Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

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Text of Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

  • Musculoskeletal ExaminationTodd Milbrandt, MD, MSPediatric Orthopaedic Surgeon

  • Musculoskeletal ExamThere are so many moving parts-how am I going to remember them all?

  • Musculoskeletal ExamI was once a first year medical student, too.That may have been a long time ago.butConsider yourself lucky.

  • Musculoskeletal ExamWe never had standardized patients.MSK information was a big black box. No one taught it because no-one felt comfortable doing it.

  • Musculoskeletal ExamThe best part about the MSK examination is that you really can touch all the parts.And you have a normal to compare it too (the other side).

  • Musculoskeletal ExamWe will divide the examination into regions:Spine, Upper Extremity and Lower Extremity.We will progress through inspection, palpation, range of motion, stability testing, and finally special tests

  • Musculoskeletal ExamRemember Anatomy?This is where you need it. I have a list of students and I am not afraid to use it!!Ward learning=Active engagement of participants!

  • Functional AnatomyName the bones of the upper extremity

  • Functional AnatomyName bones within the axial skeleton and pelvis

  • Functional AnatomyName bones within the lower extremity

  • SpineInspectionShoulder asymmetryProminent scapulaHairy patchesDimples

  • Spine examinationInspectionKyphosisLordosisPalpationSpinous processesParavertebral musclesPercussion of spine (??)

  • Spine examinationPalpationSpinous processesParavertebral musclesPercussion of spine (??)

  • Spine examination-Range of MotionModesPassive (all planes) Active (all planes)Anatomical areasCervical, thoracic, lumbar

  • Spine examination-Range of MotionCervical FlexionExtensionRotationSide bend

  • Spine examination-Range of MotionThoracicFlexionExtensionRotationSide bend

  • Spine examination-Range of MotionThoracicFlexionExtensionRotationSide bend

  • Spine examination-Special testsAxial compressionIt called the Lhermites testDont do if suspect C-spine injury!

  • Spine examination-Special testsAxial compression with head tiltedSpurlings maneuverDont do if suspect C-spine injury

  • Spine examination-Special examAdams forward bend test

  • Shoulder-Cartoon Anatomy

  • The Shoulder- X-ray Anatomy

  • Shoulder-InspectionName those areas when inspectingDeltoidAcromionClavicleAC jointSpine of the scaplua

  • Shoulder-InspectionName those areas when inspectingDeltoidAcromionClavicleAC jointLook for muscle wasting

  • Shoulder: PalpationAcromioclaviular Joint

  • Shoulder: PalpationAcromion

  • Shoulder: Palpation

  • Shoulder-Range of MotionMust do both Active and Passive!!!Must do each side separateFlexion and ExtensionInternal and External rotationAbductionAdduction

  • Shoulder-Range of MotionMust do both Active and Passive!!!Must do each side separateFlexion and ExtensionInternal and External rotationAbductionAdduction

  • Shoulder-Range of MotionMust do both Active and Passive!!!Must do each side separateFlexion and ExtensionInternal and External rotationAbductionAdduction

  • Shoulder-Range of MotionMust do both Active and Passive!!!Must do each side separateFlexion and ExtensionInternal and External rotationAbductionAdduction

  • Shoulder-Stability TestingSulcus signApprehension Sign

  • Shoulder-Stability testingSulcus signApprehension sign

  • Elbow-Cartoon Anatomy

  • Elbow-X-ray Anatomy

  • Elbow-Inspection

  • Elbow-Inspection

  • Elbows: PalpationLateral epichondyleMedial epichondyle

  • Elbows: Palpation

  • Elbow: Range of MotionFlexion and ExtensionPronation and Supination

  • Elbow: Range of MotionFlexion and ExtensionPronation and SupinationPronation

  • Elbow: Range of MotionFlexion and ExtensionPronation and SupinationPronation

  • Elbow: Range of MotionFlexion and ExtensionPronation and SupinationSupination

  • Elbow: Range of MotionFlexion and ExtensionPronation and SupinationSupination

  • Elbow: Stability testingVarus Valgus

  • Elbow: Stability testingVarus Valgus

  • Wrists-Cartoon Anatomy

  • Wrists-Cartoon Anatomy

  • Wrists-Xray Anatomy

  • Wrist-PalpationDistal radus and radial styloidDistal ulna and ulnar styloid

  • Wrist-PalpationAnatomical Snuffbox

  • Wrist: Range of MotionFlexion Extension

  • Wrist: Range of MotionFlexion Extension

  • Wrist: Range of MotionRadial-deviationUlnar deviation

  • Wrist: Range of MotionRadial-deviationUlnar deviation

  • Wrist: Special TestTinels SignThis is a tapping over any area over any nerve.Most commonly associated with wristPhalens sign

  • Wrist: Special TestTinels SignPhalens signHold wrists for 30-60 secondsWhat nerve are we compressing?What area will become numb?

  • Hands-Carton AnatomyProfundus or superficialis?

  • Hands: Inspection

  • Hands: Inspection

  • Hands: PalpationMetacarpal Phalangeal joints (MCP joints)Proximal Interphalangeal Joints (PIP)Distal Interphalangeal Joints (DIP)

  • Hands: PalpationMetacarpal Phalangeal joints (MCP joints)Proximal Interphalangeal Joints (PIP)Distal Interphalangeal Joints (DIP)

  • Hand and Finger: Range of MotionFlexionExtensionAbductionAdductionThumb opposition

  • Hand and Finger: Range of MotionFlexionExtensionAbductionAdductionThumb opposition

  • Hand and Finger: Range of MotionFlexionExtensionAbductionAdductionThumb opposition

  • Hand and Finger: Range of MotionFlexionExtensionAbductionAdductionThumb opposition

  • Hand and Finger: Range of MotionFlexionExtensionAbductionAdductionThumb opposition

  • Hip-Cartoon anatomy

  • Hip: X-ray anatomy

  • Hip: Gait pattern

  • Hip:Surface Anatomy

  • Hip:Palpation

  • Hip: Range of MotionFlexionExtensionInternalExternalAbductionAdduction

  • Hip: Range of MotionFlexionExtensionInternalExternalAbductionAdduction

  • Hip: Range of MotionFlexionExtensionInternalExternalAbductionAdduction

  • Hip: Range of MotionFlexionExtensionInternalExternalAbductionAdduction

  • Hip: Range of MotionFlexionExtensionInternalExternalAbductionAdductionOne hand should be on leg and the other on the iliac crest

  • Hip: Stability examinationBarlow testOrtolani test

  • Hip: Stability examinationBarlow testOrtolani testYou cannot dislocate a normal childs hip!!!!

  • Knees: Cartoon anatomy

  • Knees: X-ray anatomy

  • Knees: X-ray anatomy

  • Knees: X-ray anatomy

  • Knees: Surface anatomy and inspection

  • Knees: Surface anatomy and inspectionVarusValgus

  • Knees: PalpationPatellaPatella tendonQuad tendonTibial Tubercle

  • Knees: PalpationPatellaPatella tendonQuad tendonTibial Tubercle

  • Knees: PalpationPatellaPatella tendonQuad tendonTibial Tubercle

  • Knees: PalpationPatellaPatella tendonQuad tendonTibial Tubercle

  • Knees: PalpationMedial joint lineLateral joint line

  • Knees: PalpationMedial joint lineLateral joint line

  • Knees: Range of MotionFlexion Extension

  • Knees: Range of MotionFlexion Extension

  • Knees: Stability Examination Varus Valgus

  • Knees: Stability Examination Varus Valgus

  • Knees: Stability Examination Anterior drawer (at 90 degrees flexion)Lachmans maneuverPosterior drawer

  • Knees: Stability Examination Anterior drawer (at 90 degrees flexion)Lachmans maneuver (at 30 degrees of flexion)Posterior drawer

  • Knees: Stability Examination Anterior drawer (at 90 degrees flexion)Lachmans maneuver (at 30 degrees of flexion)Posterior drawer

  • Knees: Special Tests Bulge sign or Balloon sign

  • Knees: Special Tests McMurrays test-medialWhile Palpating medial joint line, axially load and externally rotate the footThis loads the medial meniscus

  • Knees: Special Tests McMurrays test-LateralWhile Palpating lateral joint line, axially load and internally rotate the footThis loads the lateral meniscus

  • Ankles and Feet: Cartoon Anatomy

  • Ankles and Feet: X-ray Anatomy

  • Ankles: palpation of ankle Palpate:Anterior aspect of jointAchilles tendonMedial and lateral malleoli

  • Ankles: palpation of ankle Palpate:Anterior aspect of jointAchilles tendonMedial and lateral malleoli

  • Ankles: palpation of ankle Palpate:Anterior aspect of jointAchilles tendonMedial and lateral malleoli

  • Ankles: palpation of ankle Palpate:Plantar FasciaAnterior Talo-Fibular Ligament

  • Ankles: palpation of ankle Palpate:Plantar FasciaAnterior Talo-Fibular Ligament

  • Foot: palpation Palpate:Metatarsal heads

  • Foot and Ankle: Range of Motion FlexionExtensionInversionEversion

  • Foot and Ankle: Range of Motion FlexionExtensionInversionEversion

  • Whew!!!! You made it!!!Thanks for listeningWatch the videos on the knee exam and shoulder examination

    My contact infoPhone 859 266 2101Email: tmilbrandt@shrinenet.org

  • The musculoskeletal examination we will be reviewing is a basic screening exam. It involves inspection, palpation, and range of motion. Muscular strength is covered under the motor exam in the neurological exam.

    For our purpos