Clinical Examination (Subscribe)

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Gait (13)
Resources relating to Gait Examination and assessment.
MeSH Search Term "Gait"[mesh]
ICD-10 Code R26 Abnormalities of gait and mobility *Not specific to gait examination.
SNOMED-CT Term Examination of gait (procedure) Concept ID: 274787008
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1999 Diagnostic classification of shoulder disorders

Only moderate agreement was found on the classification of shoulder disorders, which implies that differentiation between the various categories of shoulder disorders is complicated. Especially patients with high pain severity, chronic complaints and bilateral involvement represent a diagnostic challenge for clinicians. As diagnostic classification is a guide for treatment decisions, unsatisfactory reproducibility might affect treatment outcome. To improve the reproducibility, more insight into the reproducibility of clinical findings and the value of additional diagnostic procedures is needed.
Diagnostic classification of shoulder disorders: interobserver agreement and determinants of disagreement. de Winter AF, Jans MP, Scholten RJ, Devillé W, van Schaardenburg D, Bouter LM. Ann Rheum Dis. 1999 May;58(5):272-7.

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2001 Biomechanics of the Wrist and Hand

These (physio) lab problems are designed to help students review hand anatomy, to relate their existing knowledge to functional considerations, and to introduce new material.
University of Oklahoma Health Sciences Center Department of Rehabilitation Sciences 2001

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2008 Aching Joints Assessment Investigations and Management in Primary Care PatientPlus

The complex challenge to the physician is to safely diagnose simple arthralgia from degenerative joint disease, inflammatory arthropathies or pain secondary to other diseases.
Updated 2010

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2008 Chronic shoulder pain part I Evaluation and diagnosis

Shoulder pain is defined as chronic when it has been present for longer than six months. Common conditions that can result in chronic shoulder pain include rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. Rotator cuff disorders include tendinopathy, partial tears, and complete tears. A clinical decision rule that is helpful in the diagnosis of rotator cuff tears includes pain with overhead activity, weakness on empty can and external rotation tests, and a positive impingement sign. Adhesive capsulitis can be associated with diabetes and thyroid disorders. Clinical presentation includes diffuse shoulder pain with restricted passive range of motion on examination. Acromioclavicular osteoarthritis presents with superior shoulder pain, acromioclavicular joint tenderness, and a painful cross-body adduction test. In patients who are older than 50 years, glenohumeral osteoarthritis usually presents as gradual pain and loss of motion. In patients younger than 40 years, glenohumeral instability generally presents with a history of dislocation or subluxation events. Positive apprehension and relocation are consistent with the diagnosis. Imaging studies, indicated when diagnosis remains unclear or management would be altered, include plain radiographs, magnetic resonance imaging, ultrasonography, and computed tomography scans. Plain radiographs may help diagnose massive rotator cuff tears, shoulder instability, and shoulder arthritis. Magnetic resonance imaging and ultrasonography are preferred for rotator cuff disorders. For shoulder instability, magnetic resonance imaging arthrogram is preferred over magnetic resonance imaging.
Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Am Fam Physician. 2008 Feb 15;77(4):453-60. Full Text

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2008 Neurological Examination Orthoteers

SUMMARY
* Equipment Needed
* General Considerations
* Motor
o Observation
o Muscle Tone
o Muscle Strength
o Pronator Drift
* Coordination and Gait
o Rapid Alternating Movements
o Point-to-Point Movements
o Romberg
o Gait
* Reflexes
o Deep Tendon Reflexes
o Clonus
o Plantar Response (Babinski)
* Sensory
o General
o Vibration
o Position Sense
o Subjective Light Touch
o Dermatomal Testing
+ Discrimination

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2008 Physical Examination of the Hand and Wrist HSS

Video of routine hand/wrist examination from the Hospital for Special Surgery

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2008 Pivot Shift Sign Orthoteers

Account of the Pivot Shift sign for ACL deficiency

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2008 Posterolateral Instability of the Knee and Knee Dislocations Orthoteers

POSTEROLATERAL INSTABILITY
= when stress testing the lateral tibial plateau rotates posteriorly in relation to the femur with lateral opening of joint associated with knee dislocation (see below)

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2009 A Novel Tool for the Assessment of Pain Validation in Low Back Pain PLOS Medicine

Adequate pain assessment is critical for evaluating the efficacy of analgesic treatment in clinical practice and during the development of new therapies. Yet the currently used scores of global pain intensity fail to reflect the diversity of pain manifestations and the complexity of underlying biological mechanisms. We have developed a tool for a standardized assessment of pain-related symptoms and signs that differentiates pain phenotypes independent of etiology.
Joachim Scholz, Richard J. Mannion, Daniela E. Hord, Robert S. Griffin, Bhupendra Rawal, Hui Zheng, Daniel Scoffings, Amanda Phillips, Jianli Guo, Rodney J. C. Laing, Salahadin Abdi, Isabelle Decosterd, Clifford J. Woolf PLoS Med 6(4): e1000047. 2009 (full text)

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2009 Achilles Tendonitis and Rupture PatientPlus

Achilles tendonitis This is inflammation of the tendon, usually resulting from overuse associated with a change in playing surface, footwear or intensity of an activity.
Updated 2011 The Achilles tendon is surrounded by a connective tissue sheath (paratenon or paratendon), rather than a true synovial sheath. The paratenon stretches with movement, allowing maximum gliding action. Near the insertion of the tendon are 2 bursae, the subcutaneous calcaneal and the retrocalcaneal bursae.

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2009 Brachial Plexus Assessment and Common Injuries

Traumatic injury mostly occurs in severe road traffic accidents (especially on a motorcycle) and falls from heights. Young men are most commonly affected. The position of the arm (as the injury occurs) will determine the levels involved. If the arm was held at the side, a C8-T1 injury is usual. However, if the arm is abducted, C7 is commonly involved.

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2009 Clarification of the Simmonds–Thompson test for rupture of an Achilles tendon

The Simmonds–Thompson test, described in 1957 and 1962, respectively, remains the principal clinical test for rupture of an Achilles tendon. However, there is some discrepancy in the literature regarding its mechanical significance. A positive test has been reported to indicate a complete rupture of the tendon, and the cited mechanical reason for the positive test (complete rupture) is the loss of integrity of the soleal part of the tendon. This is consistent with Thompson’s initial description, in which he reported that “... by anatomical dissections ... plantar flexion of the foot depends on an intact soleus muscle attachment to an intact tendon of Achilles.” O’Brien, however, reported that a negative test depended on an intact connection of the gastrocnemius aponeurosis to that of the soleus muscle and further described a needle test to assess this.
James Douglas, MD Michael Kelly, MB BS† Piotr Blachut, MD‡ Can J Surg, Vol. 52, No. 2, April 2009 E40 (full text)

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2009 Geriatric Physical Diagnosis - The Upper Extremities

Elbow and shoulder problems are very common in elderly people. The upper extremity examination is clinically important because upper extremity skills are essential for the performance of activities of daily living. The assessment mainly consists of careful examination of the elbow and shoulder.
Geriatric Physical Diagnosis: The Upper Extremities Mark E. Williams, MD

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2010 Cervical Spine Examination

Video of Dr Farmer (Hospital for Special Surgery) demonstrating his routine for C Spine examination.
Free registration is required.

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2010 Comprehensive Neurological Examination of the Upper Extremity

Video of the routine taught at the Hospital for Special Surgery for neurological examination of the upper extremity - shoulder, arm and hand

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