Systematic Musculoskeletal Examination: Including Manual Medicine Diagnostic Techniques

ISBN-13: 9783642751530 / Angielski / Miękka / 2011 / 462 str.

Herbert Frisch; T. C. Telger

Opis

In response to the great demand for an English edition of the standard German handbook, Systematic Musculoskeletal Examination will soon be available. This comprehensive book contains up-to-date information for the orthopedic examination of the locomotor apparatus. In addition to the well-known techniques of the musculoskeletal examination, it also describes in detail the diagnostic techniques used in manual medicine. The numerous examinations are carried out according to five clearly defined examination stages which are the same for each joint and allow a systematic examination of the individual joint structures for functional disorders or disruptive effects (functional structural analysis). The examination is thus logically organized according to an outline, and the indications for each stage are based on the results of the previous stage and the summary of the functionally related body regions. The functions tests take into account the state of the art in biomechanics, and the symptoms requiring radiologic functional diagnosis are depicted. The systematized and streamlined examination procedure makes it possible to obtain and document results in a uniform manner. The all-inclusive nature of the text, guided by a well-designed systematic and methodical approach, will make it attractive to anyone dealing with the musculoskeletal system.

Spis treści

Examination Program.- Patient-Oriented Aspects.- Examiner-Oriented Aspects.- Examination According to the 5/5 Program.- Structure of the Systematic Examination.- Systematic History.- Basic Physical Examination.- Inspection.- Conduct of Examination.- Palpation.- Conduct of the Examination and Findings.- Motion Testing.- Conduct of the Examination.- Rationale for the Basic Physical Examination.- Adjunctive Neurologic and Angiologic Studies.- Neurologic Studies.- Conduct of the Examination.- Angiologic Studies.- Adjunctive Special Diagnostic Procedures.- Examination Positions.- Body Regions Examined.- Diagnosis.- Disease Groups Involving the Musculoskeletal System.- Structural Analysis of Function Using the Diagnostic Program.- Structural Analysis in the Patient History with Reference to Pain.- Types of Pain from a Structural Perspective.- Basic Principles in the Analysis of Pain.- Analysis of Pain During History Taking.- Joint Pain.- Muscle Pain.- Ligament Pain.- Bursitis, Tendovaginitis.- Nerve Pain.- Vascular Pain.- Vertebragenic Pain.- Structurally Specific Findings in the Arthron.- Examination of the Joint.- Inspection.- Active and Passive Motion Testing.- Palpation.- Joint Play.- Examination of the Spine.- Inspection.- Motion Testing.- Palpation.- Joint Play.- Examination of the Muscles.- Muscle Groups.- Findings of Muscle Examination.- Inspection.- Motion Testing.- Palpation.- Resistance Tests.- Examination of the Nerves.- Inspection.- Active and Passive Motion Testing.- Palpation.- Muscle Tests.- Special Neuropathologic Findings During the Basic Physical Examination.- Inspection.- Complex Motor Sequences.- Spontaneous Muscular Contractions.- Trophic Disturbances (Chiefly Involving the Hands and Feet).- Active and Passive Motion Testing.- Active Motion Testing.- Passive Motion Testing.- Palpation.- Autonomic Nervous Disorders.- Nerve Pressure Points.- Thickening of Nerve Trunks.- Muscle Tests.- Differential Diagnosis of Nerve Lesions.- Symptoms of Nerve Lesions by Location.- 1. Muscular Nociceptive Symptoms (Nociceptive Reaction of Wolff).- 2. Symptoms of Peripheral Nerve Lesions.- 3. Radicular Symptoms.- 4. Symptoms of Plexus Damage.- 5. Symptoms Due to Disturbances Involving the Neuromuscular Junction or Muscle Fiber.- 6. Symptoms of Lesions of the Central Neuron (Central Paralysis).- Practical Relevance of the Structural Analysis of function.- How Does the Control and Warning System Function?.- Proprioception.- Stability.- Coordination.- Nociception.- Testing of Irritation Zones.- Location of the Irritation Zones or Irritation Points.- Examination Technique.- Diagnostic Implications of Irritation Zone Testing.- Basic Examination of the Spine and the Joints of the Extremities.- Detailed Introduction.- Systematic History.- Interpretation of the History.- Current Pain.- 1 Location of Pain: What Hurts ? Where Does it Hurt?.- 1.1 Localized Pain (Monoarticular, Monosegmental).- 1.2 Multifocal Pain (Polyarticular, Vertebral Region or Entire Spine).- 1.3 Referred Pain (Muscle Chains, Nerve Pathways, Vessels).- 1.4 Diffuse Pain.- 1.5 Unilateral or Bilateral Pain.- 2 Pain Occurrence: When Does It Occur and When Did It First Occur?.- 2.1 24-HourRhythm.- 2.2 Periodic Pain (Ovarian Cycle, Seasons, Age).- 2.3 Episodic Pain (With or Without a Change in Pain Location).- 3 Nature of the Pain.- 3.1 Intensity.- 3.2 Character.- 3.3 Course.- 4 What Precipitates on Changes the Pain?.- 4.1 Body Posture.- 4.2 Body Movements.- 4.3 Other Mechanical Influences.- 4.4 Miscellaneous Influences.- 5 Associated Phenomena: What Accompanies the Pain?.- 5.1 Sensory Disturbances.- 5.2 Motor Disturbances.- 5.3 Circulatory Disturbances.- 5.4 Trophic Disturbances.- 5.5 Psychological Disturbances.- Previous Course, General State of Health, Other Current Diseases.- 1 What Treatments Have Been Given in the Past?.- 2 What Improved or Changed the Pain?.- 3 How Are the Vital Functions?.- 4 When Did Previous Pain Occur Involving the Spine and Joints?.- 5 What Other Diseases or Disorders Does the Patient Have Now?.- The Basic Physical Examination: Preliminary Information.- Exceptions.- Abbreviations.- Symbols Used in the Figures on Examination Techniques.- Checklist for Joint Examinations.- Checklist for Muscle Examinations.- Documentation of Findings Using Symbols.- Ten Standard Symbols.- General Symbols.- Inspection.- Palpation.- Motion Testing.- Measurements.- Joints.- Muscles.- General Inspection in the Standing Position (A).- 1 Ordinary Movements.- 1.1 Gait.- 1.2 Other Ordinary Movements.- 2 Posture.- 3 Body Contours and Proportions.- 4 Skin.- 5 Assistive Devices.- Examination of the LPH Region in the Standing Position (A/II).- 1 Inspection (see General Inspection).- 2 Active and Passive Trunk Movements in Three Planes (Regional Diagnosis).- 2.1 Sagittal Plane: Forward and Backward Bending.- 2.2 Frontal Plane: Sidebending.- 2.3 Transverse Plane: Rotation.- 3 Palpation of the Pelvic Joints.- Palpation at Rest.- 3.1 Pelvic Position, Leg Length Discrepancy.- Palpation During Movement — Testing Joint Play in Both SIJs.- 3.2 Standing Flexion Test (SIJ).- Unilateral Joint Play Testing.- 3.3 Recoil Phenomenon (SIJ), “Spine Test”.- 3.4 Hip Drop Test (Lumbar Spine).- 3.5 Lateral Shift Test (SIJ).- 4 Tests of Joint Translation.- 4.1 Traction on the Lumbar Spine.- 4.2 Compression of the Lumbar Spine.- 5 Muscle Test.- General Examination of the Lower Extremities in the Standing Position (A/I) (Supplement to Examination of the LPH Region).- 1 Three-Phase Squat.- 2 Standing on the Toes.- 3 Standing on the Heels.- 4 Standing on the Outer Edge of the Foot.- 5 Muscle Tests.- Examination of the LPH Region in the Sitting Position (B/II).- 1 Inspection.- 1.1 Relaxed and Erect Sitting Posture.- 1.2 Pelvic Position — Comparison with Findings in Standing.- 2 Active and Passive Trunk Movements in Three Planes (Regional Diagnosis).- Supplementary SIJ Test for Differentiating Motion Faults in the SIJ and Lumbar Spine.- Regional Motion Testing of the Lumbar (and Thoracic) Spine in Three Planes with the Pelvis Stationary.- 3 Palpation of the SIJ and Lumbar Spine (Segmental Diagnosis).- Palpation at Rest.- 3.1 Pelvic Position.- Palpation During Movement.- 3.2 Seated Flexion Test (for Asymmetric Excursion of the Iliac Spines).- 3.3 Segmental Motion Testing of the Lumbar Spine.- 4 Tests of Joint Translation.- 4.1 Traction.- 4.2 Compression.- 5 Muscle Tests.- Resistance Tests of the Flexors, Rotators, Abductors, and Adductors of the Hip.- Examination of the LPH Region in the Prone Position (C/II).- 1 Inspection.- 1.1 Pelvic Position and Gluteal Profile.- 1.2 Pelvis-Leg Angle.- 1.3 Leg Length Discrepancy.- 1.4 Asymmetric Muscle Contours.- 1.5 Alignment of the Vertebral Column.- 2 Active and Passive Hip and Knee Movements (Regional Diagnosis.- 2.1 Hyperextension of the Hip Joint (Extension from the Neutral Position).- 2.2 Rotation of the Hip Joint.- 2.3 Flexion, Extension, Rotation of the Knee Joint.- 3 Palpation Field of the Dorsal Pelvis: Lumbar Joints/Soft-Tissue Diagnosis (Segmental Diagnosis).- Palpation at Rest.- 3.1 Palpation Field of the Dorsal Pelvis.- 3.2 Test for Functional Leg Length Discrepancy (Functionally Short Leg).- 3.3 Segmental Palpation of the Lumbar Spine (Mobility/Pain).- 3.4 Kibler’s Skin Rolling Test.- 3.5 Connective-Tissue Stroke Test.- 4 Tests of Joint Translation.- 4.1 Lumbar Spine.- 4.2 Sacroiliac Joints.- 4.3 Hip Joints: Rotation.- 5 Muscle Tests.- 5.1 Resistance Tests of the Hip Muscles.- 5.2 Knee Muscles.- 5.3 Back Extensors.- Examination of the LPH Region in the Lateral Position (D/II).- 3 Palpation of the Lumbar Spine During Movement (Segmental Mobility).- 3.1 Forward and Backward Bending.- 3.2 Sidebending.- 3.3 Rotation.- 4 Tests of Joint Translation.- 4.1 Hypermobility Test of the SIJ.- 4.2 Hypermobility Test of the Lumbar Spine.- 5 Muscle Tests (Resistance Tests of Hip Muscles).- 5.1 Abductors.- 5.2 Adductors.- Examination of the LPH Region in the Supine Position (E/II).- 1 Inspection.- 1.1 Legs.- 1.2 Pelvic Position.- 1.3 Vertebral Column.- 1.4 Abdominal Wall.- 2 Active and Passive Motion Testing: Hip and Knee Joints, SIJ, and Lumbar Spine.- 2.1 Hip Flexion.- 2.2 Hip Rotation.- 2.3 Hip Abduction.- 2.4 Knee Joint Screening Tests.- 2.5 Differentiation of the LPH Joints: Hip Joint, SIJ, Lumbar Spine, and Muscles.- 3 Palpation Field of the Ventral Pelvis.- Palpation at Rest.- 4 Tests of Joint Translation.- 4.1 Traction and Compression of the Lumbar Spine.- 4.2 Traction and Compression of the Hip Joint.- 4.3 SIJ Springing Test via the Thigh.- 5 Muscle Tests.- 5.1 Resistance Tests of the Hip and Abdominal Muscles.- 5.2 Shortening Tests.- Examination of the Thorax (Thoracic Spine and Ribs) in the Sitting Position (B/III).- 1 Inspection.- 1.1 Thoracic Morphology.- 1.2 Respiratory Movements.- 2 Active and Passive Trunk Movements in Three Planes (Regional Diagnosis).- 3 Palpation of the Thoracic Joints (Segmental Diagnosis).- Palpation at Rest.- 3.1 Sternal and Costal Synchondroses (Sternocostal Joints 2–7), Floating Ribs.- 3.2 Costotransverse Joints.- 3.3 Segmental Muscles.- Palpation During Movement.- 3.4 Segmental Motion Testing of the Thoracic Spine.- 3.5 Segmental Motion Testing of the Ribs (“Harp”).- 4 Tests of Joint Translation.- 4.1 Bimanual Compression of the Thorax in the Frontal Plane.- 4.2 Bimanual Compression of the Thorax in the Sagittal Plane.- Examination of the Thorax (Thoracic Spine and Ribs) in the Prone Position (C/III).- 1 Inspection.- 2 Active Movements: Respiratory Movements (Deep Breathing) (Regional Diagnosis).- 3 Palpation of the Thoracic Joints (Segmental Diagnosis).- Palpation at Rest.- 3.1 Palpation Field of the Posterior Thorax.- Palpation During Movement.- 3.2 Rib Movements and Intercostal Spaces.- 4 Tests of Joint Translation.- 4.1 Thoracic Segments.- 4.2 Scapula.- 5 Muscle Tests.- Examination of the Thorax (Thoracic Spine and Ribs) in the Lateral Position (D/III).- 3 Palpation of the Thoracic Joints During Movement (Segmental Diagnosis).- 3.1 Segmental Mobility Testing of the Thoracic Spine.- 3.2 Segmental Mobility Testing of the Cervicothoracic Junction (C6-T3).- 3.3 Segmental Mobility Testing of the Lower (6th–12th) Ribs.- Examination of the Thorax (Ribs) in the Supine Position (E/III).- 1 Inspection.- 2 Active Movements: Respiratory Movements (Deep Breathing) (Regional Diagnosis).- 3 Palpation of the Ribs (Segmental Diagnosis).- Palpation at Rest.- 3.1 Palpation Field of the Anterior Thorax.- Palpation During Movement.- 3.2 Rib Movements and Intercostal Spaces.- 3.3 Segmental Mobility Testing of the Upper (2nd–6th) Ribs.- 4 Tests of Joint Translation.- 4.1 Costal Joints.- 4.2 Sternoclavicular and Acromioclavicular Joint.- 5 Muscle Test: Test for Shortening of the Pectoralis Major.- Examination of the Cervical Spine in the Sitting Position (B/V).- 1 Inspection.- 2 Active and Passive Movements of the Cervical Spine and Head in Three Planes (Regional Diagnosis).- 2.1 Sagittal Plane: Backward and Forward Bending.- 2.2 Frontal Plane: Sidebending.- 2.3 Transverse Plane: Rotation.- 2.4 Provocative Testing of the Vertebral Segments (Modified from de Kleyn).- 2.5 Provocative Test for Motion Segment Laxness (Hypermobility).- 3 Palpation of the Cervical Spine During Movement (Segmental Diagnosis).- 3.1 Mobility Testing of the Occiput/Atlas (C0/C1).- 3.2 Mobility Testing of the Atlas/Axis (C1/C2).- 3.3 Mobility Testing of the C2/C3 Segment.- 3.4 Mobility Testing of the C3–C5 Segments.- 3.5 Mobility Testing of the C5–T3 Segments (Cervicothoracic Junction).- 4 Tests of Joint Translation.- 4.1 Traction.- 4.2 Compression.- 4.3 Tests of Facet Joint Gliding.- 5 Muscle Tests — Resistance Tests of the Cervical Muscles (Synergists).- Examination of the Head (Temporomandibular Joints, Sensory Organs) in the Sitting Position (B/V).- 1 Inspection.- 1.1 Facial Asymmetries.- 1.2 Mimetic Activity.- 1.3 Sensory Organs: Eyes.- 2 Jaw Movements and Swallowing.- 2.1 Opening and Closing of the Jaw.- 2.2 Protraction and Retraction of the Jaw.- 2.3 Lateral Jaw Movements (Grinding Movements).- 3 Palpation Field of the Face.- 3.1 Trigeminal Pressure Points.- 3.2 Corneal Reflex (First Division of the Trigeminal Nerve).- 3.3 Pressure on the Tragus.- 3.4 Palpation of the Temporomandibular Joints.- 3.5 Percussion of the Frontal and Maxillary Sinuses.- 4 Passive Testing of Temporomandibular Joint Motion and Play.- 5 Muscle Tests.- 5.1 Mimetic Muscles.- 5.2 Masticatory Muscles.- 5.3 Lingual Muscles.- 5.4 Ocular Muscles.- Examination of the Cervical Spine in the Supine Position (E/V).- 1 Inspection.- 2 Active and Passive Movements of the Cervical Spine and Head in Three Planes (Regional Diagnosis).- 2.1 Forward Bending, Backward Bending, Sidebending, and Rotation.- 2.2 Side-to-Side Head Movement.- 2.3 Provocative Test for the Vertebral Artery (De Kleyn’s Hanging Test).- 3 Palpation of the Cervical Spine During Movement (Segmental Diagnosis).- 3.1 Forward Bending.- 3.2 Backward Bending.- 3.3 Sidebending.- 3.4 Rotation.- 4 Tests of Joint Translation.- 4.1 Three-Dimensional Traction on All Cervical Segments.- 4.2 C0/C1 Segment: Backward and Forward Gliding of the Occipital Condyles on the Atlas (Forward and Backward Nodding).- 4.3 C0/C1/C2 Segment: Combined Movements in the Craniovertebral Joints.- 4.4 C1/C2 Segment: Atlas Traction.- 4.5 C1/C2 Segment: Lateral Gliding of the Atlas on the Axis (Hypermobility Test).- 4.6 C2–C7 Segments: Convergent/Divergent Gliding in the Facet Joints.- 5 Muscle Tests — Resistance Testing of the Cervical Muscles.- Examination of the Upper Extremities in the Sitting Position (B/IV) Shoulder Joint.- 1 Inspection.- 1.1 Shoulder Position.- 1.2 Shoulder Contours.- 2 Active and Passive Movements of the Shoulder Joint.- 2.1 General Active Tests.- 2.2 Frontal Plane: Abduction/Adduction and Rotation of the Arms.- 2.3 Sagittal Plane: Raising the Arms Forward and Behind.- 3 Palpation Field of the Shoulder.- 4 Tests of Joint Translation (Humeral Head).- 5 Resistance Testing of the Shoulder Muscles.- 5.1 Synergists (2x4).- 5.2 Differentiating Tests (3x5).- Joints of the Shoulder Girdle.- 1 Inspection (See B/Shoulder/Sect. 1).- 2.1 Raising and Lowering the Shoulder Girdle.- 2.2 Advancing and Retracting the Shoulder Girdle.- 3 Palpation Field of the Shoulder Girdle.- 3.1 Palpation of the Shoulder Girdle at Rest.- 3.2 Palpation of the Shoulder Girdle During Movement.- 4 Tests of Joint Translation — Clavicle and Scapula.- Sternoclavicular Joint.- Acromioclavicular Joint.- Alternative Techniques.- 5 Resistance Testing of the Muscles of the Shoulder Girdle.- 5.1 Synergists.- 5.2 Scapular Rotators.- 6 Examination of the Cervical Spine.- Elbow Joint, Upper Arm, and Forearm.- 1 Inspection.- 1.1 Joint Position.- 1.2 Joint Contours.- 1.3 Changes in the Muscle Contours of the Upper Extremity.- 2 Active and Passive Elbow Movements.- 2.1 Flexion/Extension.- 2.2 Pronation/Supination.- 2.3 Abduction/Adduction (Collateral Ligament Stability Test).- 3 Palpation Field of the Elbow/Arm.- 3.1 Extensor Side of the Elbow.- 3.2 Lateral (Radial) Epicondyle.- 3.3 Medial (Ulnar) Epicondyle.- 3.4 Flexor Side of the Elbow.- 3.5 Upper Arm and Forearm.- 4 Tests of Joint Translation.- 4.1 Humeroradial Joint.- 4.2 Proximal and Distal Radioulnar Joints.- 4.3 Humeroulnar Joint.- 5 Resistance Testing of the Muscles of the Elbow Joint.- 5.1 Flexors and Extensors.- 5.2 Pronators and Supinators.- Hand and Finger Joints.- 1 Inspection.- 1.1 Shape and Position.- 1.2 Contour Changes.- 1.3 Skin and Nail Changes.- Skin Changes.- Nail Changes.- 2 Active and Passive Wrist and Finger Movements.- 2.1 Wrist Movements in Two Planes.- 2.2 Finger Movements in two Planes.- 2.3 Thumb Movements.- 3 Palpation Field of the Hand.- 3.1 Radial Border of the Hand.- 3.2 Ulnar Border of the Hand.- 3.3 Dorsum of the Hand.- 3.4 Palm of the Hand.- 3.5 Fingers and Thumb.- 4 Tests of Joint Translation.- 4.1 Wrist Joint (Five Tests).- 4.2 Intercarpal Joints (Ten Tests).- 4.3 Carpometacarpal Joint of the Thumb (Five Tests).- 4.4 Second to Fifth Carpometacarpal and Intercarpal Joints (Five Tests).- 4.5 Phalangeal Joints (Five Tests).- 5 Resistance Testing of the Hand and Finger Muscles.- 5.1 Wrist Muscles.- 5.2 Finger Muscles.- 5.3 Thumb Muscles.- Examination of the Lower Extremities in the Supine Position (E/I) Hip Joint (LPH Region).- Knee Joint, Upper Leg, Lower Leg.- 1 Inspection: Abnormalities of Shape and Position, Contours of the Upper and Lower Leg.- 1.1 Anterior Aspect.- 1.2 Lateral Aspect.- 1.3 Posterior Aspect.- 2 Active and Passive Motion Testing of the Knee Joint and Femoropatellar Joint.- 2.1 Knee Joint.- 2.2 Patellar Tracking.- 3 Palpation Field of the Knee Joint and Lower Extremity.- Palpable Findings.- 3.1 Anterior Side of the Knee (Patellar Region).- 3.2 Medial Side of the Knee (Medial Condyle).- 3.3 Lateral Side of the Knee (Lateral Condyle).- 3.4 Popliteal Fossa.- 3.5 Upper and Lower Leg Contours.- 4 Tests of Joint Translation.- 4.1 Mediolateral and Caudal Gliding Movements of the Patella.- 4.2 Traction on the Meniscotibial Joint.- 4.3 Mediolateral Gliding Movements in the Meniscotibial Joint (Shear Test).- 4.4 Anteroposterior Gliding Movements in the Meniscotibial Joint (Drawer Test).- 4.5 Mobility in the Superior Tibiofibular Joint.- 5 Tests of the Menisci and Ligaments.- Testing of the Menisci.- Testing of the Capsule and Ligaments.- Examination Technique.- 5.1 Test Group: Sagittal Plane (Tests 1–3).- Testing of the Menisci.- Testing of the Capsule and Ligaments.- 5.2 Test Group: Frontal Plane (Tests 4–7).- Testing of the Menisci.- Testing of the Capsule and Ligaments.- 5.3 Test Group: Transverse Plane.- Testing of the Menisci.- Testing of the Capsule and Ligaments.- 5.4 Testing the Posterior Horns of the Menisci by a Combination of Flexion, Lateroduction, and Rotation (Test 12).- 5.5 Specific Tests for Rotary Instability.- Joints of the Feet and Toes.- 1 Inspection.- 1.1 Shape and Position of the Foot.- 1.2 Contour Changes.- 1.3 Skin Changes.- 2 Active and Passive Motion Testing of the Pedal Joints.- 2.1 Active Movements.- 2.2 Passive Movements.- 3 Palpation Field of the Foot.- 3.1 Medial Border of the Foot.- 3.2 Lateral Border of the Foot.- 3.3 Dorsum of the Foot.- 3.4 Sole of the Foot.- 4 Tests of Joint Translation.- 4.1 Inferior Tibiofibular Joint (Distal Tibiofibular Syndesmosis).- 4.2 Tarsal Joints (Ten Tests).- 4.3 Metatarsal Joints (Five Tests).- 4.4 Phalangeal Joints: Five Tests.- 5 Resistance Testing of the Foot and Toe Muscles.- 5.1 FootMuscles.- 5.2 Toe Muscles.- Radiography.- Special Diagnostic Procedures.- Radiography.- 1 Rules for the Radiographic Examination of the Vertebral Column and the Joints of the Extremities.- 2 Analysis of the X-ray Image.- Practical Approach to the Analysis of X-ray Films.- 3 Techniques for the Radiographic Examination of the Vertebral Column.- 3.1 Anteroposterior Projection of the LPH Region (After Gutmann).- 3.2 Lateral Projection of the Lumbar Spine.- 3.3 Thoracic Spine.- 3.4 Anteroposterior Projection of the Cervical Spine (After Sandberg-Gutmann).- 3.5 Anteroposterior Functional Views of the Cervical Spine (with Sidebending).- 3.6 Lateral Projection of the Cervical Spine.- 3.7 Lateral Functional Views of the Cervical Spine (Forward and Backward Bending).- 3.8 Arlen’s Quantitative Technique for the Functional Evaluation of the Cervical Spine.- References.