musculoskeletal exam 2004-2005 primary care sports medicine department of family practice hennepin...
TRANSCRIPT
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Musculoskeletal Exam2004-2005
Primary Care Sports MedicineDepartment of Family PracticeHennepin County Medical Center
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ShoulderBone and soft tissue anatomy (anterior view)
AcromionAcromion ClavicleClavicle
A-C JointA-C Joint
Coracoid ProcessCoracoid Process
Longhead of biceps tendonLonghead of biceps tendon
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ShoulderBone and soft tissue anatomy (lateral view)
Spine ofSpine ofscapulascapula
A-C jointA-C joint ClavicleClavicle
Greater tuberosityGreater tuberosity
Lesser tuberosityLesser tuberosity
Coracoid Coracoid processprocessSupraspinatus InsertionSupraspinatus Insertion
Infraspinatus InsertionInfraspinatus Insertion
Teres Minor InsertionTeres Minor Insertion
Subscapular InsertionSubscapular Insertion
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ShoulderBone and soft tissue anatomy (posterior view)
Spine of scapulaSpine of scapula
ScapulaScapula
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ShoulderRange of Motion
Flexion 0 - 180°Extension 0 - 60°Abduction 0 - 180°Adduction 0 - 75° IR (add)0 – 90ºER (add) 0 – 90ºIR (abd)0 – 90ºER (abd) 0 – 90º
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ShoulderRange of motion
Combination ROM(extension, adduction, and internal rotation)
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ShoulderStrength testing
Supraspinatus(“empty-can” sign)
Evaluate for strength and presence of pain.
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ShoulderStrength testing
Infraspinatus(resisted external rotation in adduction)
Evaluate for strength and presence of pain.
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ShoulderStrength testing
Teres minor and infraspinatus(resisted external rotation in abduction)
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ShoulderStrength testing
Subscapularis(resisted internal rotation)
Evaluate for strength and presence of pain.
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ShoulderStrength testing
Subscapularis(“belly press”)If the elbow endsin the adductedposition, the subscapularisis weak.
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ShoulderImpingement tests
Neer’s test
Test is (+) if pain occurs.
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ShoulderImpingement tests
Hawkin’s tests
Impingement
Coracoid impingement
Tests (+) if pain occurs.
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ShoulderStability tests
Anterior
“Apprehension” test
When (+) and accompanied by recent acute trauma, suggests anterior dislocation.
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ShoulderStability tests
Anterior
Relocation test
When (+), suggests chronic anterior instability.
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ShoulderStability tests
Anterior
“Load and shift” test
Up to 25% anterior translation is considered normal.
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ShoulderStability tests
Inferior
“Sulcus sign”
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Shoulder – Sulcus sign
Without stress
With stress
(+) sulcus sign
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ShoulderStability tests
Posterior
Apply axial load.
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ShoulderStability tests
Posterior
“Load and shift” test
Up to 25% posterior translation is considered normal.
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ShoulderTests for superior labral tears
O’Brien’s test
A positive test occurs when pain occurs only in the “thumb down” position.
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ShoulderTests for superior labral tears
Anterior slide testThe test is (+) when pain or a “pop” or “click” occurs at the anterior-superior shoulder or if the maneuver reproduces the patient’s pain.
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ShoulderTests for superior labral tears
“Clunk” test
The test is (+) if a “clunk” occurs or if the patient’s pain is reproduced.
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ShoulderAcromioclavicular (AC) tests
Palpation
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ShoulderAcromioclavicular (AC) tests
Crossed adduction test
The test is (+) if the process of adduction causes pain at the AC joint.
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ShoulderLonghead of biceps test
Speed’s test
Test is (+) if pain is reproduced at longhead of biceps in humeral groove.
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ShoulderScapular stabilizer tests
Serratus anterior
Test is positive if scapular “winging” exists.
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ShoulderScapular stabilizer tests
“Wall push”
Test is (+) if scapular “winging” is observed.
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KneeBone and soft tissue anatomy (anterior)
Rightknee PatellaPatella
Patellar tendonPatellar tendon
Medial joint lineMedial joint line
MedialMedialCollateral Collateral ligamentligament
Tibial tubercleTibial tubercle
Lateral joint lineLateral joint line
Lateral Lateral CollateralCollateralligamentligament
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KneeBone and soft tissue anatomy (medial)
Right knee flexed to 90°
Medial joint lineMedial joint lineMCLMCL
Tibial tubercleTibial tubercle
PatellaPatella
Medial femoralMedial femoralcondylecondyle
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KneeBone and soft tissue anatomy (lateral)
Right kneeflexed to 90°
PatellaPatella
FibulaFibula
Lateral joint lineLateral joint line
Patellar tendonPatellar tendon
LCLLCL
Lateral Lateral femoral condylefemoral condyle
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KneeRange of motion
Flexion 0 - 135°
Extension 0 - 15°
Int Rotation 0 – 20 to 30°
Ext Rotation 0 – 30 to 40°
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KneeTests of medial stability (MCL)
Valgus stress test
Test performed at 30° of flexion. Note “end point” and if joint opens compared to uninvolved side.
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KneeTest of lateral stability (LCL)
Varus stress test
Test performed at 30° flexion. Note “end point” and if joint opens compared to uninvolved side.
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KneeTest for meniscal injury
Palpate for joint line tenderness.
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KneeTest for meniscal injury
McMurray’s test
Note pain and/or “click” or subluxing meniscus.
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KneeTest for meniscal injury
Spring (“bounce”) test
Test is (+) if pain occurs along joint line when knee “bounces” into extension.
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KneeTest for anterior stability (ACL)
Lachman’s test
Note “end point” and or anterior translation of tibia.
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Kneetest for anterior stability (ACL)
Lachman’s test (modification)
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KneeTest for anterior stability (ACL)
Lachman’s test(Modification)
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KneeTests for anterior stability
Anterior drawer
Note anterior tibial translation and presence or absence of “end point”.
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KneeTests for posterior instability
Recurvatum test
Presence of unilateral recurvatum suggests injury to posterolateral corner.
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KneeTests for posterior stability
Posterior sag
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KneeTests for posterior stability
Posterior drawer
Note position of tibial plateau in relationship to lateral femoral condyle.
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KneeTests for posterior stability
Quadriceps active test
Test is (+) if tibia translates in anterior direction when quadriceps contract.
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KneePatellofemoral tests
Patellar pseudocompression test
Test is (+) if pain is present.
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KneePatellofemoral tests
Compression test
Test is (+) if active contraction and compression cause pain.
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KneePatellofemoral tests
Palpate medial and lateral patellar facets.
Tenderness along superior and medial aspect of patella may suggest medial plica syndrome.
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KneeTest for patellar dislocation
Patellar apprehension test
Test is (+) if test causes pain and/or fear that patella might dislocate.
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ElbowBone and soft tissue anatomy (lateral view)
Right elbow
Lateral epicondyleLateral epicondyle
OlecranonOlecranon
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ElbowBone and soft tissue anatomy (anterior view)
MedialMedialepicondyleepicondyle
Lateral epicondyleLateral epicondyle
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ElbowBone and soft tissue anatomy (posterior view)
Rightelbow
Medial epicondyleMedial epicondyleLateralLateralepicondyleepicondyle
OlecranonOlecranon
Ulnar Ulnar groovegroove
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ElbowRange of motion
Flexion 0 - 140°
Extension 0 - 10°Hyperextension?
Pronation 0 - 90°
Supination 0 - 90°
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ElbowMedial epicondylitis
Tender to palpation over medial epicondyle.
Pain with resisted wrist flexion.
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ElbowLateral epicondylitis
Tender to palpation over lateral epicondyle.
Pain with resisted wrist extension.
Pain with resisted middle finger extension.
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ElbowUlnar collateral ligament injury
Valgus stress to medial epicondyle
Test is (+) when stress causes pain and/or instability.
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ElbowUlnar collateral ligament injury
“Milk maid’s” test
Test is (+) when maneuver causes pain.
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Wrist/HandBone and soft tissue anatomy
Right wrist(dorsal view)
Ulnar styloid Radial styloidTFCC
1st dorsalcompartment (black)Site of deQuervain’s
2nd dorsalcompartment (red)
Site of intersectionsyndrome(“squeaker’s wrist”)
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Wrist/HandBone and soft tissue anatomy
Right wrist(radial view)
Anatomical snuffbox
1st dorsal compartment
2nd dorsalcompartment
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Wrist/HandBone and soft tissue anatomy
Right wrist(ulnar view)
Ulnar styloid
TFCCTFCC
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WristRange of motion
Flexion 0 - 80°
Extension 0 - 70°
Ulnar deviation0 - 30°
Radial deviation0 - 15°
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WristCarpal tunnel syndrome
Tinel’s sign
Test is (+) if paresthesias are produced.
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WristCarpal tunnel syndrome
Phalen’s sign
Test is (+) if symptoms are reproduced when hands are held in that position. May have to maintain that position for 30-60 seconds.
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Wristde Quervain’s tenosynovitis
Finkelstein’s test
Test is (+) if pain is produced by maneuver.
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WristIntersection syndrome (Squeaker’s wrist”)
Swelling, tenderness, and crepitation (squeaking) over intersection of 1st and 2nd dorsal compartments with radial and ulnar deviation.
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WristScaphoid fracture
Tenderness over anatomical “snuffbox.
Tenderness over scaphoid tubercle.
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WristScapholunate dissociation
Tenderness over scapholunate interval.
Scaphoid shift (Watson “click” test)
Test is (+) if pain/click occur during maneuver.
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HandSkier’s thumb (Gamekeeper’s thumb)
Flex thumb 20°, apply valgus stress to thumb and compare instability to uninvolved side.
Test is (+) if pain/instability occur.
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FingerFlexor tendon injury
Evaluation of flexor digitorum superficialis.
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FingerFlexor tendon injury
Evaluation of flexor digitorum profundus.
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Foot/AnkleBone and soft tissue anatomy
Right ankle(anterior view)
Medial malleolusLateral malleolus
Anteriortalofibular ligament (ATFL)
Anterior tibiofibular ligamentAnterior tibiofibular ligament(syndesmotic ligament)(syndesmotic ligament)
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Foot/AnkleBone and soft tissue anatomy
Right ankle(lateral view)
Lateral malleolus
ATFLATFL
CalcaneofibularCalcaneofibularligamentligament
Posteriortalofibular ligament
Anterior tibiofibularAnterior tibiofibularligamentligament
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Foot/AnkleBone and soft tissue anatomy
Right ankle(medial view)
Medial malleolus
Tarsal navicularTarsal navicular
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Foot/AnkleBone and soft tissue anatomy
Right ankle(posterior view)
Medial malleolus Lateral malleolus
Achilles tendonPosteriortalofibular ligament
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Foot/AnkleBone and soft tissue anatomy
Right foot(plantar view)
CalcaneusCalcaneus
Distal, medial calcaneus (siteof pain of plantar fasciitis)
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Foot/AnkleRange of motion
Dorsiflexion 0 – 20º
Plantarflexion0 – 50º
Inversion 0 – 45 to 60º
Eversion 0 – 15 to 30º
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Foot/AnkleSpecial tests: ATFL injury
Anterior drawer
Test is (+) if movement of the tibia is greater than uninvolved side. (+) test suggests tear of anterior talofibular ligament (ATFL).
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Foot/AnkleSpecial tests: (CFL injury)
Talar tilt
Test is (+) if there is greater subtalar motion compared to uninvolved side. (+) test suggests tear of calcaneofibular ligament (CFL).
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Foot/AnkleSpecial tests: Syndesmotic (“high”) sprain
External rotation test
Test is (+) if maneuver produces pain at site of syndesmotic ligament (anterior tibiofibular ligament).
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Foot/AnkleSpecial tests: Syndesmotic (“high”) sprain
“Squeeze” test
Test is (+) if maneuver produces pain at site of syndesmotic ligament.
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Back – Lumbar SpineRange of motion
Forward flexion0 – 40 to 60º
Extension 0 – 25 to 35º
Lateral flexion 0 – 15 to 20º
Rotation 0 – 3 to 18º
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Back – Lumbar SpineHerniated nucleus pulposus
Straight-leg raising test
Test is (+) if radicular pain is reproduced by holding leg 30 - 70° flexion
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Back – Lumbar SpineSpondylolysis
Single-leg extension test (“stork” test)
Test is (+) if pain localizes with extension.
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Back – Lumbar SpineSacroiliac (SI) dysfunction
FABER test (Flexion, Abduction, External Rotation)
Test is (+) if pain is reproduced at SI joint on same side as pain.
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Back – Lumbar SpineSI dysfunction
Gaenslen’s test
Test is (+) if maneuver reproduces SI pain.
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The EndThe End