Principles and concepts chapter 1 | orthopedic physical assessment скачать в хорошем качестве

Principles and concepts chapter 1 | orthopedic physical assessment

Orthopedic physical assessment involves systematically evaluating the musculoskeletal system to identify injuries, abnormalities, or functional impairments. It helps clinicians determine the underlying causes of pain, movement limitations, or weakness. Here are the key principles and concepts: 1. History Taking Subjective Information: Understanding the patient’s symptoms, injury mechanism, pain characteristics (e.g., location, type, intensity), functional limitations, and relevant medical history. Activities of Daily Living (ADLs):Assessing how the condition affects normal daily activities, work, and hobbies. 2. **Observation **Posture and Gait: Assessing for abnormal postures, asymmetry, or deviations in walking or standing. **Atrophy or Swelling: Identifying muscle wasting, edema, or deformities. *Skin and Joint Changes:* Noticing skin discoloration, scars, or temperature changes in affected areas. 3. **Palpation *Bony Landmarks:* Identifying tenderness, swelling, or deformities of bones. *Soft Tissue:* Checking muscles, ligaments, tendons, and joints for tenderness, tightness, spasms, or abnormalities. *Temperature:* Differences in warmth that might indicate infection or inflammation. 4. *Range of Motion (ROM)* *Active Range of Motion (AROM):* Patient’s ability to move the joint on their own. *Passive Range of Motion (PROM):* The range the clinician can move the joint while the patient remains passive. *Comparison with Opposite Side:* Always compare bilaterally to detect abnormalities. 5. *Strength Testing* *Manual Muscle Testing (MMT):* Grading muscle strength on a scale (0 to 5), where 5 is normal and 0 is no muscle contraction. *Functional Strength Testing:* Evaluating the muscles in positions related to functional activities. 6. *Special Tests* Specific tests are designed to stress particular structures (ligaments, tendons, joints) to detect instability, tears, or dysfunctions. These tests help narrow down the diagnosis. Examples: *Lachman Test* for ACL integrity, *Finkelstein’s Test* for De Quervain’s tenosynovitis. 7. *Neurological Assessment* *Dermatomes and Myotomes:* Assessing sensory (dermatome) and motor (myotome) innervation of nerves. *Reflex Testing:* Evaluating deep tendon reflexes (e.g., patellar or Achilles tendon) to assess nerve function. *Peripheral Nerve Testing:* Checking for entrapment or injury (e.g., Tinel’s sign, Phalen’s test). 8. *Joint Integrity Testing* *Stability Tests:* Evaluating ligaments and joint capsules for excessive laxity or instability. *Meniscus or Cartilage Testing:* Performing maneuvers like the *McMurray Test* to check for meniscal injuries. 9. *Functional Testing* *Gait Analysis:* Observing walking mechanics, speed, and endurance. *Balance and Coordination:* Assessing proprioception, balance, and the ability to coordinate complex movements. 10. *Pain Assessment* *Provocation Tests:* Maneuvers that replicate the pain (e.g., loading a joint to replicate weight-bearing pain). *Pain Scales:* Using subjective pain rating scales (e.g., Visual Analog Scale) to assess pain severity. 11. *Imaging and Further Tests* While not part of the physical exam, integrating imaging (X-rays, MRI, CT) and laboratory results can assist in confirming the diagnosis after the physical assessment. Key Concepts: *Symmetry:* Comparing the affected side to the unaffected side. *Sequential Examination:* Always following a structured approach (inspection, palpation, ROM, strength, etc.) to avoid missing any steps. *Patient Communication:* Explaining findings and ensuring the patient understands what is being assessed. This comprehensive approach ensures accurate diagnosis, guiding effective treatment plans for orthopedic conditions.