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8/9/2019 dr. Mirna - Easy Assessment of Musculoskeletal System.pptx
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GALS
GAIT, ARMS, LEGS AND SPINE
Screening Questions
Do you have any pain or stiffness in your muscles, joints or
back?
Can you dress yourself completely without any difficulty?
Can you walk up and down stairs without any difficulty?
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GAITAsk the patient to walk up and down the room, turning at the
end.
Observe for :
symmetry
smoothness
ability to turn quickly
f abnormal gait, pain!
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ABNORMAL GAITAntalgic "ait
Ata#ic "ait :$ sensory
cerebellar
Scissor "ait%addling "ait
&rendelenburg "ait
'arkinsonian "ait (festinating gait)
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ARMS
Ask the patient to :$'ut their hands behind their head.
*old arms straight out, palms down, fingers outstretched.
&urn hands over.
+ake a fist.
squeee your fingers
&o bring each finger to the thumb in turn.
-ou should gently squeee across the metacarpophalangeal(mcp)oints testing for tenderness.
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LEGS
%ith patient laid on a couch:$Assess knee fle#ion and e#tension.
Assess internal/e#ternal rotation of the hips.
'erform patella tap.
nspect feet.
Squeee the +&'0s.
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SPINE
%ith the patient standing:$nspect the spine from behind and side view.
Assess lateral fle#ion of the neck (cervical spine).
Assess lumbar spine movement.
Assess temporal mandibular oints.
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1lick icon to add picture
234S&5" &*3 6AS1S
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SPECIFICS HT
'recipitating incident
trauma (macrotrauma)
repetitive stress (microtrauma)
is this a work related injury?
is there a lawsuit ongoing?
or !"#sdriver$passenger
belted$non%belted
location of impact and
severity of crash (re&uired
jaws of life, if anyone died
in the crash, thrown from
the car, etc)
speed at impactposition of the patient and
the limb in &uestion at
impact
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for pain or presenting problem
'nset
Duration
Character Course
#ggravating and relieving factors
ocation
adition
#ssociated symptoms
n addition to pain do theyhave:
Clicking
*nappingCatchingocking*ensation of giving way(including prior falls ordislocations)*welling+eakness
s it worse when they wake up in the morning?
Does it gradually get worse over the course of the day?
Does the pain ever wake them up at night?
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RED FLAGS
'ain at night or rest
Associated weight loss and loss of appetite
*#. Of cancer
Steroids use
*#. Of trauma
3#treme age
6owel or bladder symptoms
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GENERAL CONSIDERATIONS
FOR EXAMINATION
%hen taking a history for an acute problem always inquire
about the mechanism of inury, loss of function, onset of
swelling (7 89 hours), and initial treatment
%hen taking a history for a chronic problem always inquire
about past inuries, past treatments, effect on function, and
current symptoms.
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GENERAL CONSIDERATIONS
FOR EXAMINATION
&he patient should be gowned and e#posed as required for
the e#amination
Some portions of the e#amination may not be appropriate
depending on the clinical situation (performing range of
motion on a fractured leg for e#ample)
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GENERAL CONSIDERATIONS
FOR EXAMINATION
&he musculoskeletal e#am is all about anatomy
&hink of the underlying anatomy as you obtain the history
and e#amine the patient
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GENERAL CONSIDERATIONS
FOR EXAMINATION
&he cardinal signs of musculoskeletal disease are:
-ain
edness (erythema)
*welling
ncreased warmth
Deformity
oss of function
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INSPECTION
ook for scars, rashes, or other lesions like abrasions/open
wounds
ook for asymmetry, deformity, or atrophy
Always compare with the other side
ook for swelling
ook for erythema (redness)
'osture/position of the oint or limb
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PE CU ION
&ypically, we don0t percuss things in
orthopedics however the one e#ception is
nerves
f tapping over a nerve causes pain or electricshock sensations, this is called &inel0s sign
'resent when nerves are compressed or
irritated
Also used to monitor nerve recovery after
inury (in the form of an =advancing &inel0s
sign>)
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AUSCULTATION
%e don0t really listen to anything in orthopedics
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PALPATION
3#amine each maor oint and muscle group in turn
dentify any areas of tenderness
?oint line
&endinous insertions
'alpate for any crepitus
dentify any areas of deformity
Always compare with the other side
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PALPATION
%arm or cold including pulses
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RANGE OF MOTION
Active
'assive
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ACTIVE ROM
Ask the patient to move each oint through a full range ofmotion
5ote the degree and type of any limitations (pain, weakness,etc.)
5ote any increased range of motion or instabilityAlways compare with the other side
'roceed to passive range of motion if abnormalities arefound
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PASSIVE ROM
Ask the patient to rela# and allow you tosupport the e#tremity to be e#amined
"ently move each oint through its full range ofmotion
5ote the degree and type (pain or mechanical)of any limitation
f increased range of motion is detected,perform special tests for instability as
appropriateAlways compare with the other side
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VASCULAR STATUS
'ulses
pper e#tremity
Check the radial pulses on both sides
f the radial pulse is absent or weak, check the brachial
pulsesower e#tremity
Check the posterior tibial and dorsalis pedis pulses on bothsides % if these pulses are absent or weak, check the poplitealand femoral pulses
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VASCULAR STATUS
1apillary 2efill
-ress down firmly on the patient.s finger or toe nail so it
blanches
elease the pressure and observe how long it takes the nail
bed to /pink/ up Capillary refill times greater than 0 to 1 seconds suggest
peripheral vascular disease, arterial blockage, heart failure, or
shock
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