Musculoskeletal Examination Sarah Hoffmann, MD 02.17.2020
Agenda 1. Review Basic Concepts of MSK Examination 2. Upper Extremity Examination 3. Lower Extremity & Spine Examination Musculoskeletal Exam 02.17.2020
Basic Concepts Abnormalities • Deformity • Visible Swelling • Muscle Atrophy • Abnormalities in Range of Motion • Gait Abnormalities Symmetry Active and Passive Range of Motion Musculoskeletal Exam 02.17.2020
Range of Motion Active Range of Motion • Patient Initiated • Patient must cooperate • Tests Integrative Function • Integrated Function • Innervation • Muscle & Tendon Integrity • Joint Mobility Passive Range of Motion • Examiner Initiated • Tests Only Joint Mobility Musculoskeletal Exam 02.17.2020
Position, Plane, and Motion Anatomic Position • Neutral Position for each joint based on Anatomic Position • Flexion, Extension, Abduction & Adduction defined as movement away from Neutral Musculoskeletal Exam 02.17.2020
Exam Set Up Must have access to the Area • Patient must be appropriately undressed • Failure to visualize due to inadequate exposure most common error Examine Upper Extremities in Seated Position Examine Lower Extremities in Laying Down & Standing/Walking Musculoskeletal Exam 02.17.2020
Upper Extremity Musculoskeletal Exam 02.17.2020
Hands Instruct to Open Hands Inspect Dorsal & Palmar Surface • Swelling, Deformity, Atrophy (Palmar) • Assess Finger Extension- Ask to Spread Fingers • Assess Finger Flexion – Ask to Make Fist • Finger tips should be buried in palm • Inspect Fists and have turn palm up • Also Assesses Supination/Pronation Musculoskeletal Exam 02.17.2020
Finger ROM Musculoskeletal Exam 02.17.2020
Hands Musculoskeletal Exam 02.17.2020
Hands Musculoskeletal Exam 02.17.2020
Wrist Musculoskeletal Exam 02.17.2020
Hands Musculoskeletal Exam 02.17.2020
Hands Musculoskeletal Exam 02.17.2020
Hand Musculoskeletal Exam 02.17.2020
Wrist & Elbow Wrist • Inspect for Swelling, Deformity, Atrophy • Assess Dorsiflexion – Ask to make Prayer Sign • Assess Flexion – Ask to put backs of hands together • Passive ROM- Take patient hand in your Dominant Hand Elbow • Inspect for Swelling, Deformity, Atrophy • Assess Extension – Arms straight out • Assess Flexion – Ask to them to Touch their Shoulders • Passive ROM- Place your hand under olecranon Musculoskeletal Exam 02.17.2020
Wrist & Elbow ROM Musculoskeletal Exam 02.17.2020
Shoulder Shoulder • Inspect for Deformity, Atrophy • Flexion- Arms Forward and over head (Doing the Wave) • Abduction- Arms to side and out above head (Flapping Bird) • Adduction- Crossing Chest (Self Hug) • Internal Rotation- Place both hands behind back • External Rotation – Place both hands behind head, elbows out Musculoskeletal Exam 02.17.2020
Lower Extremities & Spine Musculoskeletal Exam 02.17.2020
Knee & Hip Inspect for Swelling, Deformity, Atrophy with patient lying supine Assess Knee and Hip Flexion – Ask patient to bring knee to chest • Full Knee Flexion calf will touch posterior thigh • Full Hip Flexion Thigh will be near chest Passive ROM, Examiner holds heel and supports knee • Passive Hip External Rotation- With Knee & Hip 90, heel goes medially • Passive Hip Internal Rotation- Knee & Hip 90, Heel goes laterally Assess Hip Active External Rotation – Ask to turn knee out and make “4” Musculoskeletal Exam 02.17.2020
Knee & Hip Musculoskeletal Exam 02.17.2020
Knee Musculoskeletal Exam 02.17.2020
Knee Musculoskeletal Exam 02.17.2020
Knee Musculoskeletal Exam 02.17.2020
Knee Musculoskeletal Exam 02.17.2020
Ankle & Foot Inspect for Swelling, Deformity, Atrophy with patient lying supine Ankle Dorsiflexion- Toes up toward nose Ankle Plantarflexion – Toes down, “push gas pedal” Inversion/Eversion Note Calluses Musculoskeletal Exam 02.17.2020
Ankle/Feet Musculoskeletal Exam 02.17.2020
Ankle Musculoskeletal Exam 02.17.2020
Ankle/Foot Musculoskeletal Exam 02.17.2020
Foot Musculoskeletal Exam 02.17.2020
Standing Exam Note Alignment of Hips, Knees, Ankles, Feet from in front and behind Note Symmetry and Look for atrophy Look at Alignment of Spine from behind and side Musculoskeletal Exam 02.17.2020
Spine Exam Observe Alignment Cervical Flexion- Chin to Chest Cervical Extension- Look up at ceiling Cervical Rotation- Look over Shoulder/Chin to Shoulder Cervical Lateral Bend- Ear to Shoulder Lumbar Flexion- Bend forward at waist • Full Spine Flexion allows wrists to be at knees • Touching toes involves hip flexion Lumbar Extension- Bend backward at waist Lateral Bend- Side Bend with fingertip at knee Musculoskeletal Exam 02.17.2020
Gait Exam & Beyond Cyclic movement of Gait divided into two phases • Swing Phase • Stance Phase Look for Limp, Uneven rhythm, Asymmetry Standing on Squatting • Assesses Hip, Knee, Ankle mobility and strength Musculoskeletal Exam 02.17.2020
Thank you
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