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

Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

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Page 1: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Musculoskeletal Musculoskeletal ExaminationExamination

Todd Milbrandt, MD, MSTodd Milbrandt, MD, MS

Pediatric Orthopaedic SurgeonPediatric Orthopaedic Surgeon

Page 2: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Musculoskeletal ExamMusculoskeletal Exam

There are so many moving parts-how am I going to remember them all?

Page 3: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Musculoskeletal ExamMusculoskeletal Exam

I was once a first I was once a first year medical year medical student, too.student, too.

That may have That may have been a long time been a long time ago….butago….but

Consider yourself Consider yourself lucky.lucky.

Page 4: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Musculoskeletal ExamMusculoskeletal Exam

We never had We never had standardized standardized patients.patients.

MSK information MSK information was a big black was a big black box. box.

No one taught it No one taught it because no-one because no-one felt comfortable felt comfortable doing it.doing it.

Page 5: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Musculoskeletal ExamMusculoskeletal Exam

The best part The best part about the MSK about the MSK examination is examination is that you really that you really can touch all the can touch all the parts.parts.

And you have a And you have a “normal” to “normal” to compare it too compare it too (the other side).(the other side).

Page 6: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Musculoskeletal ExamMusculoskeletal Exam

We will divide the We will divide the examination into examination into regions:regions:

Spine, Upper Spine, Upper Extremity and Lower Extremity and Lower Extremity.Extremity.

We will progress We will progress through inspection, through inspection, palpation, range of palpation, range of motion, stability motion, stability testing, and finally testing, and finally “special” tests “special” tests

Page 7: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Musculoskeletal ExamMusculoskeletal Exam

Remember Anatomy?Remember Anatomy? This is where you This is where you

need it. need it. I have a list of I have a list of

students and I am not students and I am not afraid to use it!!afraid to use it!!

Ward learning=Active Ward learning=Active engagement of engagement of participants!participants!

Page 8: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Functional AnatomyFunctional Anatomy

Name the bones Name the bones of the upper of the upper extremityextremity

Page 9: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Functional AnatomyFunctional Anatomy

Name bones Name bones within the axial within the axial skeleton and skeleton and pelvispelvis

Page 10: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Functional AnatomyFunctional Anatomy

Name bones Name bones within the lower within the lower extremityextremity

Page 11: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

SpineSpine

InspectionInspection– Shoulder Shoulder

asymmetryasymmetry– Prominent Prominent

scapulascapula– Hairy Hairy

patchespatches– Dimples Dimples

Page 12: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Spine examinationSpine examination

InspectionInspection– KyphosisKyphosis– LordosisLordosis

PalpationPalpation– Spinous Spinous

processesprocesses– Paravertebral Paravertebral

musclesmuscles– Percussion of Percussion of

spine (??)spine (??)

Page 13: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Spine examinationSpine examination

PalpationPalpation– Spinous Spinous

processesprocesses– Paravertebral Paravertebral

musclesmuscles– Percussion of Percussion of

spine (??)spine (??)

Page 14: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Spine examination-Spine examination-Range of MotionRange of Motion ModesModes

– Passive (all Passive (all planes) planes)

– Active (all Active (all planes)planes)

Anatomical Anatomical areasareas– Cervical, Cervical,

thoracic, thoracic, lumbarlumbar

Page 15: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Spine examination-Spine examination-Range of MotionRange of Motion Cervical Cervical

– FlexionFlexion– ExtensionExtension– RotationRotation– Side bendSide bend

Page 16: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Spine examination-Spine examination-Range of MotionRange of Motion ThoracicThoracic

– FlexionFlexion– ExtensionExtension– RotationRotation– Side bendSide bend

Page 17: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Spine examination-Spine examination-Range of MotionRange of Motion ThoracicThoracic

– FlexionFlexion– ExtensionExtension– RotationRotation– Side bendSide bend

Page 18: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Spine examination-Spine examination-Special testsSpecial tests Axial Axial

compressioncompression It called the It called the

Lhermites testLhermites test Don’t do if Don’t do if

suspect C-suspect C-spine injury!spine injury!

Page 19: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Spine examination-Spine examination-Special testsSpecial tests Axial Axial

compression compression with head with head tiltedtilted

Spurling’s Spurling’s maneuvermaneuver

Don’t do if Don’t do if suspect C-suspect C-spine injuryspine injury

Page 20: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Spine examination-Spine examination-Special examSpecial exam Adam’s Adam’s

forward bend forward bend testtest

Page 21: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder-Cartoon Shoulder-Cartoon AnatomyAnatomy

Page 22: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

The Shoulder- X-ray The Shoulder- X-ray AnatomyAnatomy

Page 23: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder-InspectionShoulder-Inspection

Name those areas Name those areas when inspectingwhen inspecting

DeltoidDeltoid AcromionAcromion ClavicleClavicle AC jointAC joint Spine of the Spine of the

scapluascaplua

Page 24: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder-InspectionShoulder-Inspection

Name those Name those areas when areas when inspectinginspecting

DeltoidDeltoid AcromionAcromion ClavicleClavicle AC jointAC joint Look for Look for

muscle muscle wastingwasting

Page 25: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder: PalpationShoulder: Palpation

Acromioclaviular Joint

Page 26: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder: PalpationShoulder: Palpation

Acromion

Page 27: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder: PalpationShoulder: Palpation

Page 28: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder-Range of Shoulder-Range of MotionMotion Must do both Active Must do both Active

and Passive!!!and Passive!!! Must do each side Must do each side

separateseparate Flexion and Flexion and

ExtensionExtension Internal and Internal and

External rotationExternal rotation AbductionAbduction AdductionAdduction

Page 29: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder-Range of Shoulder-Range of MotionMotion Must do both Active Must do both Active

and Passive!!!and Passive!!! Must do each side Must do each side

separateseparate Flexion and Flexion and

ExtensionExtension Internal and Internal and

External rotationExternal rotation AbductionAbduction AdductionAdduction

Page 30: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder-Range of Shoulder-Range of MotionMotion Must do both Active Must do both Active

and Passive!!!and Passive!!! Must do each side Must do each side

separateseparate Flexion and Flexion and

ExtensionExtension Internal and Internal and

External rotationExternal rotation AbductionAbduction AdductionAdduction

Page 31: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder-Range of Shoulder-Range of MotionMotion Must do both Active Must do both Active

and Passive!!!and Passive!!! Must do each side Must do each side

separateseparate Flexion and Flexion and

ExtensionExtension Internal and Internal and

External rotationExternal rotation AbductionAbduction AdductionAdduction

Page 32: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder-Stability Shoulder-Stability TestingTesting Sulcus signSulcus sign Apprehension Apprehension

SignSign

Page 33: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Shoulder-Stability Shoulder-Stability testingtesting Sulcus signSulcus sign ApprehensioApprehensio

n signn sign

Page 34: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow-Cartoon Elbow-Cartoon AnatomyAnatomy

Page 35: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow-X-ray AnatomyElbow-X-ray Anatomy

Page 36: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow-InspectionElbow-Inspection

Page 37: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow-InspectionElbow-Inspection

Page 38: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbows: PalpationElbows: Palpation

Lateral epichondyle Medial epichondyle

Page 39: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbows: PalpationElbows: Palpation

Page 40: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and

ExtensionExtension Pronation and Pronation and

SupinationSupination

Page 41: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and

ExtensionExtension Pronation and Pronation and

SupinationSupination

Pronation

Page 42: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and

ExtensionExtension Pronation and Pronation and

SupinationSupination

Pronation

Page 43: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and

ExtensionExtension Pronation and Pronation and

SupinationSupination

Supination

Page 44: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow: Range of Elbow: Range of MotionMotion Flexion and Flexion and

ExtensionExtension Pronation and Pronation and

SupinationSupination

Supination

Page 45: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow: Stability Elbow: Stability testingtesting Varus Varus ValgusValgus

Page 46: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Elbow: Stability Elbow: Stability testingtesting Varus Varus ValgusValgus

Page 47: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrists-Cartoon Wrists-Cartoon AnatomyAnatomy

Page 48: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrists-Cartoon Wrists-Cartoon AnatomyAnatomy

Page 49: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrists-Xray AnatomyWrists-Xray Anatomy

Page 50: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrist-PalpationWrist-Palpation

Distal radus and Distal radus and radial styloidradial styloid

Distal ulna and Distal ulna and ulnar styloidulnar styloid

Page 51: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrist-PalpationWrist-Palpation

Anatomical Anatomical “Snuffbox”“Snuffbox”

Page 52: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrist: Range of MotionWrist: Range of Motion

FlexionFlexion ExtensionExtension

Page 53: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrist: Range of MotionWrist: Range of Motion

Flexion Flexion ExtensionExtension

Page 54: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrist: Range of MotionWrist: Range of Motion

Radial-Radial-deviationdeviation

Ulnar Ulnar deviationdeviation

Page 55: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrist: Range of MotionWrist: Range of Motion

Radial-Radial-deviationdeviation

Ulnar Ulnar deviationdeviation

Page 56: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrist: Special TestWrist: Special Test

Tinel’s SignTinel’s Sign– This is a This is a

tapping over tapping over any area any area over any over any nerve.nerve.

– Most Most commonly commonly associated associated with wristwith wrist

Phalen’s signPhalen’s sign

Page 57: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Wrist: Special TestWrist: Special Test

Tinel’s SignTinel’s Sign Phalen’s signPhalen’s sign

– Hold wrists for Hold wrists for 30-60 seconds30-60 seconds

– What nerve are What nerve are we we compressing?compressing?

– What area will What area will become numb?become numb?

Page 58: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hands-Carton AnatomyHands-Carton Anatomy

Profundus or superficialis?

Page 59: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hands: InspectionHands: Inspection

Page 60: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hands: InspectionHands: Inspection

Page 61: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hands: PalpationHands: Palpation

Metacarpal Metacarpal Phalangeal Phalangeal joints (MCP joints (MCP joints)joints)

Proximal Proximal InterphalangeInterphalangeal Joints (PIP)al Joints (PIP)

Distal Distal InterphalangeInterphalangeal Joints (DIP)al Joints (DIP)

Page 62: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hands: PalpationHands: Palpation

Metacarpal Metacarpal Phalangeal Phalangeal joints (MCP joints (MCP joints)joints)

Proximal Proximal InterphalangeInterphalangeal Joints (PIP)al Joints (PIP)

Distal Distal InterphalangeInterphalangeal Joints (DIP)al Joints (DIP)

Page 63: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hand and Finger: Hand and Finger: Range of MotionRange of Motion

FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb

oppositionopposition

Page 64: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hand and Finger: Hand and Finger: Range of MotionRange of Motion

FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb

oppositionopposition

Page 65: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hand and Finger: Hand and Finger: Range of MotionRange of Motion

FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb

oppositionopposition

Page 66: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hand and Finger: Hand and Finger: Range of MotionRange of Motion

FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb

oppositionopposition

Page 67: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hand and Finger: Hand and Finger: Range of MotionRange of Motion

FlexionFlexion ExtensionExtension AbductionAbduction AdductionAdduction Thumb Thumb

oppositionopposition

Page 68: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip-Cartoon anatomyHip-Cartoon anatomy

Page 69: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip: X-ray anatomyHip: X-ray anatomy

Page 70: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip: Gait patternHip: Gait pattern

Page 71: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip:Surface Hip:Surface AnatomyAnatomy

Page 72: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip:Hip:PalpatioPalpationn

Page 73: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip: Range of MotionHip: Range of Motion

FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction

Page 74: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip: Range of MotionHip: Range of Motion

FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction

Page 75: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip: Range of MotionHip: Range of Motion

FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction

Page 76: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip: Range of MotionHip: Range of Motion

FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction

Page 77: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip: Range of MotionHip: Range of Motion

FlexionFlexion ExtensionExtension InternalInternal ExternalExternal AbductionAbduction AdductionAdduction

One hand should be on leg and the other on the iliac crest

Page 78: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip: Stability Hip: Stability examinationexamination

Barlow testBarlow test Ortolani testOrtolani test

Page 79: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Hip: Stability Hip: Stability examinationexamination

Barlow testBarlow test Ortolani testOrtolani test

You cannot dislocate a normal child’s hip!!!!

Page 80: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Cartoon Knees: Cartoon anatomyanatomy

Page 81: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: X-ray anatomyKnees: X-ray anatomy

Page 82: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: X-ray Knees: X-ray anatomyanatomy

Page 83: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: X-ray Knees: X-ray anatomyanatomy

Page 84: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Surface anatomy Knees: Surface anatomy and inspectionand inspection

Page 85: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Surface anatomy Knees: Surface anatomy and inspectionand inspection

Varus Valgus

Page 86: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: PalpationKnees: Palpation

PatellaPatella Patella tendonPatella tendon Quad tendonQuad tendon Tibial TubercleTibial Tubercle

Page 87: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: PalpationKnees: Palpation

PatellaPatella Patella tendonPatella tendon Quad tendonQuad tendon Tibial TubercleTibial Tubercle

Page 88: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: PalpationKnees: Palpation

PatellaPatella Patella tendonPatella tendon Quad tendonQuad tendon Tibial TubercleTibial Tubercle

Page 89: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: PalpationKnees: Palpation

PatellaPatella Patella tendonPatella tendon Quad tendonQuad tendon Tibial TubercleTibial Tubercle

Page 90: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: PalpationKnees: Palpation

Medial joint lineMedial joint line Lateral joint lineLateral joint line

Page 91: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: PalpationKnees: Palpation

Medial joint lineMedial joint line Lateral joint lineLateral joint line

Page 92: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Range of Knees: Range of MotionMotion

Flexion Flexion ExtensionExtension

Page 93: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Range of Knees: Range of MotionMotion

Flexion Flexion ExtensionExtension

Page 94: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Stability Knees: Stability Examination Examination

Varus Varus ValgusValgus

Page 95: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Stability Knees: Stability Examination Examination

Varus Varus ValgusValgus

Page 96: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Stability Knees: Stability Examination Examination

Anterior drawer Anterior drawer (at 90 degrees (at 90 degrees flexion)flexion)– Lachman’s Lachman’s

maneuvermaneuver Posterior drawerPosterior drawer

Page 97: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Stability Knees: Stability Examination Examination

Anterior drawer Anterior drawer (at 90 degrees (at 90 degrees flexion)flexion)– Lachman’s Lachman’s

maneuver (at 30 maneuver (at 30 degrees of degrees of flexion)flexion)

Posterior drawerPosterior drawer

Page 98: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Stability Knees: Stability Examination Examination

Anterior drawer Anterior drawer (at 90 degrees (at 90 degrees flexion)flexion)– Lachman’s Lachman’s

maneuver (at 30 maneuver (at 30 degrees of degrees of flexion)flexion)

Posterior drawerPosterior drawer

Page 99: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Special Tests Knees: Special Tests

Bulge sign or Bulge sign or Balloon signBalloon sign

Page 100: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Special Tests Knees: Special Tests

McMurray’s test-McMurray’s test-medialmedial– While Palpating While Palpating

medial joint line, medial joint line, axially load and axially load and externally rotate externally rotate the footthe foot

– This “loads” the This “loads” the medial meniscusmedial meniscus

Page 101: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Knees: Special Tests Knees: Special Tests

McMurray’s test-McMurray’s test-LateralLateral– While Palpating While Palpating

lateral joint line, lateral joint line, axially load and axially load and internally rotate internally rotate the footthe foot

– This “loads” the This “loads” the lateral meniscuslateral meniscus

Page 102: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Ankles and Feet: Ankles and Feet: Cartoon AnatomyCartoon Anatomy

Page 103: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Ankles and Feet: X-ray Ankles and Feet: X-ray AnatomyAnatomy

Page 104: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Ankles: palpation of Ankles: palpation of ankleankle

Palpate:Palpate: Anterior aspect Anterior aspect

of jointof joint Achilles tendonAchilles tendon Medial and Medial and

lateral malleolilateral malleoli

Page 105: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Ankles: palpation of Ankles: palpation of ankleankle

Palpate:Palpate: Anterior aspect Anterior aspect

of jointof joint Achilles tendonAchilles tendon Medial and Medial and

lateral malleolilateral malleoli

Page 106: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Ankles: palpation of Ankles: palpation of ankleankle

Palpate:Palpate: Anterior aspect Anterior aspect

of jointof joint Achilles tendonAchilles tendon Medial and Medial and

lateral malleolilateral malleoli

Page 107: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Ankles: palpation of Ankles: palpation of ankleankle

Palpate:Palpate: Plantar FasciaPlantar Fascia Anterior Talo-Anterior Talo-

Fibular LigamentFibular Ligament

Page 108: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Ankles: palpation of Ankles: palpation of ankleankle

Palpate:Palpate: Plantar FasciaPlantar Fascia Anterior Talo-Anterior Talo-

Fibular LigamentFibular Ligament

Page 109: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Foot: palpationFoot: palpation

Palpate:Palpate: Metatarsal headsMetatarsal heads

Page 110: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Foot and Ankle: Range Foot and Ankle: Range of Motionof Motion

FlexionFlexion ExtensionExtension InversionInversion EversionEversion

Page 111: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Foot and Ankle: Range Foot and Ankle: Range of Motionof Motion

FlexionFlexion ExtensionExtension InversionInversion EversionEversion

Page 112: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon

Whew!!!! You made Whew!!!! You made it!!!it!!! Thanks for listeningThanks for listening Watch the videos on the knee Watch the videos on the knee

exam and shoulder examinationexam and shoulder examination

My contact infoMy contact info

Phone 859 266 2101Phone 859 266 2101

Email: [email protected]: [email protected]

Page 113: Musculoskeletal Examination Todd Milbrandt, MD, MS Pediatric Orthopaedic Surgeon