physical examination-2 iau 3.sınıf.pptx

Physical Examination Doç.Dr.Samet Erinç İstanbul Aydın University Orthopaedics and Traumatology Department • Orthopedic physical examination; • It consists of – observation – inspection, – palpation, – evaluation of joint range of motion, – performing special physical orthopedic tests, – neurolog...

Physical Examination Doç.Dr.Samet Erinç İstanbul Aydın University Orthopaedics and Traumatology Department • Orthopedic physical examination; • It consists of – observation – inspection, – palpation, – evaluation of joint range of motion, – performing special physical orthopedic tests, – neurological and vascular evaluation. Shoulder • The joint with the widest range of motion • Glenohumeral , Akromiclavicular, Sternoclavicular, Scapulotorasic • Inspection • • • • • • Skin scar Symmetry Swelling Atrophy Hipertrophy Scapular winging • It should be evaluated comparatively for the right and left sides.. • Deltoid atrophy is typical in axillary nerve lesion. • The acromioclavicular separation can be observed by inspection. • Scapular Wingining • Popeye Sign Shoulder • Palpation – Muscle, joint, and bony prominences should be palpated. – The acromioclavicular joint is painful on palpation in conditions of chronic inflammation and degenerative arthritis. – Having swelling and warm (septic arthritis) Range of Motion • Forward Flexion • Extension • Abduction • Adduction • Internal Rotation • External Rotation • Different anatomical structures in the shoulder joint require special procedures. • Rotatuar Cuff Pathology • Shoulder Instability • Biceps Pathology • • • • • • • • Specific Tests for Rotator Cuff Disease Neer Sign Neer Test Hawkins Test Drop Arm Hornblower’s Sign Lift off Belly Press • Neer Sign Forced forward flexion is performed while the patient's arm is in internal rotation. Pain indicates that the test is positive. • Neer Test Pain relief after 1% 10 cc lidocaine injection indicates that the test is positive. • Hawkins Test: In 90 degrees of elevation, the elbow is in 90 degrees of flexion, the shoulder is forced into adduction and internal rotation. • Drop Arm The patient's shoulder is abducted 90 degrees and then the patient is asked to slowly lower the arm in the same arc. The test is positive if the patient is unable to do this or if the arm falls painfully down. Indicates a tear in the rotator cuff. • Hornblower ‘s Sign • It is applied to test the isolated function of the teres minor muscle. • If the patient has a teres minor tear when the shoulder is abducted at 90 degrees and the elbow is passively placed in external rotation at 90 degrees of flexion, the patient cannot maintain this position and the arm goes to the neutral position. • Lift-off Test: • The shoulder is in internal rotation adduction and the forearm is in pronation. The patient is asked to move his hand away from his back. If it cannot be removed, this is considered a sign of subscapularis tear or insufficiency. Biceps Test • Speed Test • Shoulder forward flexion is performed while the elbow • Yergason Test • It is pain along the biceps trace is in extension and the during pronation of the forearm forearm is in supination. against resistance at the elbow in Pain in the face of 90° flexion. It is positive in biceps resistance indicates that the tendinitis and/or instability. test is positive. Instability Test • Anterior Apprehension Sign: In the supine or sitting position, 90 degrees of abduction, 90 degrees of elbow flexion, external rotation is forced by applying direct force to the posterior of the shoulder. The patient experiences the fear that his shoulder will come off Instability Test • Anterior Drawer test: After fixing the scapula with one hand, the humerus is passively pushed anteriorly. Displacement of the humeral head above the level of the glenoid cavity makes the test positive. Elbow Examination • Elbow mainly consists of 3 joints. – Humeroradial – Humeroulnar – Radioulnar Elbow Examination • Inspection • Carrying angle • When the elbow is in extension, it is the plaster between the long axis of the humerus and the axis of the forearm • Olecranon bursitis Elbow Examination • Palpation • Local temperature increase • Bone structures should be palpated • Lateral Epicondil • Medial Epicondil • Radius Head • Olecranon Elbow Examination • Range Of Motion Elbow Examination • Varus/Valgus Stres test • Varus valgus stress is applied when the elbow is flexed 20-30 degrees. Wrist and Hand Examination Carpal Tunnel Syndrome Tinel Sign • The Tinel sign test is used with imaging tests to find compressed or squeezed nerves and nerve regrowth • Phallen test • performed by asking the patient to place both elbows on a table while keeping both forearms vertical and flexing both wrists at 90 degrees for 60 seconds. A positive test is defined as the occurrence of pain or paresthesias in at least one finger innervated by the median nerve. De Quervain's Tenosynovitis abduktor pollisis longus and ekstensör pollisis brevis (APL ve EPB) •tenderness over 1st dorsal compartment at level of radial styloid •provocative tests •Finkelstein maneuver •On grasping the patient’s thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is painful •more indicative of EPB > APL tendon pathology Hip Examination • Physical examination methods of hip joint; Inspection, palpation, joint range of motion, muscle strength and specific hip joint examinations and neurological examination can be examined under subheadings. Inspection • • • • • • Standing stance, SIAS’s should be in line. Gait Pattern Deformity Spinal Curvatures Shortening Atrophy • Trendelenburg Sign Palpation • • • • • Vascular System – Distal pulses Sensation (Neurological Examination) Temperature – Infection / Inflammation Swelling – Effusion, Synovial thickening, Extra capsular Tenderness • Lumbar spine • Pelvis: Iliac crest, ASIS, Pubic rami, Symphysis pubis, PSIS, SIJ, Ischial tuberosity, Sacrum, Coccyx • Greater trochanter • Inguinal ligament • Femoral triangle (hip joint) • Knee Range Of Motion • Flexion; 120 degrees with knee flexed • Extension 30 degrees • Abduction 45-50 degrees • Adduction 20-30 degrees • • internal rotation 35 degrees • eksternal rotation 45 degrees Hip Examination Faddir Test • The patient lies supine. • The examiner grasps the affected leg near the heel with one hand and at the knee with the other and passively flexes the hip and knee. • Then the hip is hyper flexed, internally rotated, and adducted. 1. 2. 3. • Femoroacetabular impingement syndrome. Anterior labral tear. Iliopsoas tendinitis. This test is also called Femoroacetabular Impingement Test. Hip Examination Fabere Test • The patient's tested leg is placed in a "figure-4" position, where the knee is flexed and the ankle is placed on the opposite knee. • The hip is placed in flexion, abduction, and external rotation (which is where the name FABER comes from). • A positive test occurs when groin pain or buttock pain is produced. Hip Examination • Ober Test • patient placed in lateral position with affected side up • with hip in slight extension, abduct the leg then allow it to drop into adduction • if unable to adduct leg, suspect tight Iliotibal Band Hip Examination • Thomas testi • with patient supine, fully flex one hip. • if contralateral hip lifts off table, there is likely a fixed flexion deformity Knee Examination • Inspection • Skin • Soft Tissue • Bone Structures • Gait patern Knee Examination • Palpation Knee Examination • Range Of Motion • The knee joint can perform 135 flexion and extension up to 0 degrees. • If there is a decrease in this amount or if a contracture has developed, these should be noted. Knee Examination • Meniscus injury • Joint line tenderness • Effusion • McMurray's test • flex the knee and place a hand on medial side of knee, externally rotate the leg and bring the knee into extension • a palpable pop or click is a positive test and can correlate with a medial meniscus tear Knee Examiantion • Meniscal İnjuries  Apley Test; With the patient in the prone position, the knee being tested is flexed to 90 degrees while the other leg is fully extended, resting on the exam table Knee Examination • MCL and LCL • Valgus instability = medial opening • Varus instability = lateral opening Knee Examination • ACL Injury • Lachmann; To perform this test have your patient in supine line position and bring your patient’s tests leg into 30 degrees of flexion. Fixate the femur with your other hand Bring the tibia into slight external rotation and then try to translate the tibia anteriorly Knee Examination • ACL Injury • Anterior Drawer Test: While the patient is supine , the knee is 90 degree, The examiner sits on the patient's foot and stabilizes the leg. The tibia is then pulled forward. An anterior displacement of the tibia more than 1.5 cm is considered positive. Knee Examination • PCL Injuries • Posterior drawer (at 90° flexion) • with the knee at 90° of flexion, a posteriorly directed force is applied to the proximal tibia and posterior tibial translation is quantified • the medial tibial plateau of a normal knee at rest is ~1 cm anterior to the medial femoral condyle Ankle and Foot Examination Inspection • Alignment • Deformity • Gait • Swelling Ankle and Foot Examination Ankle and Foot Examination Palpation • Metatarsal and tarsal bones • Tarsal joint • Ankle joint • Subtalar joint • Calcaneum • Medial/lateral malleoli • Distal fibula • Achilles tendon Ankle and Foot Examination Ankle and Foot Examination • Range of Motion – Plantar Flexion – Dorsal flexion – Supination – Pronation Ankle and Foot Examination • Achilles Tendon Rupture • patient usually reports a "pop" • weakness and difficulty walking • pain in heel • Thompson test • lack of plantar flexion when calf is squeezed