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SOCM Physical Exam of the Musculoskeletal System PFN: SOMPYL0L Hours: 2.0 JSOMTC, SWMG(A) Slide 1 Terminal Learning Objective Action: Communicate knowledge of Physical Exam of Musculoskeletal System Condition: Given a lecture

  1. SOCM Physical Exam of the Musculoskeletal System PFN: SOMPYL0L Hours: 2.0 JSOMTC, SWMG(A) Slide 1 Terminal Learning Objective  Action: Communicate knowledge of “Physical Exam of Musculoskeletal System”  Condition: Given a lecture in a classroom environment  Standard: Received a minimum score of 75% IAW course standards on the formative quizzes and the Physical Exam Practical Test grade sheet JSOMTC, SWMG(A) Slide 2 References  BATES’ Guide to Physical Examination And History Taking , 11 th Edition, 2013, Chapter 16, Pages 571‐653  Merck Manual , 18 th Edition, 2006, Chapters 30 & 206, Pages 251‐349; 1748‐1758  Clinically Oriented Anatomy , 6 th edition, 2010  CURRENT Medical Diagnosis & Tx, 56 th edition, 2012 JSOMTC, SWMG(A) Slide 3 1

  2. Agenda  Define the medical vocabulary components related to the physical exam of the musculoskeletal (MSK) system  Identify common or concerning symptoms of the musculoskeletal system  Communicate the important topics for health promotion and counseling for the musculoskeletal system JSOMTC, SWMG(A) Slide 4 Agenda  Communicate the important areas of examination for each of the major joints of the musculoskeletal system  Communicate the inspection, palpation, range of motion, and maneuvers of the shoulder  Communicate the inspection, palpation, range of motion, associated structures, and maneuvers of the elbow JSOMTC, SWMG(A) Slide 5 Agenda  Communicate the inspection, palpation, range of motion, and maneuvers of the wrist and hands  Communicate the inspection, palpation, range of motion, and maneuvers of the spine  Communicate the inspection, palpation, range of motion, and maneuvers of the hip JSOMTC, SWMG(A) Slide 6 2

  3. Agenda  Communicate the inspection, palpation, range of motion, and maneuvers of the knee  Communicate the inspection, palpation, range of motion, and maneuvers of the ankle and foot  Communicate the limitation in motion of a joint and how to record your findings relating to the musculoskeletal system JSOMTC, SWMG(A) Slide 7 Reason As a SOF medic/corpsman, your ability to conduct a correct physical exam of the musculoskeletal system will be crucial as these patients will represent the bulk of your patient population. JSOMTC, SWMG(A) Slide 8 Medical Vocabulary Components Related to the Physical Exam of the Musculoskeletal (MSK) System JSOMTC, SWMG(A) Slide 9 3

  4. Vocabulary  Ligament – ropelike bundles of collagen fibrils that connect bone‐to‐bone  Tendon – collagen fibers connecting muscle‐to‐bone  Bursae – pouches of synovial fluid that cushion the movement of tendons & muscles over bone or other structures  Idiopathic –condition that arises spontaneously or from an obscure or unknown cause JSOMTC, SWMG(A) Slide 10 Vocabulary  Monoarticular – pertaining to or affecting a single joint  Polyarticular – affecting many joints  Myalgia – "aches & pains" in the muscles  Arthralgia – pain but no evidence of arthritis  Scoliosis – lateral & rotatory curvature of the spine JSOMTC, SWMG(A) Slide 11 Vocabulary  Osteoporosis – bone density loss of greater than 25%  Crepitus – a grating or crackling sound or sensation (as the produced by the fractured ends of a bone moving against each other; foreign bodies in the joint (tear); subcutaneous emphysema)  Kyphosis – exaggerated thoracic curvature JSOMTC, SWMG(A) Slide 12 4

  5. Vocabulary  Lordosis – exaggerated lumbar curvature  Subluxation – partial dislocation  Genu varum – “bowlegs” (genu = knee)  Genu valgum – “knock‐knees”  Valgus – angulation of the part away from the midline of the body  Varus – angulation of the part towards the midline of the body JSOMTC, SWMG(A) Slide 13 Common or Concerning Symptoms of the Musculoskeletal System JSOMTC, SWMG(A) Slide 14 Common/Concerning Symptoms  Low back pain (LBP)  Neck pain  Monoarticular or polyarticular joint pain  Inflammatory or infectious joint pain  Joint pain with systemic features  Joint pain with symptoms from other organ systems JSOMTC, SWMG(A) Slide 15 5

  6. Common/Concerning Symptoms  Low back pain  2 nd most common reason for office visits  Midline?  Radiating into the legs?  Bladder or bowel dysfunction?  Red Flags – systemic disease • > 50 y/o • Pain at night or • History of cancer rest (>6weeks) • Infection • Unexplained weight loss • Hx IV drug use • Pain lasting > 1 month JSOMTC, SWMG(A) Slide 16 Common/Concerning Symptoms  Neck pain  Trauma  Radiation  Arm/leg weakness  Change in bladder/bowel function  Degenerative  Note: red flags from LBP JSOMTC, SWMG(A) Slide 17 JSOMTC, SWMG(A) Slide 18 6

  7. The Important Topics for Health Promotion and Counseling for the Musculoskeletal System JSOMTC, SWMG(A) Slide 19 Health Promotion & Counseling  Nutrition, exercise, and weight  Balanced diet • Nutritional supplements  Regular exercise • Increases and maintains bone mass • Prevents obesity, diabetes, hypertension, PAD • Decreases stress • 30 min a day walking  Weight management • Reduces wear and tear on joints JSOMTC, SWMG(A) Slide 20 Health Promotion & Counseling  Low back  60‐80% experience 1x / lifetime  30‐60% experience recurrences ‐ work related  Correct lifting techniques  Correct posture  Exercise  Falls – increase in the elderly  Exercise helps mitigate these risk factors  Osteoporosis  Any age JSOMTC, SWMG(A) Slide 21 7

  8. The Important Areas of Examination for Each of the Major Joints of the Musculoskeletal System JSOMTC, SWMG(A) Slide 22 Common/Concerning Symptoms: Subjective Exam  Subjective Exam – What the Pt tells you  Joint pain  History (Hx) • OPQRST • Previous treatments  Do you have any pain in your joints? • Localized – monoarticular • Diffused – polyarticular  Pattern of involvement  Symmetric  Migrating / spreading? – “Does the pain move?” JSOMTC, SWMG(A) Slide 23 Common/Concerning Symptoms: Subjective Exam • Extra‐articular – tendons, bursae, ligaments  Myalgias  Arthralgia's  Timing – onset • Rapidly – “How long has this been going on?” • Insidiously over a length of time • Periods of improvement/worsening • Over the course of the day JSOMTC, SWMG(A) Slide 24 8

  9. Common/Concerning Symptoms: Objective Exam  Objective Exam – physical exam findings (Exam, Observation, Inspection, Palpation, ROM, Strength)  Inflammation • Tenderness, warmth, or redness  Swelling  Stiffness – resistance to movement • Decreased range of motion • Changes in level of activity JSOMTC, SWMG(A) Slide 25 General Techniques of Examination: Objective Exam  Observe general appearance  Body proportions  Facial expressions  Gait  Posture  Inspection  Joint symmetry of involvement  Alignment  Nodules  Bony deformities  Atrophy  Skin changes  Swelling JSOMTC, SWMG(A) Slide 26 General Techniques of Examination  Palpation  Tenderness  Swelling  Temperature  Texture ‐ nodules  Pulse • Active – by the Pt  ROM – limitations • Passive – by the examiner  Maneuvers ‐ laxity  Muscle strength JSOMTC, SWMG(A) Slide 27 9

  10. The Inspection, Palpation, Range of Motion, and Maneuvers of the Shoulder JSOMTC, SWMG(A) Slide 28 Anatomy Overview ‐ Shoulder  Functional anatomy ‐ overview  Glenohumeral (synovial) – ball & socket joint  Flexion, extension, abduction, adduction, medial & lateral rotation, circumduction  Dynamic stabilizers – SITS muscles  Static stabilizers – Superior • Bony shoulder girdle glenohumeral ligament Transverse humeral • Glenoid labrum ligament • Articular capsule • Glenohumeral ligament JSOMTC, SWMG(A) Slide 29 Anatomy Overview ‐ Shoulder  Bony anatomy  Humerus • Greater & lesser tubercle  Clavicle – pectoral girdle/axial skeleton • Articulations: AC & SC joints  Scapula • Acromion • Coracoid process JSOMTC, SWMG(A) Slide 30 10

  11. Anatomy Overview ‐ Shoulder  Joints and articulations  Glenohumeral joint  Sternoclavicular (SC) joint  Acromioclavicular (AC) joint JSOMTC, SWMG(A) Slide 31 Anatomy Overview ‐ Shoulder  Muscle groups (3)  Scapulohumeral group – SITS • Supraspinatus JSOMTC, SWMG(A) Slide 32 Anatomy Overview ‐ Shoulder  Muscle groups (3)  Scapulohumeral group – SITS • Infraspinatus JSOMTC, SWMG(A) Slide 33 11

  12. Anatomy Overview ‐ Shoulder  Muscle groups (3)  Scapulohumeral group – SITS • Teres minor JSOMTC, SWMG(A) Slide 34 Anatomy Overview ‐ Shoulder  Muscle groups (3)  Scapulohumeral group – SITS • Subscapularis JSOMTC, SWMG(A) Slide 35 Anatomy Overview ‐ Shoulder  Muscle groups  Axioscapular group • Trapezium JSOMTC, SWMG(A) Slide 36 12

  13. Anatomy Overview ‐ Shoulder  Muscle groups  Axioscapular group • Serratus anterior JSOMTC, SWMG(A) Slide 37 Anatomy Overview ‐ Shoulder  Muscle groups  Axioscapular group • Rhomboids JSOMTC, SWMG(A) Slide 38 Anatomy Overview ‐ Shoulder  Muscle groups  Axioscapular group • Levator scapulae JSOMTC, SWMG(A) Slide 39 13

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