table of contents - prohealthsys sample pa.pdf · 2016-06-14 · vizniak i prohealth table of...

iVizniak www.prohealthsys.com

ProHealth Table of Contents

His

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As one of the most up-to-date, functional and cost effective clinical texts available,

assessment. To assemble the information contained in this text from individual sources would cost hundreds, if not thousands of dollars. Countless hours of

gap between basic classroom learning and clinical application. Information sources include: hundreds of original journal articles with cutting-edge information, evidence-

experience.In order to get the most clinical utility from this text, it must be available at all

this text contains more useful information than most full-size textbooks. Coil binding

based learning materials (videos, images, quizzes). Another cost saving measure is free web based video support, allowing review from any computer with internet

chapter provides a detailed table of contents for that section.

using about 70% less paper and requiring much less in shipping fuel consumption for delivery. In addition, the use of web based video consumes 33% less energy and emits 40% less CO2

1. To help ensure gender equality, ‘his’

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History & Records ....................... 1Physical Exam ............................ 23Neurologic Exam ......................... 77Cervical Spine Exam ................... 123Shoulder Exam ............................ 151Elbow Exam ................................. 189Wrist & Hand Exam ..................... 205Thoracic Spine Exam .................. 231Lumbar Spine Exam .................... 249SI & Pelvis Exam ......................... 279Hip & Thigh Exam ....................... 297Knee Exam .................................. 319Ankle & Foot Exam ...................... 349Diagnostic Imaging ..................... 371Appendix ...................................... 385Index ............................................ 403

30 www.prohealthsys.com Vizniak

ProHealth

Physical E

xam

Posture Assessment

workers) or in the stance they spend most of their day (cashiers, machinist)

Procedure (patient is examined in their habitual, relaxed standing posture):

normally stand” - “try and stand as relaxed as possible.”Observe body in 4 different positions (anterior, right lateral, left lateral, & posterior view)Plumb line is suspended from the ceiling to be used as an alignment device.

Patient is best observed in underwear or swim suit

to record type of device)

postural and AROM assessment

Common Postures

Head: forward

C-spine:hyperlordosis

T-spine:hyperkyphosis

L-spine:hyperlordosis

Pelvis: anteriortilt

Hips:Knees:

hyperextended

Ankle: plantar

behind midline

Head: neutral

C-spine:hypolordosis

T-spine:hypokyphosis

L-spine:hypolordosis

Pelvis: posteriortilt

Hips: extended

Knees:extended

Ankle: slightly

Head: forward

C-spine:hyperlordosis

T-spine: mildhyperkyphosis

L-spine: mildhyperlordosis

Pelvis: posteriortilt, but anteriorto midline

Hips: extended

Knees:hyperextended

Ankle: neutral

Ligament laxityMuscle tightnessFascial restrictionsMuscle tonusExcess weightJoint dysfunction

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PainMuscle imbalanceJoint mobilityPoor habitsType of shoesPeer pressure

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Age (osteoporosis)Respiratory conditionsLeg length discrepancyScoliosisPelvic angelsAnatomical variation

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31Vizniak www.prohealthsys.com

ProHealth

Phy

sica

l Exa

m

Posture AssessmentAnterior View

pubicsymphysis, umbilicus, xiphoid,suprasternal notch, nasal bones

Foot angle, arches, malleoliFibular heads levelKnees straight (varum/valgum)Patellae point straight aheadLevel at symphysis pubis

Palms (hands) face body inrelaxed positionElbows carrying angle (5°-15°)Waist angles (equal, arms equal

Ribs/sternum, clavicles/ ACJoint (level & symmetrical)Shoulders (level, normal fordominant side to be lower)Trapezius neck (slope ondominant may be greater)Nose (midline)Jaw (in resting position)Head (straight at midline, tilting,rotation)

Lateral View x 2

Anterior to lateral malleolusFibular headGreater trochanterAcromiumBodies of cervical vertebraExternal auditory meatus/tragus

Pelvic angle (normal male0-10°, female 15-30°)Chest (pectus excavatum/pectus carinatum)Muscles of abdomenChest and backShoulders (anterior rotationor military stance)Spine (normal spinalcurvatures)Ear lobe - align withacromion and iliac crest othervertical landmarks

Posterior View

S2C7

Heels (straight, angled in/out)Achilles tendon (straight,angled in/out)Popliteal fossa levelsGluteal folds (level, symmetry)

Arms (equal distance frombody)Waist angles (equal/level,equal distance from body)Ribs (protruding)Spine (straight, curvedlaterally)Scapulae (inferior angles level)Shoulders levelHead (midline)

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ProHealth

Physical E

xam

Inspection & palpation1. Size, shape of auricle2. Position & alignment of head3. Skin condition (color, lumps, lesions)4. Auricular & tragus movement5. Evaluate external auditory meatus (size,

swelling, redness, discharge, cerumen)

Otoscopic examinationTo help align external auditory meatus to slope ofear canal, apply traction to the pinna:

Adult: traction pinna posteriorly & superiorlyInfant: traction ear inferiorly (perhaps poste-riorly)

1. Inspect external canal

2. Note cerumen, discharge, lesions, foreign bodies

3. Redness & swelling of canal wall

4. Inspect tympanic membrane� Membrane integrity� Short process of malleus (lateral process)� Manubrium of malleus (‘handle’)� Umbo�� }�� ^��; �^��8��$>�� 8��$�;*��' ��'��

tympanic membrane)

5. Pneumatic otoscopy�� ~��'�8��"' "��"��'��

air to observe tympanic motion� Normal: membrane moves briskly

��+��'��normal in infants younger than 7months

� Abnormal: sluggish or absentresponse may indicate presence��8�'��'��"��membrane

6. Hearing acuity� Weber, Rinne (tuning fork)� Voice test, ticking watch test

7. Vestibular function� Swivel chair test, Dix-Halpike maneuver

Ear & Otoscopic Exam

On-line videos demonstrations & clinical chart forms are available athttp://www.prohealthsys.com

External Right Ear

Triangularfossa

Tragus

Right Tympanic Membrane

Cone ofLight

Parstensa

Umbo

Manubriumof Malleus

Short processof malleus

Pars Flaccida& ‘attic’

Fibrous annulus

ExternalAuditoryMeatus


ProHealth

Neurologic E

xam

(posterior)

Peripheral NerveDermatome LevelGreater occipital n.

Transverse cervical n.

Axillary n.

Intercostal brachial n.

Radial n. (posterior brachial cutaneous)

Medial brachial cutaneous n.

Musculocutaneous n.(lateral antebrachial cutaneous)

Radial n.

Median n.

Ulnar n.

Lateral femoral cutaneous n.

Obturator n.

Medial antebrachial cutaneous n.

Posterior femoral cutaneous n.

Saphenous n.

C3

C4

C7

C

T4

T2

T10

T8

T6

T12

L1

L4

S1

T2

T1

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L3

S4S3

S1

Lesser occipital n.

Great auricular n.

Supraclavicular n.

Radial n. (posterior antebrachial cutan.)

L

Sural & sural cutaneous nn.

Calcaneal n.

Lateral plantar n.

Medial plantar n.

Iliohypogastric n.

Clunialnn.

Lateral thoracic rami

Dorsal spinal rami©VIZNIAK

There is usually no C1 dermatome as it has no dorsal

(suboccipital nerve) is purely motor in function


ProHealth

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Cervical S

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Cervical Spine PROM

Compare bilaterally; if possible palpate joint during PROM & use the shortest levelpossible, apply over pressure at end ROM; introduction statement:

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Extension (> 50º-70º)Tissue Stretched: ��

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Lateral Flexion (> 45º-60º)Tissue Stretched:

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Rotation (> 80º-90º)Tissue Stretched:

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Seated

PROM may be performed with the patient seated or supine

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221Vizniak www.prohealthsys.com

ProHealth

s R SN SP LR+/LR-

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EtiologyProcedure

Interpretation

Clinical notes

SN: 61 SP: 83)5

EtiologyPinch Grip StrengthProcedure

Interpretation

Clinical notes

EtiologyPhalen’s TestProcedure

Interpretation

Clinical notes

R: 0.79 SN: 10-88 SP: 33-100 LR+: 0.7-41.5 LR-: 0.1-1)5, 13, 17, 18, 20, 27, 24, 31, 33, 35, 37, 38, 39, 41, 42, 46, 51, 53, 59, 60,64,

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EtiologyPress TestProcedure

Interpretation

Clinical notes

372 www.prohealthsys.com ��

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Diagnostic Im

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Selected Imaging Types

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EtiologyComputer Aided Tomography

table of contents - prohealthsys sample pa.pdf · 2016-06-14 · vizniak i prohealth table of...

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