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

Transcription

1 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 Lungs OK Rales Wheeze Blood pressure mmhg Urinary sample OK Glucose NECK Neck without pain Palpation cervical spine Left Right M. Masseter OK Pain OK Pain M. Temporalis OK Pain OK Pain Protuberance occipitalis ext. OK Pain OK Pain M. Trapezius pars descendens OK Pain OK Pain M. Sternocleidomastoideus OK Pain OK Pain If positive findings, register level Processus spinosus OK Pain Intraspinal OK Pain Paravertebral OK Pain left right Range of motion in degrees if not OK can be approximated in 5-degree segments (normal according to Joint Motion). Passive ROM is not examined if active ROM is OK. Definitions and normal values are given in Greene W.B., Heckman J.D., eds. The Clinical Measurement of Joint Motion. 1994, American Academy of Orthopaedic Surgeons Cervical spine Active Degrees (5-90) Passive Degrees (5-90) Rotation, left OK OK Rotation, right OK OK Lateral flexion, left OK OK Lateral flexion, right OK OK Flexion OK OK Extension OK OK Pain at resisted motion Cervical spine Left Right Rotation to the No Yes No Yes Lateral flexion to the No Yes No Yes Flexion No Yes Extension No Yes 1

2 Diagnostic tests Left Right Foramen compression test Negative Positive Negative Positive Cervical spine Lasègue Negative Positive Negative Positive 1. Performed with the patient sitting with his/her head rotated to the right and left with simultaneous lateral flexion to the right and left with a light axial compression. Likelihood ratio of 7 for ruling in nerve or cord compression. The test is positive when radiating pain or tingling in the lower arm and hand are reported by the patient. Red flag rheumatoid arthritis. 2. Performed with the patient sitting, push down the shoulder by axial compression of the acromion with simultaneous lateral flexion of the patient s cervical spine towards the contralateral side. This procedure will extend the plexus and instead of the axial compression of the acromion you can pull down the shoulder with a firm grip at the patient s wrist. The test is positive only if radiating pain or tingling is felt in the forearm, hand and fingers. It is important to perform these two tests at all types of pain, ache or disturbed sensations in the arm, hand and fingers. Traction cervical spine Negative Positive The test is positive if pain arises in the cervical spine. AER (Roos test) Left Right Negative sek Negative sek The abduction external rotation test should be performed for 60 seconds at least (it is also common to perform a 3-minute test). NB. The test is positive when tingling or pain is felt in the forearm, in most cases on the ulnar side. If pain or ache in the neckshoulder angle is perceived by the patient, you can register this but it is does not mean that the test is positive. If there is a colour change in the forearm this should be registered since it could be an indication of possible vascular thoracic outlet syndrome (uncommon). If so, you should place a stethoscope in the supraclavicular fossa during the test to register possible murmurs which could indicate vascular TOS. SHOULDER Shoulder without pain Inspection Muscle atrophy No Yes, what muscles AC/SC joint OK Abnormal Elevated shoulders No Yes, left Yes right Palpation Acromioclavicular OK Pain Processus coracoideus OK Pain The insertion of the short head of the biceps and the minor pectoral muscles Tuberculus majus OK Pain The insertion of the teres minor, the supraspinatus and infraspinatus muscles Tuberculum minus OK Pain The insertion of the teres major and the subscapular muscles Sulcus intertubercularis OK Pain The tendon to the long head of the biceps muscles moves in the sulcus Trapezius pars descendens OK Pain Infraspinatus OK Pain On the scapula Rhomboides OK Pain Between the scapular blades Levator scapulae OK Pain The upper medial corner of the scapula Fossa supraclavicularis OK Pain 2

3 Left shoulder Flexion OK Impaired Abduction OK Impaired Extension OK Impaired Outward rotation OK Impaired Inward rotation OK Impaired Painful arc 1 OK Impaired 1. For the painful arc, register the range of abduction that promotes most symptoms. Right shoulder Flexion OK Impaired Abduction OK Impaired Extension OK Impaired Outward rotation OK Impaired Inward rotation OK Impaired Painful arc 1 OK Impaired 1. For the painful arc, register the range of abduction that promotes most symptoms. Pain at resisted movement Left shoulder Right shoulder Elevation of shoulder girdle No Yes No Yes Abduction (30 o ) No Yes No Yes Flexion No Yes No Yes Extension No Yes No Yes Inward rotation No Yes No Yes Outward rotation No Yes No Yes Bursa test 1 No Yes No Yes AC compression 2 No Yes No Yes 1. One hand pushes under the elbow while the other hand pushes the acromion. 2. Acromioclavicular compression. Horizontal flexion of the arm in the glenohumeral joint. A positive test gives pain in the acromioclavicular area. ELBOW Elbow joint without pain ROM = If not OK, register impaired range of motion in degrees. Elbow Active Degrees (5-180) Passive Degrees (5-180) Flexion, left OK OK Flexion, right OK OK Extension, left OK OK Extension, right OK OK Supination, left OK OK Supination, right OK OK Pronation, left OK OK Pronation, right OK OK Carrying angle Left degrees Right degrees Pain at resisted movement Left Right Force grip No Yes No Yes Extension, wrist No Yes No Yes 3

4 Palpation Left Right Lateral epicondyle OK Pain OK Pain Lateral epicondyle, muscle belly OK Pain OK Pain Medial epicondyle OK Pain OK Pain Medial epicondyle, muscle belly OK Pain OK Pain Frohse s arcade 1 OK Pain OK Pain 1. An opening in M. Supinator where N. Interosseus posterior (N. Radialis) passes with risk of entrapment 2-3 cm from the lateral epicondyle. Normally, you feel tenderness at this point but with an entrapment the patient reports tingling in the forearm down to the dorsum of the hand. Diagnostic tests Left Right Pronator Teres test OK Pain OK Pain Middle finger extension OK Pain OK Pain (Maudsley s test) HAND/WRIST Hand/wrist without pain Inspection (e.g. ganglions) OK Abnormality ROM = If not OK, register impaired range of motion in degrees. Left Right Flexion, wrist OK Impaired OK Impaired Extension, wrist OK Impaired OK Impaired Radial deviation OK Impaired OK Impaired Ulnar deviation OK Impaired OK Impaired Palpation Left Right CMC 1 OK Pain OK Pain CMC 2 OK Pain OK Pain CMC 3 OK Pain OK Pain MCP OK Pain OK Pain IP OK Pain OK Pain Carpal bones OK Pain OK Pain Prox of extensor retinaculum OK Pain OK Pain Forearm muscles Left Right Flexor carpi radialis OK Atrophy/Hyper- OK Atrophy/Hyper- Flexor carpi ulnaris OK Atrophy/Hyper- OK Atrophy/Hyper- Flexor digitorum OK Atrophy/Hyper- OK Atrophy/Hyper- ROM = If not OK, register impaired range of motion in degrees. Left Right Flexion fingers OK Impaired OK Impaired Extension fingers OK Impaired OK Impaired Finger-spread OK Impaired OK Impaired Thumb movement 1 OK Impaired OK Impaired Tendonitis stenosans 2 No Yes No Yes 1. Opposition. 2. Put your index finger in the patient s palm below MCP and then above MCP and ask the patient to flex and extend his/her fingers repeatedly. If positive, you may feel a bump in the tendons. 4

5 Superficial sensitivity (cotton wool) Left Right Index finger OK Impaired OK Impaired Middle finger OK Impaired OK Impaired Little finger OK Impaired OK Impaired Reflexes Left Right Brachioradialis OK Decreased Exaggerated Decreased Exaggerated Biceps OK Decreased Exaggerated Decreased Exaggerated Triceps OK Decreased Exaggerated Decreased Exaggerated Diagnostic tests Left Right Finkelstein s test 1 Negative Positive Negative Positive Phalen s test Negative Positive Negative Positive Tinel s test Negative Positive Negative Positive 2-point discrimination OK mm OK mm Temperature perception² OK Impaired OK Impaired 1. The thumb is kept along the index finger (the fingers should not grip on the thumb) and then the patient is asked to perform ulnar deviation of his/her hand with a straight arm. 2. A tuning fork at room temperature should be perceived as cold on the index and little finger s digital pulp Muscular strength grip force (Vigorimeter) Dominant hand Left-handed Right-handed Ambidextrous Left maximum value of 3 attempts kpa Right maximum value of 3 attempts kpa LOW BACK Low back without pain Movement Free Stiff With difficulty Painful Scoliosis No Yes Pelvic tilting, difference in level No Yes Muscle atrophy No Yes, what muscles Movements in the thoracic and low back OK Impaired Hypermobility Painful Right Left Forward flexion Right Left Backward flexion Right Left Lateral flexion left Right Left Lateral flexion right Right Left Rotation left Right Left Rotation right Right Left Functional muscle strength OK Left impaired Right impaired Standing on toe Standing on heels Squatting 5

6 Movement in hip joint OK Left impaired Right impaired Flexion Inward rotation Outward rotation Abduction Adduction Palpation if positive findings, register level Processus spinosus OK Pain L1-L5 Ligamentum intraspinali OK Pain L1-L5 Paraspinal OK Pain left L1-L5 Pain right L1-L5 Sacroiliaca joints OK Pain left L1-L5 Pain right L1-L5 Neurology Lasègue SLR OK Positive left Positive right (degrees) Dorsiflexion of the foot OK Positive left Positive right (degrees) Extensor hallucis OK Weak left Weak right MM Extensor digitorum 1 OK Weak left Weak right Patellar reflex OK Decreased left Decreased right Exaggerated left Exaggerated right Achilles reflex OK Decreased left Decreased right Exaggerated left Exaggerated right 1. A bump of muscles can be seen on the lateral side of the dorsum of the foot. Atrophy could indicate nerve damage. Sensitivity L4 (medium malleolus) OK Impaired L5 (dorsum of the foot) OK Impaired S1 (lateral malleolus) OK Impaired Estimated pain during examination 0 10 Constant pain/ache during the last 3 months Yes No 6