dr. mirna - easy assessment of musculoskeletal system.pptx

8/9/2019 dr. Mirna - Easy Assessment of Musculoskeletal System.pptx

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GALS

GAIT, ARMS, LEGS AND SPINE

Screening Questions

Do you have any pain or stiffness in your muscles, joints or

back?

Can you dress yourself completely without any difficulty?

Can you walk up and down stairs without any difficulty?


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GAITAsk the patient to walk up and down the room, turning at the

end.

Observe for :

symmetry

smoothness

ability to turn quickly

f abnormal gait, pain!


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ABNORMAL GAITAntalgic "ait

Ata#ic "ait :$ sensory

cerebellar

Scissor "ait%addling "ait

&rendelenburg "ait

'arkinsonian "ait (festinating gait)


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ARMS

Ask the patient to :$'ut their hands behind their head.

*old arms straight out, palms down, fingers outstretched.

&urn hands over.

+ake a fist.

squeee your fingers

&o bring each finger to the thumb in turn.

-ou should gently squeee across the metacarpophalangeal(mcp)oints testing for tenderness.


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LEGS

%ith patient laid on a couch:$Assess knee fle#ion and e#tension.

Assess internal/e#ternal rotation of the hips.

'erform patella tap.

nspect feet.

Squeee the +&'0s.


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SPINE

%ith the patient standing:$nspect the spine from behind and side view.

Assess lateral fle#ion of the neck (cervical spine).

Assess lumbar spine movement.

Assess temporal mandibular oints.


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1lick icon to add picture

234S&5" &*3 6AS1S


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SPECIFICS HT

'recipitating incident

trauma (macrotrauma)

repetitive stress (microtrauma)

is this a work related injury?

is there a lawsuit ongoing?

or !"#sdriver$passenger

belted$non%belted

location of impact and

severity of crash (re&uired

jaws of life, if anyone died

in the crash, thrown from

the car, etc)

speed at impactposition of the patient and

the limb in &uestion at

impact


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for pain or presenting problem

'nset

Duration

Character Course

#ggravating and relieving factors

ocation

adition

#ssociated symptoms

n addition to pain do theyhave:

Clicking

*nappingCatchingocking*ensation of giving way(including prior falls ordislocations)*welling+eakness

s it worse when they wake up in the morning?

Does it gradually get worse over the course of the day?

Does the pain ever wake them up at night?


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RED FLAGS

'ain at night or rest

Associated weight loss and loss of appetite

*#. Of cancer

Steroids use

*#. Of trauma

3#treme age

6owel or bladder symptoms


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GENERAL CONSIDERATIONS

FOR EXAMINATION

%hen taking a history for an acute problem always inquire

about the mechanism of inury, loss of function, onset of

swelling (7 89 hours), and initial treatment

%hen taking a history for a chronic problem always inquire

about past inuries, past treatments, effect on function, and

current symptoms.


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FOR EXAMINATION

&he patient should be gowned and e#posed as required for

the e#amination

Some portions of the e#amination may not be appropriate

depending on the clinical situation (performing range of

motion on a fractured leg for e#ample)


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FOR EXAMINATION

&he musculoskeletal e#am is all about anatomy

&hink of the underlying anatomy as you obtain the history

and e#amine the patient


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FOR EXAMINATION

&he cardinal signs of musculoskeletal disease are:

-ain

edness (erythema)

*welling

ncreased warmth

Deformity

oss of function


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INSPECTION

ook for scars, rashes, or other lesions like abrasions/open

wounds

ook for asymmetry, deformity, or atrophy

Always compare with the other side

ook for swelling

ook for erythema (redness)

'osture/position of the oint or limb


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PE CU ION

&ypically, we don0t percuss things in

orthopedics however the one e#ception is

nerves

f tapping over a nerve causes pain or electricshock sensations, this is called &inel0s sign

'resent when nerves are compressed or

irritated

Also used to monitor nerve recovery after

inury (in the form of an =advancing &inel0s

sign>)


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AUSCULTATION

%e don0t really listen to anything in orthopedics


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PALPATION

3#amine each maor oint and muscle group in turn

dentify any areas of tenderness

?oint line

&endinous insertions

'alpate for any crepitus

dentify any areas of deformity

Always compare with the other side


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PALPATION

%arm or cold including pulses


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RANGE OF MOTION

Active

'assive


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ACTIVE ROM

Ask the patient to move each oint through a full range ofmotion

5ote the degree and type of any limitations (pain, weakness,etc.)

5ote any increased range of motion or instabilityAlways compare with the other side

'roceed to passive range of motion if abnormalities arefound


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PASSIVE ROM

Ask the patient to rela# and allow you tosupport the e#tremity to be e#amined

"ently move each oint through its full range ofmotion

5ote the degree and type (pain or mechanical)of any limitation

f increased range of motion is detected,perform special tests for instability as

appropriateAlways compare with the other side


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VASCULAR STATUS

'ulses

pper e#tremity

Check the radial pulses on both sides

f the radial pulse is absent or weak, check the brachial

pulsesower e#tremity

Check the posterior tibial and dorsalis pedis pulses on bothsides % if these pulses are absent or weak, check the poplitealand femoral pulses


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VASCULAR STATUS

1apillary 2efill

-ress down firmly on the patient.s finger or toe nail so it

blanches

elease the pressure and observe how long it takes the nail

bed to /pink/ up Capillary refill times greater than 0 to 1 seconds suggest

peripheral vascular disease, arterial blockage, heart failure, or

shock

dr. mirna - easy assessment of musculoskeletal system.pptx

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