Download Atlas of Orthopedic Examination of the Peripheral Joints - L. Ombregt, P. Bisschop (W B Saunders, 1999) WW PDF

TitleAtlas of Orthopedic Examination of the Peripheral Joints - L. Ombregt, P. Bisschop (W B Saunders, 1999) WW
TagsMedical
LanguageEnglish
File Size10.0 MB
Total Pages144
Table of Contents
                            Front Cover
Back Cover
Front Matter
Contents
Preface
Introduction
Chapter 1- Shoulder
Chapter 2- Elbow
Chapter 3- Wrist
Chapter 4- Hip
Chapter 5- Knee
Chapter 6- Ankle and Foot
Index
                        
Document Text Contents
Page 1

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ATLAS OF

C) rt h () I) C (j i (
Exanlirlati()n ()f tile
rCri�)tlcral J()irlts

Many students learn the details of skeletal anatomy but then find it difficult to relate

that knowledge to real human beings when they present for clinical examination

and assessment. This atlas aims to fill the information gap between descriptive

and palpatory anatomy and to help the student make the link between the two.

It addresses the clinical appearance of normal tissues and their function, and

provides guidance on how to examine and assess normal joints.

Key features

• Introduces the basics of clinical examination

• Provides step-by-step guidance to the clinical assessment of the peripheral

joints and their associated tissues and structures

• Details the examination of the major joints of the body one by one:

Shoulder/Elbow/Wrist/Hip/Knee/Foot and describes the normal findings

in healthy individuals

• Emphasizes the importance of performing diagnostic movements correctly

• Addresses the common mistakes in examination techniques and explains

where people go wrong

• Profusely illustrated with high quality photographs and diagrams

• Text design ensures that the illustrations appear close to the relevant text

This Atlas of Orthopedic Examination of the Peripheral/oints will provide an

invaluable source of reference for medical students and members of all health

care professions concerned with the management of orthopedic problems.

W. B. SAUNDERS
9 780702 021244

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62 ATLAS OF ORTHOPEDIC EXAMINATION

Grind test for the trapezium-first
metacarpal joint (Fig. 3.61)

Significance. This test is meant to detect crepitus
as a symptom indicating arthrosis.

Positioning. The subject stands with the arm
hanging and the elbow 90° flexed. The examiner
stands level with the subject's hand. The contra­
lateral hand grasps and stabilizes the wrist. The
other hand takes hold of the distal part of the first
metacarpal bone.

Procedure. Exert axial pressure and circumduct
the first metacarpal bone.

Fig. 3.61 Grind lest

Finkelstein's test (Fig. 3.62)

Significance. This test is meant to confirm the
presence of de Quervain's disease. It should
be more painful than the ulnar deviation test as
described on page 51.

Positioning. The subject stands with the arm
hanging, the elbow flexed to a right angle and
the forearm pronated. The examiner stands next
to the subject. The contralateral hand carries the
forearm, which is kept between his arm and trunk.
The other hand grasps the subject's hand distally
on the metacarpals, first metacarpal included.

Procedure. Pull the subject's wrist to the ulnar
side until the end of range is reached.

Fig. 3.62 Finkelstein's lest.

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CHAPTER CONTENTS

Surface and palpatory anatomy 63
Anterior 63

Bony landmarks 63
Palpation of soft tissue 64

Posterior 66
Bony landmarks 66
Palpation of soft tissue 68

Functional examination of the hlp 69
Passive tests 70

Passive flexion 70
Passive external rotation 70
Passive medial rotation 71
Passive abduction 71
Passive adduction 72
Passive extension 72

Isometric contractions 73
Resisted flexion 73
Resisted abduction 74
Resisted adduction 74
Resisted extension 75
Resisted medial rotation 75
Resisted lateral rotation 76
Resisted flexion of the knee 77
Resisted extension of the knee 77

Specific tests 78
Bilateral passive medial rotation in prone

position 78
Adduction in flexion 79
Forceful upwards thrust to the heel 79
Ortolani's test 79
Barlow's test 80

Hip

SURFACE AND PALPATORY
ANATOMY

ANTERIOR

Bony landmarks (Fig. 4.1)

The inguinal fold can easily be identified. It covers
the inguinal ligament (A) that can be palpated as
a strong fibrous band.

The anterior superior iliac spine (B) is located
at the craniolatera] end of the fold. This bony
prominence forms the point of origin of both
the sartorius muscle and the tensor fasciae latae

Fig. 4.1 Bony landmarks in vivo.

C

63

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136 INDEX

Posterior interosseous nerve lesions,
57

Posterior superior iliac spine, 66
Posterior talofibular ligament

palpation, I13
squeezing, 126

Posterior tibial artery, 115
Pronator ter<.'S muscle

lesions, 35
palpation, 22-23, 30

Psoas
bursitis, 71
tendinitis, 74

I�ubic tubercle, 64, 66

Q

Quadratus femoris
innervation, 75. 77
palpation, 66

Quadriccps extension. 83--84
Quadriceps femoris

innervation. 78, 99
lesions, 78

R

Radial artery. 48
Radial collateral ligament

palpation, 40
sprains, 51

Radial nerve lesions. 34, 36, 53, 56, 58
Radial tuberosity. avulsion fractures,

34
Radiohumeral joint line, 23
Radioulnar jOint

distal, see Distal radioulnar joint
lesions, 32, 33

Radius
distal epiphysis, periostitis, 50
dorsal tubercle, 41
neck, 23
palpation, 41
stylOid process, 39, 41

Rectus abdominus tendon, 64
Rectus (emoris

innervation, 73
palp<ltion, 64, 83
tendinitis, 74

Rhizarthrosis,52
Rib fractures, 13
Rotator cuff tendinitis, 9, 11, 16

s

51 palsies, 77
52 palsies, 73, 77
Sacroiliac joints, 69

inflamed, 74, 75
Sacroiliac ligaments, strained, 74, 75
S'lcrotuberous ligament, 67

Sartorius muscle
innervation, 73, 77, 100
lesions, 77
palpation, 63, 64, 65, 86
tendinitis, 74

Scaphoid (navicular) bone, 39, 40, 41,
44

periostitis,.50
Scaphoid tuberoSity, 114
Scapula, 2-3
Sciatic nerve, 68
Second metacarpal bone, 45, 47
Semimembranoslls

innervation, 77, 100
palpation, 68, 86, 88

Semitendinosus
innervation, 77, 100
palpation, 68, 88

Shoulder, 1-20
active test, 8-9
adductor muscle lesions, 13
anatomy, 1--8
anterior capsule contraction, 10, 11
anterior drawer test, 19
apprehension tests, 17
arthritis, 9, 10, II, 12
arthrosis, 9, 10, 11
extracapsular lesions, 9, 10
functional eXamination, 8-20
instability, 10, 11,12
isometric contractions, 12-17
neurological conditions, 9, 14
painful impingement, 9
palpation, 1--8
passive horizontal adduction, 17
passive tests, 9-20
posterior d ra wer test, 19-20
recurrent dislocation, 17
resisted abduction, 1�14
resisted adduction, 12-13
resisted external rotation, 14
resisted internal rotation, 14-15
soft tissue palpation, 3-8

Sinus tarsi, III
Spring ligament, 115
Subacromial bursitis, I I
Subcoracoid bursitis, 10
Subdeltoid bursitis, 9, 10, 12, 13, 14, 16
Subscapularis tendon

lesions, 10, 15
palpation, 5-6
rupture, 15

Subtalar joint
arthritis, 126
capsular lesions, 119
passive tests, 118-119
valgus movement, 119
varus movement, 118-119

Superficial nexors, 64
Superior acromioclavicular ligament,

2
Supinator muscle

lesions, 36
palpation, 27

Suprapatellar tendon, 83
Suprascapular nerve, 14
Supraspinatus muscle

lesions, 11
palpation, 4
tendinitis, 13
tendon rupture, 13--14

Supraspinous fossa, 3
Sustentaculum tali, 114

T

T l nerve root lesions. 61
Talar head, 114
Talofibular ligament, thickened, 128
Talonavicular joint. 114
Talus, 110, 111
Tennis elbow, 36
Tenosynovitis, crepitating. 56, 57
Tensor fasciae latae muscle

innervation, 73, 76, 99, 100, 101
palpation,6J.-.64

Teres major, 15
Thoracic wall lesions, 13
Thumb,5�57

resisted abduction, 56-57
resisted adduction, 57
resisted extension, 56
resisted nexion, 55-56

Tibia, 81
TIbial artery, 89
TIbial crest, 81
TIbial nerve, 88, 89
TIbial tuberosity, 81
TIbial vein, 89
Tibialis anterior

innervation, 123, 125
tendon, 114, 116

Tibialis posterior
innervation, 123, 125
tendinitis, 126
tendon, 110. 114, 115

TIbiofibular ligaments, 129
linel's test, 61
Transverse ligament, 45
Trapezium, 39--W, 41,45
Trapezium-first metacarpal joint,

51-52
Grind test, 62

Trapezoid bone, 41
Triangular fibrocartilaginous complex

lesions, 51
Triceps muscle

lesions, 34
palpation, 28
rupture, 34
tendinitis, 17
tendon, 28

Triceps surae, 123, 125
Trigonum o( Scarpa, 65
Triquetra! bone, 41, 43
T rochanters

bursitis, 71, 72

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Trochanters (collld)
pain, 72
palpation.67-Q8

Trochlear proCL-'SS, 110
Tubercle of Gcrdy, 82

u

Ulna
palpation. 41
styloid process, 41, 43

Ulnar artery, 46
Ulnar coll.lteral ligament

lesions, 51
palpation, 28, 44

Ulnar nerve
lesions, 56, 57, 61
palpation, 27, 28, 46

v

Valgus strain, 93--94
Varus strain, 94-95
Vastus lateralis. 83
Vastus medialis, 83

w

Wrist
anatomy. 39-48
dorsal ganglion, 50
dorsal ligament lesions, 50
extensor tendon lesions, 50
flexor tendon lesions, SO
forced flexion (Phalen's test), 61
functionaJ examination, 48-62

INDEX 137

isometric contractions, 52--61
palma,r ligament lesions, 50
palpation, 39-48
radial extensors

palpation, 24-26, 42-43
tennis elbow, 36

resisted extension, 36, 53-54
resisted flexion, 36-37, 52-53
resisted radial deviation, 54
resisted. ulnar deviation, 54-55

Wrisljoint
arthritis, 50
arthrosis, 50
passive extension, 50
passive flexion, 50
passive radial deviation, 51
passive tests, 49-51
passive ulnar deviation, 51

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