Musculoskeletal Examination Sarah Hoffmann, MD 02.17.2020 Agenda - - PowerPoint PPT Presentation

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Musculoskeletal Examination Sarah Hoffmann, MD 02.17.2020 Agenda - - PowerPoint PPT Presentation

Jun 11, 2023 1.72k likes •2.1k views

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

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Sarah Hoffmann, MD

02.17.2020

Musculoskeletal Examination

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Agenda

02.17.2020 Musculoskeletal Exam

  • 1. Review Basic Concepts of MSK Examination
  • 2. Upper Extremity Examination
  • 3. Lower Extremity & Spine Examination
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Basic Concepts

02.17.2020 Musculoskeletal Exam

Abnormalities

  • Deformity
  • Visible Swelling
  • Muscle Atrophy
  • Abnormalities in Range of Motion
  • Gait Abnormalities

Symmetry Active and Passive Range of Motion

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Range of Motion

02.17.2020 Musculoskeletal Exam

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
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Position, Plane, and Motion

02.17.2020 Musculoskeletal Exam

Anatomic Position

  • Neutral Position for each joint based on Anatomic Position
  • Flexion, Extension, Abduction & Adduction defined as movement

away from Neutral

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Exam Set Up

02.17.2020 Musculoskeletal Exam

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

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Upper Extremity

02.17.2020 Musculoskeletal Exam

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Hands

02.17.2020 Musculoskeletal Exam

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
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Finger ROM

02.17.2020 Musculoskeletal Exam

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Hands

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Hands

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Wrist

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Hands

02.17.2020 Musculoskeletal Exam

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Hands

02.17.2020 Musculoskeletal Exam

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Hand

02.17.2020 Musculoskeletal Exam

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Wrist & Elbow

02.17.2020 Musculoskeletal Exam

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
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Wrist & Elbow ROM

02.17.2020 Musculoskeletal Exam

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Shoulder

02.17.2020 Musculoskeletal Exam

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
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Lower Extremities & Spine

02.17.2020 Musculoskeletal Exam

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Knee & Hip

02.17.2020 Musculoskeletal Exam

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”

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Knee & Hip

02.17.2020 Musculoskeletal Exam

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Knee

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Knee

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Knee

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Knee

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Ankle & Foot

02.17.2020 Musculoskeletal Exam

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

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Ankle/Feet

02.17.2020 Musculoskeletal Exam

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Ankle

02.17.2020 Musculoskeletal Exam

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Ankle/Foot

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Foot

02.17.2020 Musculoskeletal Exam

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Standing Exam

02.17.2020 Musculoskeletal 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

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Spine Exam

02.17.2020 Musculoskeletal 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

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Gait Exam & Beyond

02.17.2020 Musculoskeletal Exam

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
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Thank you