Transcript 2 CLINICAL EXAMINATION copy

CLINICAL
EXAMINATION
Diagnostic approach
depends upon assessment
of function
SELECTIVE TENSION
• Passive movements stress
inert structures
• Resisted movements test
contractile structures
EXAMINATION FOLLOWS
A SET ROUTINE
OBSERVATION
• Face
• Posture
• Gait
HISTORY
• Age and occupation, sports
hobbies, lifestyle
• Site and spread
• Onset and duration
HISTORY
• Symptoms and behaviour
• Other joint involvement
• Past medical history
• Medications
INSPECTION
• Bony deformity
• Colour changes
• Wasting
• Swelling
PERIPHERAL JOINTS
Palpate for:
• Heat
• Swelling
• Synovial thickness
• Not for tenderness
STATE AT REST
• Position of the pain
ACTIVE MOVEMENTS
• Pain
• Range
• Willingness
OTHER FINDINGS
• Painful arc
PASSIVE MOVEMENTS
FOR INERT STRUCTURES
• Joint capsule
• Bursa
• Dura mater
• Nerve root
• Ligament
• Fascia
• Dural nerve
root sleeve
• Relaxed muscle
and tendon
PASSIVE MOVEMENTS
FOR INERT STRUCTURES
• Pain
• Range
• End-feel
PASSIVE MOVEMENTS
• Capsular pattern
• Non-capsular pattern
NORMAL END-FEEL
• Hard
• Soft
• Elastic
ABNORMAL END- FEEL
• ‘Hard’
• Spasm
• Springy
• Empty
CAPSULAR PATTERN
• Arthritis
• Varies from joint to joint
• Limitation in a fixed proportion
which varies according to the
joint
• Same whatever the cause of
the arthritis
NON-CAPSULAR PATTERN
• Intra-articular displacement
• Ligamentous lesion
• Extra-articular lesion
RESISTED TESTS
FOR CONTRACTILE STRUCTURES
• Muscle
• Tendon
• Attachments to bone
RESISTED TESTS
• Pain
• Power
• Relaxed contractile unit may
produce pain on passive
stretching
RESISTED TESTS
• Joint in mid position
• No joint movement
• Eliminate muscles not tested
• Test muscles strongly
• Patient and examiner positioned
to advantage
RESISTED TESTS
• Strong and painless
• Strong and painful
• Weak and painless
• Weak and painful
• Painful on repetition
• All painful/juddering
NEUROLOGICAL
EXAMINATION
• Reflexes
• Power
• Sensation
• Plantar response
OTHER TESTS
• Mechanical/neural tests
• Blood tests
• X-ray
• EMG
• Scans
PALPATION
Once the structure at fault has
been identified