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Pemeriksaan Fisik Ortopedi
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Musculoskeletal Physical Examination
Terminology• Valgus: describes the position of a joint when the distal segment is
angled away from the midline of the body• Varus: opposite of valgus, the distal segment is angled toward the
midline of the body• Abduction: refers to motion away from the midline of the body• Adduction: refers to motion toward the midline of the body• Proximal: means closer to any point of reference, opposed to distal• Distal: means further from any point of reference, opposed to
proximal• Volar: the palmar surface of the hand• Dorsal: the posterior surface (back) of the hand
Basic principal• Look
– Swelling, scar, simetrical, deformity, atrophy of muscle? Always compare side to side
– Look from anterior, lateral, posterior• Feel
– Locate important anatomic landmarks– Any tenderness, increase or decrease temperature, mass, muscle spasm?
• Move– Active and passive, muscle power
• Special Test– Perform essential exam manuevers needed to effectively diagnose
problems
Basic Principal
• Examine based on history of:– Pain• Location, character
– Stiffness– Locking or popping– Instability
Skin
Soft Tissue
Bone
Shoulder• Look
– Scapula winging?• Feel
– Sternoclavicular joint, clavicula, acromioclavicular joint, anterior and posterior glenoid rim, spina scapula, both supraspinatus and infraspinatus muscle
• Move– Flexion, Extension, Abduction, Internal & External Rotation
• Special Test– Neer’s sign, Hawkin test, Crossover test– Lift off test– Labrum grind test– Anterior apprehension test,
Inferior apprehension test, Sulcus sign
Elbow
• Look– Cubital valgum or cubital varus?
• Feel– Epicondylus medial and lateral, olecranon, head of radius,
thickening of ulnar nerve?• Move– Flexion, extension, pronation, supination
• Special test– Test for Tennis Elbow– Test for Golfer Elbow
Hand• Look
– Finger deformity, thenar or hypothenar muscle wasting• Feel
– Distal and proximal interphalang joint, metacarpophalang joint, Radiocarpal Joint
• Move– Finger: flexion, extension, abduction, adduction– Thumb: extension, abduction, adduction, flexion, opposition– Radiocarpal joint: flexion, extension, radial and ulnar deviation
• Special Test– Tinel test– Phalen test– Finkelstein test
Hip• Look
– Trendelenburg sign?– Gait– Leg length discrepancy?
• Feel– Trochanter major tenderness?
• Move– Test for iliopsoas dysfunction at sitting position– Flexion, extension, adduction, abduction, external and internal rotation
• Special Test– Thomas test– FABER– Ober’s test
Knee• Look
– Anterior-> genu valgum or genu varum?– Lateral-> genu recurvatum?– Posterior-> baker’s cyst, aneurysm?– Q-line
• Feel– Tibial tuberosity, both tibial and femoral condyle, patella margin, pes anserine, iliotibial tract
(knee flexion 90 degrees)• Move
– Flexion, extension• Special Test
– Patellar tap test, Bulge sign– Patellar apprehension test– Anterior drawer test, Posterior drawer test, Lag sign– Valgus stress test, Varus stress test– McMurray test
Ankle
• Look• Feel– Both malleolus, deltoid ligament, talofibular ant and
post ligament, Calcaneofibular ligament, Achilles tendon• Move– Dorsoflexion, plantarflexion, inversion, eversion
• Special Test– Thompson test– Anterior drawer test
Cervical• Look• Feel– Processus spinosum (C3-T1), paraspinal muscle,
lymphadenopaty?• Move– Flexion, Extension, Lateral rotation, Lateral flexion
• Special Test– Spurling Test
Lumbal• Look
– Hair? -> spina bifida– Scoliosis, lordosis, kifosis?
• Feel– Processus spinosum, paraspinal muscle
• Move – Flexion, extension,
lateral flexion, rotation• Special Test
– Lasegue test– Bowstring sign
Reference
• Apley’s System of Orthopaedics and Fractures, Ninth ed.
• Hattam P, Smeatham A. Special tests in Musculoskeletal Examination. Elsevier.