Académique Documents
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Orthopedic
Cervical
Inspeksi
Posisi kepala tegak lurus gerakan
terkoordinasi
Yang harus diperhatikan luka,
jejas, perubahan warna
Palpasi
Move
Muscle test
Neurolgic examination
Sensation test
Ring and little fingers and forearms ul
Motor dermatomes
Examination
Reflexes
Clinical Evaluation
Inspection
Posture
Movement Pattern
Clinical Evaluation
Palpation: Thoracic Spine
Position: Supine, prone, seated
Spinous Processes
Supraspinous Ligaments:
Costovertebral Junction:
Trapezius:
Origin to insertion
Rhomboids and levator scapulae lie deep to
middle/upper traps
Paravertebral Muscles
Scapular Muscles
1 Spinous
Processes
2 Supraspinous
Ligaments
3 Costovertebral
Junction
4 Trapezius
5 Paravertebral
Muscles
6 Scapular
Muscles
Clinical Evaluation
C7
T1
T2
T3
T4
T5
ROM Test
Motion
Normal Value
Flexion
20-40 degrees
Tissue stretch
15-30 degrees
Tissue stretch or
bony block
Lateral Flexion
25-30 degrees
Tissue stretch
Rotation
5-20 degrees
Tissue stretch
Extension
Clinical Evaluation
Resistive Range of Motion:
Flexion:
Patient position supine with knees
flexed and feet flat on table
Stabilization pelvis
Resistance applied to the superior
sternum as patient lifts the scapulae
off the table
Muscles tested rectus abdominis,
internal oblique, external oblique
Clinical Evaluation
Resisted Range of Motion:
Extension:
Patient position prone with arms
interlocked behind the head
Stabilization lower lumbar region
Resistance applied to upper thoracic spine
as patient lifts head, chest, and arms off
table
Muscles tested iliocostalis lumborum,
iliocostalis thoracis, longissimus thoracis,
spinalis thoracis, semispinalis thoracis,
rotators, latissimus dorsi
Clinical Evaluation
Resisted Range of Motion:
Rotation:
Patient position supine (hands
interlocked behind head)
Stabilization opposite ASIS
Resistance anterior aspect of
shoulder as it is rotated off the table
Muscles tested internal oblique,
external oblique (opposite side),
rotators
Thoracic Rotation
Passive Rotation
Resisted rotation
Dural test
Lhermitte sign
Neurological Examination
Beevors sign
Cremasteric reflex (in men)
Oppenheims sign
Clinical Evaluation
Beevors Sign:
Test for thoracic nerve inhibition
Patient performs an abdominal curl-up from hooklying position
Normal Findings: abdominal muscles receive
concurrent innervation from T5-T12 nerve roots
(umbilicus does not move)
Positive Test: umbilicus is pulled toward the head
Characteristic of spinal cord injury between T6 and T10
levels
Upper abdominal muscles (rectus abdominis) are
intact at the top of the abdomen but weak at the
lower portion, patient is asked to do a sit up only
the upper muscles contract (umbilicus pulled toward
the head)
Physical examination of
the spine
Inspection
Gait
Skin color, scar, nevus, caf au lait
Any swelling Lipoma, cold abscess
Muscle wasting
Deformity - Scoliosis
Abnormal growth hair
Inspection
Laterally:
Spinal curves
Kyphosis
Lordosis
Anterior:
Abnormal posture
Are the shoulder and pelvis in alignment?
Asymmetry of upper body muscles
Feel
Local rise in temperature
Any swelling, fluctuation
Palpate all spinous process are they
in alignment?
Palpate sacroiliac joint any
tenderness?
Palpate paraspinal muscles any
tenderness/spasm?
Move
Lumbar lateral flexion
Lumbar extension
Lumbar flexion place two finger on
lumbar spine distance between
two finger should increase during
flexion
Pemeriksaan Neurologi
Neurologic level L4
Muscle testing
Tibialis anterior : L4, n. peroneal
profunda
Reflex testing : refleks patella
Sensation testing : medial of the leg
Neurologic level L5
Muscle testing
Extensor hallucis longus : L5, n. peroneal
profunda
Gluteus medius : L5, n. gluteal superior
Extensor digitorum longus and brevis :
L5, n. peroneal profunda
Reflex testing : (-)
Sensation testing : lateral leg and
dorsum manus
Neurologic level S1
Muscle testing
Peroneus longus and brevis : S1, n.
peroneal superficial
Gluteus maximus : S1, n. gluteal inferior
Reflex testing : refleks achiles
Sensation testing : lateral malleolus,
lateral side andplantar surface of the
foot
Special test
Test to stretch spinal cord/sciatic
nerve
Test to increase intrathecal pressure
Test to rock the sacroiliac joint
Neurologic segmental innervations
test
Neurologic segmental
innervations test
Shoulder physical
examination
Examination
LOOK
FEEL
MOVE
Special tests
Rotator cuff.
Instability
AC joint.
Impingement syndrome.
Biceps
SLAP
Thoracic outlet Syndrome
Conditions
Instability
Subacromial impingement
Rotator cuff rupture
SLAP Lesions
Superior labral anterior-posterior
Rotator cuff
ROTATOR CUFF INTEGRITY:
Active ROM + strength of:
Supraspinatus
Infraspinatus.
Subscapularis
Teres minor
Lag signs.
Subscapularis
Lift-off Test
Supraspinatus
Jobe test
Infraspinatus
Teres minor
Lag signs
Drop sign
Lag signs
Lag signs
IMPINGEMENT TESTS
IMPINGEMENT TESTS
IMPINGEMENT TESTS
IMPINGEMENT TESTS
LAXITY TESTS
Sulcus sign
TRANSLATION TESTS
INSTABILITY TESTS
Apprehension Test
INSTABILITY TESTS
Relocation test
Release test
INSTABILITY TESTS
SLAP
SLAP
Supination
Pronation
SLAP
SLAP
AC joint
Scarf test
Biceps
Speed test
Look
Dorsum
Any scars? Trauma?
Previous surgery?
Any nodes?
Any nail changes?
Pitting, onycholysis,
psoriasis
Any deformity?
Plantar
Any scars? Swelling?
Skin colour? Any
deformity?
Thenar/hypothenar
wasting carpal tunnel
syndrome
Dupytrons contracture
alcohol liver disease,
diabetes
Elbows
Any nodules?
Feel
Elbow
Palpate elbow/arm for nodules
Palm
Palpate thenar / hypothenar
Temperature - warm joints in inflamatory
Palmar thickening
Check pulse radial pulse and ulnar
pulse
Sensation
Median nerve thenar eminence
Ulnar nerve hypothenar eminence
Radial nerve first dorsal web
space
Move
Assess each of the following
movements passively first, feeling for
crepitus & noting any pain. Then carry
out active movements(patient does the
movements independently).
Wrist extensionput palms of your hands
together & extend wrists fullyROM 90
Wrist flexion put backs of your hands
together & flex wrists fullyROM 90
Finger flexionmake a fist
Finger extension open your fist & splay
your fingers
Motor assessment
Ask the patient to carryout the following
movements against resistance.
This is a screening test to quickly assess
the3 major nerves of hand.
Wrist / finger extension(against
resistance)radial nerve
Finger abduction(against resistance) index
finger ulnar nerve
Thumb abduction(against
resistance)median nerve
Function
Power grip squeeze my fingers
with your hands
Pincer grip place your thumb &
index finger together & dont let
meseparatethem
Pick up small object can you pick
up thissmall coin?
Special Test
Medial epicondylitis a.k.a. Golfers Elbow
Ask the patient to actively flex the wrist
whilst the elbow is flexed.
Localised pain over the medial epicondyle
suggests a diagnosis of medial
epicondylitis.
Lateral epicondylitis a.k.a. Tennis Elbow
Ask the patient to actively extend the wrist
whilst the elbow is flexed.
Localised pain over the lateral epicondyle
suggests a diagnosis of lateral
epicondylitis.
Hip Examination
LOOK
Scar
Swelling
Compare and measure the
disntance from the anterior
superior iliac spine to the
medial malleolus on each side.
Feel
Skin temperature
The anterior superior iliac
spines (ASIS)
Ischial spines
Greater trochanter
Movement
Flexion
Flexi hip and knee of affected side and note ROM
(120)
Extension
ROM (20 )
Abduction
Stabilise pelvis and hold ankle with other hand . Abduct and note
(45 )
Adduction
As above and note ROM (30 )
Interna rotation
ROM (45 )
External rotation
ROM (60 )
Special tests
Trendelenburg test
Thomas test
The Apprehension test Thomas test for flexion deformity of the hip
Knee
Knee is the largest joint in the body
It is ginglymus (modified hinge) joint,
provide fairly wide ROM
Knee is not protected by layers of fat
or muscle, so it has high incidence of
injury
Inspection
Scar
Swelling
Bone deformities
Muscle atrophy
Masses
Evidence of local
trauma
Abrasions
Contusions
Lacerations
Palpation
Temperat
ure
Bone
palpation
Soft
tissue
palpation
Anterior
Medial
Lateral
Posterio
r
Range of Motion
Flexion
Extention
Internal rotation
External rotation
Neurologic Examination
Extention
Quadriceps
Femoral nerve, L2, L3, L4
Flexion
Hamstring
Reflex
Sensoric
McMurray Test
Apleys Compression
Ballotable Patella
Foot
Inspeksi
Lihat bentuk kaki dan sepatu
Deformitas
Oedem unilateral atau bilateral
Trauma
Kulit ( jaringan parut?memar?
eritema?, sendi ( bengkak?
effusi?), otot ( lemah?), tumit
(berkulit tebal), diantara jari
kaki (ulkus?) , kuku (psoriasis),
permukaan ekstensor tungkai
bawah ( plak psoriasis, nodul
rheumatoid, tophus pada gout
Palpasi
Palpasi tulang dan sendi, tendon (medial
ankle), lateral ligament complex( lateral
ankle), tendon Achilles
Jaringan plantar : tebal, lembut,
fibromatosis
Nyeri tekan
Benjolan
Pulsasi a.dorsalis pedis, a. tibialis posterior
Temperatur (ankle, midfoot, toes)
Move
Ankle motion (dorsofleksi dan
plantarfleksi)
Subtalar motion (inversi dan eversi)
Midtarsal motion ( forefoot adduction
dan forefoot abduction)
Toe motion ( fleksi dan ekstensi)
Lokasi nyeri
1. Lateral anterior talofibular
ligament, calcaneofibular ligament,
posterior talofibular ligament, peroneal
tendon, lateral malleolus.
2. Medial deltoid ligament, tibialis
posterior tendon, medial malleolus.
3. Posterior achilles tendon, OS
trigonum.
4. Anterior talus, tibiotalar joint.
PEMERIKSAAN Pergelangan
kaki
Dilakukan pada dua sisi untuk membandingkan
perbedaannya.
Inspeksi
Memeriksa dan membandingkan kedua pergelangan kaki
sepenuhnya dari depan, samping dan dari belakang.
Melihat bentuk asimetri serta deformitas, pembengkakan
atau ecchymosis. harus melihat pola pemakaian sepatu
Palpasi
Meraba kaki bagian bawah, pergelangan kaki dan kaki
berikut ini bidang kelembutan: 1. kaki bagian bawah: fibula,
membran interoseus, kompartemen anterior ,garis sendi
pergelangan kaki anterior 2. pergelangan kaki tengah :
maleolus medial, ligament deltoid,tendon tibialis posterior .
3. pergelangan kaki Lateral : maleolus lateral, anterior
talofibular ligamentum (ATFL), ligamen calcaneofibular
(CFL), posterior ligamen talofibular (ATFL), peroneal tendon
(Gambar 62). 4. pergelangan kaki bawah: tendon Achilles ,
kalkaneus. 5. kaki : proksimal 5 th metatarsal , navicular
Range of Motion
Gerakan pergelangan kaki pertama harus
dinilai secara aktif dan kemudian pasif,
membandingkan kedua pergelangan kaki
untuk mencari asimetri.
Periksa adanya keterbatasan gerakan atau
nyeri .
1. dorsofleksi biasanya sekitar 20 (Gambar
63)
2. Plantar fleksi sekitar 50
3. Inversi sekitar 30
4. Eversi sekitar 10
Tes khusus
Berbagai tes dapat dilakukan pada pergelangan kaki untuk menilai integritas
ligamen pergelangan kaki dan
tendon. Ketika melakukan tes ini, memeriksa adanya kelemahan dan / atau nyeri.
1. Anterior drawer test - dilakukan dengan menstabilkan kaki bagian bawah
dengan satu tangan sementara melengkungkan
tumit dengan yang lain, kemudian menarik ke depan pada kalkaneus / talus
kompleks
Kelemahan dibandingkan dengan sisi yang tidak terlibat menunjukkan lateral
yang ligamen pecah.
2. Talar tilt test - yang dilakukan adalah menstabilkan kaki bagian bawah dengan
satu tangan sementara bekamelengkungkan
tumit dengan yang lain, membalikan sendi pergelangan kaki. Kelemahan inversi
dibandingkan dengan tidak terlibat
sisi menunjukkan robeknya ligamen lateral, sementara rasa sakit dengan
manuver ini menunjukkan
cedera ligamen.
3. Squeeze test- dilakukan dengan menekan tibia dan fibula proksimal bersama
sambil menanyakan apakah ada rasa sakit dibagian distal pada pergelangan kaki
Nyeri di pergelangan kaki menunjukkan cedera yang tibiofibular
ligamen (syndesmosis keseleo). pemutaran Pasif pada pergelangan kaki ke rotasi
eksternal juga
memperburuk rasa sakit dari cedera syndesmosis