《中医骨科学外文版 (5).ppt》由会员分享，可在线阅读，更多相关《中医骨科学外文版 (5).ppt（60页珍藏版）》请在taowenge.com淘文阁网|工程机械CAD图纸|机械工程制图|CAD装配图下载|SolidWorks_CaTia_CAD_UG_PROE_设计图分享下载上搜索。
1、Bone and Joint ExaminationnMethod and sequencenMeasurement methodnLimb length measurementnLimb girth measurementnJoint movement measurementnMuscle strength examinationnClinical examinationMuscle strength examinationMuscle VolumeAppearance(atrophy,deformity,limb circumference,limb girth)Muscle Tensio
2、nMuscles maintain some degree of tension at rest.Measure resistance during passive movement(increase,decrease,disappear)Muscle StrengthStrength,amplitude and speed of muscle active movement Note on examination of muscle strengthMeasurement standard of muscle strength(divided into six levels)Grading
3、of muscle strengthGrade 0:no muscle contraction(complete paralysis)Grade 1:slight muscle contraction but inability to move the joint(near paralysis)Grade 2:Muscle contraction can drive the joint horizontally but can not withstand earth gravity(severe paralysis)Grade 3:Muscle contraction can withstan
4、d earth gravity to move joints but can not withstand resistance(mild paralysis)Grade 4:Muscle contraction can withstand earth gravity to move limbs and certain resistance(near normal)Grade 5:Muscle contraction can withstand strong resistance to move limbs(normal)nUnderstand muscle developmentnLocali
5、ze nerve injurynGuide to develop treatment regimennDifferentiate prognosisSignificance of Muscle Strength ExaminationBone and Joint ExaminationnMethod and sequencenMeasurement methodnLimb length measurementnLimb girth measurementnJoint movement measurementnMuscle strength examinationnClinical examin
6、ationClinical examinationnTouch diagnosisnInjured sitenUnderstand the injury(degree,fracture,dislocation,direction of displacement)nPreparation for treatment(manipulation and fixation)nContentnPain,deformity,skin temperature,nAbnormal movements,elastic fixation,massSpecial ExaminationnNecknLower bac
7、knPelvisnShouldernElbownWrist and handnHipnKneenAnkleSpecial ExaminationnNecknLower backnPelvisnShouldernElbownWrist and handnHipnKneenAnkleNecknSeparation testPull open the intervertebral foramen to reduce articular capsule pressure,relieve muscle spasm and reduce nerve root compressionSpecial Exam
8、inationNecknSeparation testnCompression test of cervical intervertebral foramenSpecial ExaminationNarrow the intervertebral foramen and increase the stimulation to cervical nerve rootNecknSeparation testnCompression test of cervical intervertebral foramennTraction test of brachial plexusSpecial Exam
9、inationPerform countertraction of intervertebral foramen.The nerve root slides to touch the intervertebral disc,and the radiating pain and numbness are aggravatedSpecial ExaminationnNecknLower backnPelvisnShouldernElbownWrist and handnHipnKneenAnkleLower backStraight leg raise testIntensification te
10、stThe sciatic nerve is pulled by straight leg raising.If the lumbar spinal canal is diseased,and the sciatic nerve is compressed or adherent,lower back and leg pain will be caused by traction.Special ExaminationLower backStraight leg raise testPick-up testIt is normal when the child bends upright to
11、 pick up objects.The spine is diseased,the waist can not be flexed forward.The child flexed the hip and the knee,and straighten his back.If he squats to pick up objects with hand on the keen,the test result is positiveSpecial ExaminationLower backStraight leg raise testPick-up testSupine lift-up tes
12、t1.Lift up abdomen2.Puff3.Cough4.Press jugular veinIncrease abdominal pressure to form vertebral canal pressureSpecial ExaminationLower backStraight leg raise testPick-up testSupine lift-up testDorsiflexion testSpecial ExaminationExtreme hyperextension of back in standing positionIf there are lesion
13、s in lumbar muscle,articular process,vertebral plate,ligamentum flavum,supraspinous ligament and interspinous ligament,the test result is positiveSpecial ExaminationnNecknLower backnPelvisnShouldernElbownWrist and handnHipnKneenAnklePelvisnCompression test of pelvisSpecial ExaminationKey points:Alon
14、g the iliac wingCompress toward the midlinePelvic fracture(+)Sacroiliac joint(+)PelvisnCompression test of pelvisnSeparation test of pelvisSpecial ExaminationKey points:Along the iliac wingSqueeze outward and downwardPelvic fracture(+)Sacroiliac joint(+)PelvisnCompression test of pelvisnSeparation t
15、est of pelvisnVertical compression test of pelvisSpecial ExaminationInitiated from verticalPain in sacroiliac jointUnilateral pelvic fracturePelvisnCompression test of pelvisnSeparation test of pelvisnVertical compression test of pelvisnKnee and hip flexion testSpecial ExaminationPassive flexion of
16、lumbosacral regionPain in lumbosacral region(+)Lesions in lumbosacral ligament and lumbosacral jointPainPelvisnCompression test of pelvisnSeparation test of pelvisnVertical compression test of pelvisnKnee and hip flexion testnPiriformis tension testThe piriformis starts from both sides of the anteri
17、or aspect of the 2nd 4th sacral vertebrae,goes out of the greater sciatic foramen and ends at the tip of the greater trochanter of the femur,with abduction and lateral rotation of the thigh.Special ExaminationPiriformisIschiu NPelvisnCompression test of pelvisnSeparation test of pelvisnVertical comp
18、ression test of pelvisnKnee and hip flexion testnPiriformis tension testSpecial ExaminationFirst adduction and medial rotation,ischium N(+)Quick abduction and lateral rotation,ischium N(-)PelvisnCompression test of pelvisnSeparation test of pelvisnVertical compression test of pelvisnKnee and hip fle
19、xion testnPiriformis tension testSpecial ExaminationFirst adduction and medial rotation,ischium N(+)Quick abduction and lateral rotation,ischium N(-)PelvisnCompression test of pelvisnSeparation test of pelvisnVertical compression test of pelvisnKnee and hip flexion testnPiriformis tension testn4 tes
20、tSpecial ExaminationFlexion,abduction and lateral rotation of hipCausing pain in sacroiliac joint(+)Lesions in sacroiliac jointPelvisnCompression test of pelvisnSeparation test of pelvisnVertical compression test of pelvisnKnee and hip flexion testnPiriformis tension testn4 testnDiagonal adjustmentS
21、pecial ExaminationHip flexion and knee flexion for the upper leg,extension for the lower legShoulder to back,hip to abdomenLesions in sacroiliac joint and lower backSpecial ExaminationnNecknLower backnPelvisnShouldernElbownWrist and handnHipnKneenAnkleShouldernDugas testSpecial ExaminationNormalElbo
22、w against chestAlso known as Dugas test:Check the shoulder adduction.It is normal if the hand can reach the opposite shoulder and the elbow can be close to the chest,otherwise it is shoulder dislocation.ShouldernDugas testnBiceps brachii resistance testSpecial ExaminationThe long head of biceps brac
23、hii starts from the supraglenoid tuberosity of scapula,and the short head starts from the coracoid of scapula.The long and short heads converge into the muscle belly in the middle of humerus,descend to the lower end of humerus,and the integrated tendon ends at the radial tuberosity.In proximal fixat
24、ion,the biceps brachii flexes and rotates the forearm at the elbow joint and the upper arm at the shoulder joint.In distal fixation,the biceps brachii brings the upper arm forward to the forearm.ShouldernDugas testnBiceps brachii resistance testSpecial ExaminationThe patient bends the elbow forceful
25、ly,with abduction and lateral rotation,and the doctor gives resistance.If biceps brachii tendon slips out or pain occurs in the interubercular sulcus,it is positive.The former is olisthe of the long head tendon and the latter is tendinitis of the long head.ShouldernDugas testnBiceps brachii resistan
26、ce testnRuler testSpecial ExaminationThe ruler is attached to the outside of the upper arm,and the acromion cannot be touched normally.If it is touched,it is shoulder dislocation.or deltoid muscle atrophyShouldernDugas testnBiceps brachii resistance testnRuler testnPain arc testSpecial ExaminationPa
27、in with shoulder abduction to 60 to 120Lesion in rotator cuff below acromionShouldernDugas testnBiceps brachii resistance testnRuler testnPain arc testnSupraspinatus tendon rupture testSpecial ExaminationShoulder abduction to 30 60 shows deltoid contraction and cannot be abducted and lifted.After pa
28、ssive abduction exceeds 60,it can lift up actively.Indicating supraspinatus tendon rupture or tearSpecial ExaminationnNecknLower backnPelvisnShouldernElbownWrist and handnHipnKneenAnkleElbownWrist extensor tension testSpecial Examination Wrist and finger flexionWrist dorsal extendingPain in lateral
29、epicondyle of humerus(+)ElbownWrist extensor tension testnPercussion testSpecial Examination Acroanesthesia and twinge when the nerve trunk is percussedSignificance:Nerve conduction recovedNeuromaSpecial ExaminationnNecknLower backnPelvisnShouldernElbownWrist and handnHipnKneenAnkleWrist and handnFi
30、nkelstein testSpecial Examination Also called Finkelstein TestAdduction of thumb,flexion of other fingersClenched fist with ulnar deviationPain in radial styloid process(+)Stenosing tenosynovitisWrist and handnFinkelstein testnCrush test of cartilage in carpal triangleSpecial Examination Bend the el
31、bow 90,put the palm downward to make passive ulnar deviation,and extend the wrist to squeeze and grind the ulnar deviation of the wrist joint.If there is pain,it is positive,considering injury in the wrist triangular cartilage.Wrist and handnFinkelstein testnCrush test of cartilage in carpal triangl
32、enScaphoid percussion testSpecial Examination Radial deviation of wristPercussion of 2nd and 3rd metacarpal heads,with severe painWhich indicates scaphoid fractureWrist and handnFinkelstein testnCrush test of cartilage in carpal trianglenScaphoid percussion testnFlexor disitorum profundus and muscul
33、us flexor digitorum superficialis testSpecial Examination No flexion occursTendon rupture in the corresponding areaInnervation disorderFlexor digitorum profundusFlexor digitorum superficialisHomeworkn1.Which muscles are the rotator cuff composed of?n2.what are the main functions of the rotator cuff?
34、n3.What is the principle of the appearance of pain arc?n4.How does the supraspinatus run and what is its function?n5.How to differentiate supraspinatus injury from deltoid injury?(3060 process)Special ExaminationnNecknLower backnPelvisnShouldernElbownWrist and handnHipnKneenAnkleHipnTest of flexing
35、contracture of hip jointSpecial Examination Also called(Thomas)Thomas testPatients with hip flexion contracture deformityTB of hip,rheumatoidWhen one side of the thigh with hip flexion and knee flexion is close to the abdomen,The other thigh automatically lifts up.When the thigh is straight,the wais
36、t straightens away from the bed.HipnTest of flexing contracture of hip jointnTest of hyperextension of hip jointSpecial Examination Psoas major contracture testBend the knee 90Lift the lower limb with the anklePelvis lifted with it(+)Psoas abscess,TB of hipAnkylosed hipHipnTest of flexing contractur
37、e of hip jointnTest of hyperextension of hip jointnTelescope testSpecial Examination Ask the patient to lie supine,the assistant fixes the pelvis,the examiner holds the patients affected lower leg with both hands to straighten his hip and knee joints,and then pushes and pulls them up and down,HipnTe
38、st of flexing contracture of hip jointnTest of hyperextension of hip jointnTelescope testSpecial Examination The patient lies supine,the examiner places the left thumb at the iliac crest,the remaining four fingers pressing the greater trochanter,and the right hand pulls down the lower leg.HipnTest o
39、f flexing contracture of hip jointnTest of hyperextension of hip jointnTelescope testSpecial Examination The patient lies supine,with the hip and knee joints flexed to 90.The examiner fixes the affected pelvis with one hand and holds the knee joint to push and pull the femoral head up and down with
40、the other hand for several times.The children is diagnosed as congenital hip dislocation.HipnTest of flexing contracture of hip jointnTest of hyperextension of hip jointnTelescope testnTest of frog postureSpecial Examination Both hips and knees flexed 90Abduction and lateral rotation of both hips to
41、 frog posture,and inability to touch the bed of both lower limbs(+)Congenital hip dislocationFlexion,abduction,lateral rotation,femur into the acetabulumAdduction,medial rotation,extension,dislocated femoral headHipnTest of flexing contracture of hip jointnTest of hyperextension of hip jointnTelesco
42、pe testnTest of frog posturenLeg shortening testAlso known as(Allis test)Special Examination Hip flexion and knee flexion,legs togetherFlat flush,observe the heightUnequal height:Posterior dislocation of hip joint,shortening of femur and tibiaSpecial ExaminationnNecknLower backnPelvisnShouldernElbow
43、nWrist and handnHipnKneenAnkleKneenMcmurray testSpecial Examination Hip and knee flexedHeel touches hip(Internally)full lateral rotation and abduction of the lower leg to straighten the knee(Externally)full medial rotation and adduction of the lower leg to straighten the kneeSnapping,grinding sensat
44、ion(+)Meniscus injuryKneenMcmurray testnApleys testSpecial Examination Knee flexed 90Fix the popliteal fossa and press the foot downwardRotation of lower leg Pain(+)Injury in meniscus and articular cartilageKneenMcmurray testnApleys testnDrawer testSpecial Examination Anteroposterior movement testMo
45、vement of 1 cm indicating(+)Injury in anterior and posterior cruciate ligamentTibial plateau moves posteriorlyPosterior cruciate ligament brokenTibial plateau moves anteriorlyAnterior cruciate ligament brokenKneenMcmurray testnApleys testnDrawer testnLateral pressure testSpecial Examination Lateral
46、movement testPainful mouth entryCollateral ligament injuryKneenMcmurray testnApleys testnDrawer testnLateral pressure testnFloating patellar testSpecial Examination Extend the lower limb and press the suprapatellar bursa with one hand.Fix the inner and outer edges of the patella with the other hand.
47、The patella sinks under heavy pressure and floats after loosening the fingers.Intra-articular effusionJoint effusionPatellaSpecial ExaminationnNecknLower backnPelvisnShouldernElbownWrist and handnHipnKneenAnkleAnklenAnkle dorsiflexion testSpecial Examination During knee flexion,the ankle joint can b
48、e extended,During knee extension,the ankle joint cannot be extended,-Its gastrocnemius contractureNeither during knee extension nor knee flexion,the ankle joint can be extended,-Its a contracture of the soleus.GastrocnemiusSoleusnThe gastrocnemius starts from the medial and lateral epicondyles of th
49、e femur in two heads,respectively.nThe soleus is on the deep side of the gastrocnemius and starts posterior to the upper ends of the tibia and fibula.nThe two muscles are combined in the middle of the lower leg,and the Achilles tendon with stout behavior stops at the calcaneal tuberosity.AnklenAnkle dorsiflexion testnAnkle stretching testSpecial Examination Extension and lifting of the lower limb,Strong ankle extension movementPositive for pain in calf musclesThrombophlebitis of deep leg veins