Post on 29-Apr-2017
Nadhilla Nurayu LathifaMedical Faculty Trisakti UniversityRSUD BekasiThifa_qq@yahoo.com
UPPER EXTREMITIES EXAMINATION
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History InspectionPalpationRange of Motion (ROM)Muscular and Neurological Assessment
GENERAL APPROACH
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An accurate history is essentialHow symptomp started? (mechanism of injury)Duration of onset?Locaton, nature of pain, and symptomps?Alleviate or aggregavate maneuveres?
HISTORY
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Observe how the patient moves as they go into the room or move from chair to table
General AppearanceBody Proportions
GENERAL INSPECTION
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Look for assymetry between sidesSwellingDeformitiesAtrophyErythema
INSPECTION OF SPECIFIC AREA
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INSPECTION
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INSPECTION
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Know the anatomy of the structure before palpatingWarmth, skin temperatureSoft tissue Swelling or joint effussionBones Evaluating location of tenderness, abnormalities
compared to other side
PALPATION
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PALPATION
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PALPATION
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MOVEMENT
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MOVEMENT
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Range the JointsDecreased / increased movement?Watch for swelling, pain, stiffness, weakness in
movementListen for crepitus or “popping”Watch for abnormal movementNote: quality of movement, crepitus, painful range,
looseness or excessive range
RANGE OF MOTION (ACTIVE)
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MOVEMENT
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MOVEMENT
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MOVEMENT
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MOVEMENT
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Range the joint passively, compare to the active points
Note any decreased / increased movementPain with the movementAny crepitus or popping?
RANGE OF MOTION (PASSIVE)
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SPECIAL TEST
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SPECIAL TEST
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SPECIAL TEST
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Neer's sign (forward flexion/internal rotation) for subacromial impingement
SPECIAL TEST - SHOULDER
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Hawkin's sign (90° abduction and 45° of horizontal adduction, then humeral internal rotation) for sub- acromial impingement.
SPECIAL TEST - SHOULDER
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ELBOW
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INSPECTION
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INSPECTION
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PALPATION
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PALPATION
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MOVEMENT
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MOVEMENT
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MOVEMENT
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SPECIAL TEST - ELBOW
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WRIST
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Swelling or deformitiesFlexion, extensionUlnar & radial deviation of the wrist?
INSPECTION
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INSPECTION
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INSPECTION
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NSPECTION
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PALPATION
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PALPATION
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PALPATION
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MOVEMENT
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MOVEMENT
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MOVEMENT
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Determine stability of joint by examining for abnormal mobility
Testing integrity of ligaments and articular surface
Mild : minimal fibres torn, stability OKModerate : partial tear, some loss of stabilitySevere : complete rupture, unstable joint
LIGAMENT STRESS TESTING
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MOVEMENT
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MOVEMENT
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MOVEMENT
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SPECIAL TEST FOR WRIST
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SPECIAL TEST FOR THE WRIST
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SPECIAL TEST FOR WRIST
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THE HAND
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INSPECTION
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INSPECTION
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INSPECTION
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INSPECTION
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INSPECTION
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INSPECTION
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INSPECTION
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PALPATION
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MOVEMENT
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MOVEMENT
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MOVEMENT
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Thank You