. 320 The wrist.......................

More information

National Boards Part 4 Technique. Exam Format 5 stations (1 doctor and 1 patient). 2 setups per station (5 minutes) cervical

National Boards Part 4 Technique. Exam Format 5 stations (1 doctor and 1 patient). 2 setups per station (5 minutes) cervical 1 National Boards Part 4 Technique Exam Format 5 stations (1 doctor and 1 patient). 2 setups per station (5 minutes) cervical thoracic lumbar pelvic extremity Expect examiner interaction Graded on a Scantron

More information

Wrist and Hand Complaints

Wrist and Hand Complaints Wrist and Hand Complaints Charles S. Day, M.D., M.B.A. Chief, Hand & Upper Extremity Surgery St. Elizabeth s Medical Center Tufts University School of Medicine Primary Care Internal Medicine 2018 Outline

More information

Mastering Your Musculoskeletal Exam Laurel Short, MSN, FNP-c

Mastering Your Musculoskeletal Exam Laurel Short, MSN, FNP-c Mastering Your Musculoskeletal Exam Laurel Short, MSN, FNP-c Disclosure I have no current affiliation or financial interest with any grantor or commercial interests that may have direct interest in the

More information

Body Organizations Flashcards

Body Organizations Flashcards 1. What are the two main regions of the body? 2. What three structures are in the Axial Region? 1. Axial Region (Goes down midline of the body) 2. Appendicular Region (limbs) 3. Axial Region (Goes down

More information

Prevention and Treatment of Injuries. Anatomy. Anatomy. Chapter 20 The Knee Westfield High School Houston, Texas

Prevention and Treatment of Injuries. Anatomy. Anatomy. Chapter 20 The Knee Westfield High School Houston, Texas Prevention and Treatment of Injuries Chapter 20 The Knee Westfield High School Houston, Texas Anatomy MCL, Medial Collateral Ligament LCL, Lateral Collateral Ligament PCL, Posterior Cruciate Ligament ACL,

More information

Goniometry. Wrist Flexion: Pt seated with forearm resting on table (use olecranon process & midline of ulna as reference for stationary arm)

Goniometry. Wrist Flexion: Pt seated with forearm resting on table (use olecranon process & midline of ulna as reference for stationary arm) Goniometry Wrist Flexion: Pt seated with forearm resting on table (use olecranon process & midline of ulna as reference for stationary arm) Wrist Extension: Pt seated with forearm resting on table (Goniometer

More information

BIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY 2017

BIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY 2017 BIOMECHANICAL EXAMINATION OF THE PEDIATRIC LOWER EXTREMITY 2017 B. RESSEQUE, D.P.M., D.A.B.P.O. Professor, N.Y. College of Podiatric Medicine ARCH HEIGHT OFF WEIGHTBEARING Evaluate arch height by placing

More information

10/12/2010. Upper Extremity. Pectoral (Shoulder) Girdle. Clavicle (collarbone) Skeletal System: Appendicular Skeleton

10/12/2010. Upper Extremity. Pectoral (Shoulder) Girdle. Clavicle (collarbone) Skeletal System: Appendicular Skeleton Skeletal System: Appendicular Skeleton Pectoral girdle Pelvic girdle Upper limbs Lower limbs 8-1 Pectoral (Shoulder) Girdle Consists of scapula and clavicle Clavicle articulates with sternum (Sternoclavicular

More information

Chapter 6 part 2. Skeletal Muscles of the Body

Chapter 6 part 2. Skeletal Muscles of the Body Chapter 6 part 2 Skeletal Muscles of the Body Basic Principles 600 + muscles in the human body (you are required to learn 45, lucky kids)! Skeletal Muscles pull on bones Origin of a muscle = point of attachment

More information

Country Health SA Medical Imaging

Country Health SA Medical Imaging Country Health SA Medical Imaging REMOTE OPERATORS POSITIONING GUIDE Contents Image Evaluation Page 4 Positioning Guides Section 1 - THORAX 1.1 Chest Page 5 1.2 Bedside Chest Page 7 1.3 Ribs Page 8 Section

More information

Monster Walk Stand with your feet slightly closer than shoulder-width apart in an athletic stance. Loop an elastic band around your ankles.

Monster Walk Stand with your feet slightly closer than shoulder-width apart in an athletic stance. Loop an elastic band around your ankles. Off-season Lower-Body Tennis Exercises Research conducted on elite tennis players shows that lower-body strength is the same on both the left and right sides. Therefore, lower-body training for tennis

More information

What is Kinesiology? Basic Biomechanics. Mechanics

What is Kinesiology? Basic Biomechanics. Mechanics What is Kinesiology? The study of movement, but this definition is too broad Brings together anatomy, physiology, physics, geometry and relates them to human movement Lippert pg 3 Basic Biomechanics the

More information

IFAST Assessment. Name: Date: Sport: Review Health Risk Assessment on initial consult form. List Client Goals (what brings you here?

IFAST Assessment. Name: Date: Sport: Review Health Risk Assessment on initial consult form. List Client Goals (what brings you here? IFAST Assessment Name: Date: Sport: Review Health Risk Assessment on initial consult form List Client Goals (what brings you here?) Cardiovascular Measurements Blood Pressure Resting Heart Rate Body Composition

More information

Physical examination protocol in the study of VPT and nerve conduction in working women with and without chronic pain

Physical examination protocol in the study of VPT and nerve conduction in working women with and without chronic pain Physical examination protocol in the study of VPT and nerve conduction in working women with and without chronic pain ID number General health OK Affected Height cm Weight kg Heart OK Arrhythmia Murmurs

More information

Lecture Notes The LocomotorSystem. W. P. Howlett 2017

Lecture Notes The LocomotorSystem. W. P. Howlett 2017 Lecture Notes The LocomotorSystem W. P. Howlett 2017 Symptoms Main Symptoms Pain Stiffness Swelling Weakness The History Joints: involved Pain: onset, precipitating& relievingfactors Stiffness: pattern

More information

17a A&P:! Skeletal System - Joint Actions and Articulations

17a A&P:! Skeletal System - Joint Actions and Articulations 17a A&P:! Skeletal System - Joint Actions and Articulations 17a A&P:! Skeletal System - Joint Actions and Articulations! Class Outline" 5 minutes" "Attendance, Breath of Arrival, and Reminders " 10 minutes

More information

RN(EC) ENC(C) GNC(C) MN ACNP *** MECHANISM OF INJURY.. MOST IMPORTANT ***

RN(EC) ENC(C) GNC(C) MN ACNP *** MECHANISM OF INJURY.. MOST IMPORTANT *** HISTORY *** MECHANISM OF INJURY.. MOST IMPORTANT *** Age of patient - Certain conditions are more prevalent in particular age groups (Hip pain in children may refer to the knee from Legg-Calve-Perthes

More information

copyrighted material by PRO-ED, Inc.

copyrighted material by PRO-ED, Inc. Contents Preparation for Functional Sitting Partial Pull to Sit.......................................................... 2 Pull to Sit................................................................ 3

More information

Solving Today s Pain and Injury Puzzle with Erik Dalton An Online Workshop for ABMP Members Session 4 Handout

Solving Today s Pain and Injury Puzzle with Erik Dalton An Online Workshop for ABMP Members Session 4 Handout Solving Today s Pain and Injury Puzzle with Erik Dalton An Online Workshop for ABMP Members Session 4 Handout Please Note: Erik Dalton teaches his Myoskeletal Alignment Techniques with the expectation

More information

BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK Musculoskeletal Anatomy & Kinesiology ROM & GONIOMETRY

BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK Musculoskeletal Anatomy & Kinesiology ROM & GONIOMETRY BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK Musculoskeletal Anatomy & Kinesiology & GONIOMETRY MSAK201-II Session 2 LEARNING OBJECTIVES: By the end of this session, the student will

More information

Balanced Body Movement Principles

Balanced Body Movement Principles Balanced Body Movement Principles How the Body Works and How to Train it. Module 3: Lower Body Strength and Power Developing Strength, Endurance and Power The lower body is our primary source of strength,

More information

Inspection. Physical Examination of the Elbow. Anterior Elbow 2/14/2017. Inspection. Carrying angle. Lateral dimple. Physical Exam of the Elbow

Inspection. Physical Examination of the Elbow. Anterior Elbow 2/14/2017. Inspection. Carrying angle. Lateral dimple. Physical Exam of the Elbow of the Elbow Anthony A. Romeo, MD Professor, Department of Orthopedics Head, Section of Shoulder and Elbow Surgery Rush University President-Elect, American Shoulder Elbow Surgeons Team Physician, Chicago

More information

Elbow. Chapter 2 LISTEN. Mechanism of Injury (If Applicable) Pain

Elbow. Chapter 2 LISTEN. Mechanism of Injury (If Applicable) Pain Preface The first decade of the twenty-first century has witnessed the continuation of an explosion in our knowledge and understanding of all aspects of disease. Accompanying this has been the increasing

More information

1. Occupation; Right or left handed, Age

1. Occupation; Right or left handed, Age SHOULDER HISTORY 1. Occupation; Right or left handed, Age 2. Pain: Site. Any referred pain to the deltoid insertion Any localizing pain at Acromio-clavicular joint How long? Continuous or not Night pain

More information

Module Three: Interventions of the Foot/Ankle

Module Three: Interventions of the Foot/Ankle Evidence-Based Treatment of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs Module Three: Interventions of the Foot/Ankle (75 minutes) Skilled Process a rearfoot

More information

ORTHOSCAN MOBILE DI POSITIONING GUIDE

ORTHOSCAN MOBILE DI POSITIONING GUIDE ORTHOSCAN MOBILE DI POSITIONING GUIDE Table of Contents SHOULDER A/P of Shoulder... 4 Tangential (Y-View) of Shoulder... 5 Lateral of Proximal Humerus... 6 ELBOW A/P of Elbow... 7 Extended Elbow... 8 Lateral

More information

79b Orthopedic Massage: Technique Demo and Practice! Rotator Cuff and Carpal Tunnel!

79b Orthopedic Massage: Technique Demo and Practice! Rotator Cuff and Carpal Tunnel! 79b Orthopedic Massage: Technique Demo and Practice! Rotator Cuff and Carpal Tunnel! 79b Orthopedic Massage: Technique Demo and Practice! Rotator Cuff and Carpal Tunnel! Class Outline" 5 minutes" "Attendance,

More information

Anatomy. Anatomy deals with the structure of the human body, and includes a precise language on body positions and relationships between body parts.

Anatomy. Anatomy deals with the structure of the human body, and includes a precise language on body positions and relationships between body parts. Anatomy deals with the structure of the human body, and includes a precise language on body positions and relationships between body parts. Proper instruction on safe and efficient exercise technique requires

More information

Main Menu. Wrist and Hand Joints click here. The Power is in Your Hands

Main Menu. Wrist and Hand Joints click here. The Power is in Your Hands 1 The Wrist and Hand Joints click here Main Menu K.5 http://www.handsonlineeducation.com/classes/k5/k5entry.htm[3/23/18, 1:40:40 PM] Bones 29 bones, including radius and ulna 8 carpal bones in 2 rows of

More information

UPPER EXTREMITY INJURIES. Recognizing common injuries to the upper extremity

UPPER EXTREMITY INJURIES. Recognizing common injuries to the upper extremity UPPER EXTREMITY INJURIES Recognizing common injuries to the upper extremity ANATOMY BONES Clavicle Scapula Spine of the scapula Acromion process Glenoid fossa/cavity Humerus Epicondyles ANATOMY BONES Ulna

More information

ELBOW - 1 FLEXION: ROM (Supine / Sitting)

ELBOW - 1 FLEXION: ROM (Supine / Sitting) ELBOW - 1 FLEXION: ROM (Supine / Sitting) Position (A) Patient: Place arm against side of trunk. Helper: Hold elbow to stabilize. (B) - Lift hand toward shoulder, palm up. - Keep wrist straight. Do sessions

More information

Biology 325 Fall 2003

Biology 325 Fall 2003 Name: pre-lab exercise due at beginning of your lab session Matching a. fibrous joints b. cartilaginous joints c. synovial joints 1. exhibit a joint cavity 2. types are sutures and syndesmoses 3. bones

More information

Year 2004 Paper one: Questions supplied by Megan

Year 2004 Paper one: Questions supplied by Megan QUESTION 47 A 58yo man is noted to have a right foot drop three days following a right total hip replacement. On examination there is weakness of right ankle dorsiflexion and toe extension (grade 4/5).

More information

80b Orthopedic Massage: Technique Review and Practice! Rotator Cuff and Carpal Tunnel!

80b Orthopedic Massage: Technique Review and Practice! Rotator Cuff and Carpal Tunnel! 80b Orthopedic Massage: Technique Review and Practice! Rotator Cuff and Carpal Tunnel! 80b Orthopedic Massage: Technique Review and Practice! Rotator Cuff and Carpal Tunnel! Class Outline 5 minutes Attendance,

More information

Osteopathic Manipulation for the Knee and Shoulder

Osteopathic Manipulation for the Knee and Shoulder Osteopathic Manipulation for the Knee and Shoulder Carlton A Richie III DO FAAFP CAQ; Sports Medicine Associate Professor; Midwestern University Disclosure Statement Nothing to disclose Learning Objectives

More information

Body Planes & Positions

Body Planes & Positions Learning Objectives Objective 1: Identify and utilize anatomical positions, planes, and directional terms. Demonstrate what anatomical position is and how it is used to reference the body. Distinguish

More information

NHS Training for Physiotherapy Support Workers. Workbook 11 The articular system

NHS Training for Physiotherapy Support Workers. Workbook 11 The articular system NHS Training for Physiotherapy Support Workers Workbook 11 The articular system Contents Workbook 11 The articular system 1 11.1 Aim 3 11.2 Learning outcomes 3 11.3 The articular system 4 11.4 Individual

More information

Unraveling the Mystery of Knee Pain #7: Clinical Applications

Unraveling the Mystery of Knee Pain #7: Clinical Applications Unraveling the Mystery of Knee Pain #7: Clinical Applications 1 Instructor: Ben Benjamin, Ph.D. 2 1 Instructor: Ben Benjamin, Ph.D. www.benbenjamin.com 3 Webinar Goal To stretch and challenge your ability

More information

Post test for O&P 2 Hrs CE. The Exam

Post test for O&P 2 Hrs CE. The Exam Post test for O&P 2 Hrs CE The Exam This examination is taken in "open book" format. That means you are free to answer the questions after research or discussion with your fellow workers. We feel this

More information

Prevention and Treatment of Injuries. Anatomy. Anatomy. Tibia: the second longest bone in the body

Prevention and Treatment of Injuries. Anatomy. Anatomy. Tibia: the second longest bone in the body Prevention and Treatment of Injuries The Ankle and Lower Leg Westfield High School Houston, Texas Anatomy Tibia: the second longest bone in the body Serves as the principle weight-bearing bone of the leg.

More information

An Illustrated Guide For Peripheral Nerve Examination. Bedside Teaching for 2 nd year medical Students

An Illustrated Guide For Peripheral Nerve Examination. Bedside Teaching for 2 nd year medical Students An Illustrated Guide For Peripheral Nerve Examination Bedside Teaching for 2 nd year medical Students Prepared by: Dr. Farid Ghalli Clinical Teacher (Hon) November 2016 Before Examination : Wash hands

More information

Pectoral (Shoulder) Girdle

Pectoral (Shoulder) Girdle Chapter 8 Skeletal System: Appendicular Skeleton Pectoral girdle Pelvic girdle Upper limbs Lower limbs 8-1 Pectoral (Shoulder) Girdle Consists of scapula and clavicle Clavicle articulates with sternum

More information

AAP Boot Camp KNEE AND ANKLE EXAM

AAP Boot Camp KNEE AND ANKLE EXAM AAP Boot Camp KNEE AND ANKLE EXAM Disclosures I have no relevant financial relationships with the manufacturers of any commercial products and or providers of commercial services discussed in this CME

More information

PRIMARY CARE EXAMINATION OF KEY JOINTS. Thomas M. Howard, MD, FACSM FFPC Sports Medicine

PRIMARY CARE EXAMINATION OF KEY JOINTS. Thomas M. Howard, MD, FACSM FFPC Sports Medicine PRIMARY CARE EXAMINATION OF KEY JOINTS Thomas M. Howard, MD, FACSM FFPC Sports Medicine General exam principles: Expose entire joint and opposite limb for comparison Have a Differential Diagnosis Exam

More information

i;l Contents PART I INTRODUCTIOM TO GONIOMETRY, I ~haoter '1 Basic Conceots. 3 Chapter 2 Procedures, 19 Chapter 3 Validity and Reliability, 39

i;l Contents PART I INTRODUCTIOM TO GONIOMETRY, I ~haoter '1 Basic Conceots. 3 Chapter 2 Procedures, 19 Chapter 3 Validity and Reliability, 39 w Contents i;l PART I INTRODUCTIOM TO GONIOMETRY, I ~haoter '1 Basic Conceots. 3 Goniometry, 3 Joint Motion, 4 Arthrokinematics, 4 Osteokinematics, 5 Planes and Axes, 5 Range of Motion, 6 Active Range

More information

Shoulder Dislocation. Explanation. Causes. Symptoms. Treatment. Diagnosis

Shoulder Dislocation. Explanation. Causes. Symptoms. Treatment. Diagnosis Shoulder Dislocation Explanation A dislocated shoulder occurs when the humerus separates from the scapula at the glenohumeral joint, or in simpler terms, the head of the upper arm bone (humerus) is dislodged

More information

Wrist & Hand Assessment and General View

Wrist & Hand Assessment and General View Wrist & Hand Assessment and General View Done by; Mshari S. Alghadier BSc Physical Therapy RHPT 366 m.alghadier@sau.edu.sa http://faculty.sau.edu.sa/m.alghadier/ Functional anatomy The hand can be divided

More information

NEWBORN NURSES POLICY AND PROCEDURES. PURPOSE: Varying positions helps to stimulate physiological functioning and provides rest.

NEWBORN NURSES POLICY AND PROCEDURES. PURPOSE: Varying positions helps to stimulate physiological functioning and provides rest. NEWBORN NURSES POLICY AND PROCEDURES SUBJECT: POSITIONING EFFECTIVE DATE: 6/91 PURPOSE: Varying positions helps to stimulate physiological functioning and provides rest. POLICY: 1. The nurse will vary

More information

Review shoulder anatomy Review the physical exam of the shoulder Discuss some common causes of acute shoulder pain Discuss some common causes of

Review shoulder anatomy Review the physical exam of the shoulder Discuss some common causes of acute shoulder pain Discuss some common causes of Review shoulder anatomy Review the physical exam of the shoulder Discuss some common causes of acute shoulder pain Discuss some common causes of chronic shoulder pain Review with some case questions Bones:

More information

POST OP CLOSED BANKART PROCEDURE

POST OP CLOSED BANKART PROCEDURE POST OP CLOSED BANKART PROCEDURE WEEKS 1-6 Do 1. Wear sling until advised otherwise 2. Keep dressing clean and dry 3. Do passive pendulum exercises to 90 degrees 4. Ice for 15 minutes after exercising

More information

Elbow, Wrist & Hand Evaluation.

Elbow, Wrist & Hand Evaluation. Elbow, Wrist & Hand Evaluation www.fisiokinesiterapia.biz Common Injuries to the Elbow, Wrist, Hand & Fingers Lateral epicondylitis tennis elbow Medial epicondylitis golfer s s elbow, little league elbow

More information

How to Triage Orthopaedic Care. David W. Gray, M.D.

How to Triage Orthopaedic Care. David W. Gray, M.D. How to Triage Orthopaedic Care David W. Gray, M.D. OBJECTIVES: Define basic assessments skills needed to identify orthopedic injuries Differentiate when an orthopedic injury is a medical emergency Determine

More information

History Taking and the Musculoskeletal Examination

History Taking and the Musculoskeletal Examination History Taking and the Musculoskeletal Examination Introduction A thorough rheumatologic assessment is performed within the context of a good general evaluation of the patient. The patient should be undressed

More information