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