MUSCULOSKELETAL EXAM

Содержание

1. MUSCULOSKELETAL EXAM
2. Things you must DoIs the pain worse
3. Make the patient focus!
4. How not to write your history
5. RECORDING THE EXAMIn the real world-”BJM are
6. BONDING“Our hands are central to our psychology
7. UPPER BODY Nails
8. Слайд 8
9. Слайд 9
10. Слайд 10
11. UPPER BODY NailsPalms, Hands…….. Grip strength and “ knuckle sign” are very helpful.
12. Depression
13. More or less susceptible to myocardial infarction?
14. Heberden’s Nodes
15. Bouchard’s Nodes
16. Clue to an infectious arthritis
17. Слайд 17
18. Palmar Erythema
19. telangiectasia
20. Double Jointed
21. This Patient should stop what?
22. What are the yellow nodules?
23. What drug should this patient have been on?
24. Synovitis
25. Rheumatoid arthritis
26. Слайд 26
27. UPPER BODY NailsPalms, Hands…….. Grip strength and
28. What is this?
29. UPPER BODY NailsPalms, Hands…….. Grip strength and
30. Слайд 30
31. Слайд 31
32. UPPER BODY Cervical Spine and ……..don’t forget the TMJ!Shoulders
33. Quick Assessment of Shoulder FunctionIf the pt
34. WHAT MEDI-CATION IS SHETAKING?
35. A SLIGHTLY HIGHER YIELD THAN SPINAL PERCUSSION
36. DOES THIS MAN HAVE HEART DISEASE?
37. LOWER BODY Skin
38. ERYTHEMA MIGRANS
39. ERYTHEMA NODOSUM
40. LOWER BODY SkinFeet- MTPs are sentinel joints for inflammatory arthritisAnkle
41. Podagra
42. Psoriasis
43. LOWER BODY Kneeflexionextensionpatello/femoral clickingdon’t forget the anserine bursa
44. WHAT IS THE ANSERINE BURSA?VERY COMMONLY MISSED
45. LOWER BODY SkinFeetAnkleKneeHipinternal/external ROM while knee flexed
46. TERMS/SYNDROMESArthralgia/arthritisMyalgiaBaker’s cystGanglion cystMedial and lateral epicondylitisPatello-femoral syndromeHypermobility syndrome
47. The End
48. Recording the ExamS…L…T graded on a scale
49. Скачать презентанцию

Things you must DoIs the pain worse on weight bearing?Is the worst pain and stiffness present upon arising?What drugs have you tried, what dose and what happened?Always do bilateral assessments of

Слайды и текст этой презентации

Слайд 1MUSCULOSKELETAL EXAM
37M people have some form of arthritis-you will have

lots of patients
Rheumatology- needs more than just a few good

physicians- needs a lot of physicians
Value of the H&P- a truism…if you don’t know 90% of the time or better what the patient has by the end of the HPI..you are in trouble

MUSCULOSKELETAL EXAM37M people have some form of arthritis-you will have lots of patientsRheumatology- needs more than just

Слайд 2Things you must Do
Is the pain worse on weight bearing?
Is

the worst pain and stiffness present upon arising?
What drugs have

you tried, what dose and what happened?
Always do bilateral assessments of joints

Things you must DoIs the pain worse on weight bearing?Is the worst pain and stiffness present upon

Слайд 3Make the patient focus!

Слайд 4How not to write your history

Слайд 5RECORDING THE EXAM
In the real world-”BJM are normal”or “all joints:ROM

intact”
Can use either a table format or Stick diagram/template
STL system

is 0-4 with 4 being the worst possible and 0 is normal
Worst is maximal swelling, severe tenderness and complete loss of motion
Simply state whether fluid is present or not

RECORDING THE EXAMIn the real world-”BJM are normal”or “all joints:ROM intact”Can use either a table format or

Слайд 6BONDING
“Our hands are central to our psychology as they continually

switch between executive, exploratory and expressive activity”

Слайд 7UPPER BODY
Nails

Слайд 11UPPER BODY
Nails
Palms, Hands…….. Grip strength and “ knuckle sign” are

very helpful.

Слайд 13More or less susceptible to myocardial infarction?

Слайд 14Heberden’s Nodes

Слайд 15Bouchard’s Nodes

Слайд 16Clue to an infectious arthritis

Слайд 18Palmar Erythema

Слайд 19telangiectasia

Слайд 20Double Jointed

Слайд 21This Patient should stop what?

Слайд 22What are the yellow nodules?

Слайд 23What drug should this patient have been on?

Слайд 25Rheumatoid arthritis

Слайд 27UPPER BODY
Nails
Palms, Hands…….. Grip strength and “ knuckle sign” are

very helpful.
Do a Tinel’s sign while you are there
Arms-

slide hand along ulna for nodules

UPPER BODY NailsPalms, Hands…….. Grip strength and “ knuckle sign” are very helpful. Do a Tinel’s sign

Слайд 29UPPER BODY
Nails
Palms, Hands…….. Grip strength and “ knuckle sign” are

very helpful.
Do a Tinel’s sign while you are there
Arms-

slide hand along ulna for nodules
Elbow-synovial thickening at ulnar groove and epitroclear nodes are the “S4s” of the rheumatology consult!
Olecranon bursal effusions are likely when elbow has full ROM

Слайд 30

Слайд 31

Слайд 32UPPER BODY
Cervical Spine and ……..don’t forget the TMJ!
Shoulders

Слайд 33Quick Assessment of Shoulder Function
If the pt can abduct, elevate

the arm above the head and touch the contralateral shoulder-then

re-elevate and by reverse motion to touch the L-S spine..it is highly unlikely there is significant pathology present.
Rotator Cuff assessment: by history there will be inability/pain on abducting arm >90o and by PX pain on internal /external rotation at 90o
Pt may also have + beer can sign
If there is abnormal and/or pain upon motion of the humerus in the A-P dimension, pathology is in the G-H joint