运动系统检查 Musculoskeletal Examination

Slides:



Advertisements
Similar presentations
Regional Anatomy Introduction 海南医学院解剖学教研究室 Yi Xi-Nan
Advertisements

歷史簡介 米開朗基羅 精研肌膚、血管紋路及關節與 肌肉組織構造 第一時期:西元前 → 文藝復興 ( 十七世紀 ) 觀察描述的階段.
NEUROLOGY R1 陳安芝 2008/08/05 腦中風的神經學檢查及評估. 檢查的原則 原有功能喪失 額外的症狀 運動 / 感覺.
分娩前徵狀 體溫下降是重要的指標。在分娩第一期肛 溫下降明顯,可能在 12 小時內開始分娩。 體溫下降是重要的指標。在分娩第一期肛 溫下降明顯,可能在 12 小時內開始分娩。 小型狗下降到 35 ℃,中型狗下降到 36 ℃。 小型狗下降到 35 ℃,中型狗下降到 36 ℃。 分娩 小時前狗會造巢,伴隨子宮收縮.
骨科系申報編碼作業 病歷管理組 黃素勤 財團法人嘉義基督教醫院.
肩關節常見疾病.
西醫觀點談運動傷害防治 - 96學年度 健康促進 -- 運動傷害防治
Osteoarticular and muscular system
參考教材:美語常用2000字 (陳文豊編著)/ Yahoo!奇摩字典
腔室症候群.
第 七 章 上 肢 Ⅱ (The upper limb) 主讲人 李文春 副教授.
问 题 引 入 1.观察自己的上下肢,比较上肢肌肉和下肢 肌肉有何不同。 2.运动自己的下肢肌,看看这些肌肉收缩可 以引起哪些运动。
盆腔器官脱垂的治疗 郑州大学第三附属医院妇产科 王鲁文.
学习目标: 对脊柱与四肢进行检查评估 (正常、异常、常见疾病)
Chapter VIII :Examination of spine and Extremities
脊柱及四肢 检 查.
上海理工大学医疗器械与食品学院 医学基础教研室 王 艳
关节脱位.
关节运动检查 各关节功能活动范围 常用特殊检查.
致谢 本课件中部分图片选自刘丰春《人体X线解剖学》课件,再此表示感谢!.
脊髓灰质炎 Poliomyelitis.
肩峰下滑囊炎 Sub-acromial bursitis
第十四章 人体各部分损伤 第三节 肩关节 损伤 肩关节损伤的原因 运动 急性损伤 工作 日常活动 先天性.
标题 上 肢 The Upper Limb.
Neurological Assessment
实习 生长发育测量 主讲:贾丽红 预防实验室试验中心.
项目 一 关节活动度测量 康复教研室.
快樂地 進入職場 行政院衛生署立桃園醫院 復健科主任 李偉強醫師.
腹 部 体 检 ( Physical Diagnosis of the Abdomen )
The Local Anatomy of Oral Maxillo-Facial and Neck
内眦赘皮的矫正 —“开眼角” 河北省人民医院 张芾男.
局部解剖学(一) Regional anatomy
产后耻骨联合分离症 产后耻骨联合分离症.
运 动 系 统 Locomotor System.
第六章 清洁卫生的护理.
Prevention & Treatment of Chronic Pains 慢性疼痛病的防治
目 录 PartⅠ 胸部体表标志 检 查 方 法 骨骼标志 胸部视诊方法 胸廓的体表标志线 胸部触诊方法 胸廓的解剖区和陷窝 胸部叩诊方法.
多媒体教学系列课件之一 上肢肌 蚌埠医学院解剖学教研室 编制.
神经系统 nervous system 脊 神 经 The spinal nesve.
上肢的局部解剖学 刘朝晖 教授,系主任 人体解剖与组织胚胎学系.
针灸推拿临床诊疗基础 推 拿 教 研 室 谢远军.
脊柱和四肢 Spine & Extremities
踝关节损伤lauge-hansen分型 山西医科大第二医院骨科 梁凯恒.
Congenital Malrotation of Midgut – A Case Report 先天性中腸扭轉案例報告
浙江大学医学院八年制教学 神经精神与运动1(模块2) 运动系统慢性疾病 肩关节周围炎、腱鞘炎 股骨头坏死 浙江大学医学院附属二院骨科 吴立东.
Spinal Nerves 脊神经.
你的學員對你的教學表現隨時在給回饋 - 他們透過肢體語言給我們打分數
运动系统检查 Musculoskeletal Examination
The muscles of limbs 四 肢 肌
運動醫學的定義 運動員之評估與訓練 預防運動傷害與疾病 運動傷害與疾病之診斷 與治療 復健、 及早回復運動.
Chapter 5 Myology.
Book Reading 3 Stroke Rehabilitation--- Chapter 6 Rehabilitating Movement OTs 左惠心 指導老師 江茂碩老師.
Unit 10 Review and check.
From 206 to One 葉志偉 中心診所醫院骨科 主任醫師 基督教風一族職場教會 主任牧師.
英语表示人体部位的词 Body Parts in English 温州中学 张怡.
OSCE-神經系統 神經外科 陳世翰醫師.
The Locomotor SystemⅡ Mar JING LI
句子成分的省略(1).
Traditional Chinese Medicine
儿童肘部损伤X线诊断 涂占海.
Nervous system 神经系统.
Dislocation of the Patella
人脑与脑血管 解剖分析.
抬腳運動 核心肌群肌力訓練 起始姿勢Position (20%) 動做 movement (20%)
Urinary System 泌尿系统.
運動傷害專題講座 Hip Joint Skeletal.
肌肉骨骼系統 Musculoskeletal System
Hong Kong Catholic Diocesan Schools Council (Primary Schools Section) 香港天主教教區學校聯會(小學組) 學生意外保險 (2009年度 – 2010年度)
Upper limb Neurological Examination
一位27歲男性病患因工作關係被壓傷右(左)前臂,導致Extensor carpi radialis 傷害而前來尋求醫療服務,您是物理治療師,將執行電刺激以減緩肌肉的萎縮,請先示範以527電療儀器來對具有神經支配之肌肉進行電刺激之治療技術,並說明和去神經支配肌肉電刺激之差異。
Presentation transcript:

运动系统检查 Musculoskeletal Examination 浙江大学医学院附属第一医院骨科 徐三中

REVIEW Anatomy: bone ligament muscle nerve Bone numbers of the bones numbers of the vertebras Ligament ,joint Muscle 206 7,12,5

运动系统 脊柱:Cervical spine -7 Thoracic spine -12 Lumbar spine -5 Sacral spine -5 Coccyx spine -4 四肢和关节:Upper extremities: shoulder joint, elbow joint,wrist joint Lower extremities: hip joint, knee joint,ankle joint

muscle force 0-V 肌力分六级: 0级 -肌肉完全瘫痪。 1级 -有肌肉收缩,但无关节活动。 2级 -有肢体活动,但不能对抗自身重力 3级 -能对抗重力的活动。 4级 -能对抗轻微的阻力。 5级 -完全正常。

REVIEW Nerve: 中枢和周围 周围:颈丛,臂丛,胸部(肋间神经),腰,骶丛 upper extremity : axillary(腋神经),musculocutaneous(肌皮神经),radial(桡神经),median(正中神经),ulnar(尺神经) lower extremity : femoral(股神经) sciatic(坐骨神经)

Principles of Examination Approach patient with Kindness (cause no pain)(亲切、和蔼) Precision (observe patient‘s face and record findings)(精确) Style(方式 )(be cheerful and timely)及时

Principles of Examination Always Look(望) Feel (触) Move(动) Measure(量)

sequence of Examination (检查顺序) 1. Observe the patient as a whole. 2 . Neck--- Back--- Shoulder---Elbow---Wrist&Hand---Hip---Knee---Ankle&Foot

whole Walk (carriage): 跛行(神经,血管,关节, 骨骼等) Morphous(shape形态): abnormity Tenderness(压痛)(superficial or deep) and percussion pain(扣痛)(direct or indirect扣痛)

whole Skin (vein edema ) muscle (hypertrophy 肥大 and atrophy 萎缩) Always bilateral Contrast

spine望 脊柱弯曲异常 A . Scoliosis(侧凸) 姿势性的侧凸;器质性侧凸。 特发性的脊柱侧凸(idiopathic scoliosis) 原发性、继发性和先天性的脊柱侧凸

B. Kyphosis(后突) 小儿: 佝偻病(rickets) 儿童青少年:胸椎结核 成年人: 强直性脊柱炎 老年人: 骨质疏松 成年人: 强直性脊柱炎 老年人: 骨质疏松 Healthy spine Kyphotic spine

C. Lordosis(前突) 1:pregnance 2:CDH(先髋)

spine触-体表定位 1.体表可及的骨突来定位 第三胸椎棘突 第七胸椎棘突 第四腰椎下部 第五腰椎和第 一 骶椎棘突之间

spine触 压痛:表浅,深部,棘突,棘突旁。 叩击痛:直接叩击法和间接叩击法。 腰背肌有无痉挛和萎缩

Spine动 1 瑞-舒(Wright-Schober)测试法, 2 拾物试验 3 坐位屈颈试验(Lindner) 2 拾物试验 3 坐位屈颈试验(Lindner) 4 直腿抬高试验和加强试验(Lasegue) 5 腰骶关节试验 6 髋关节“4”字试验 7 跟臀试验(ely test) 后面细讲

Spine量

Examination of the Neck 1. Observe the neck and shoulders from in front and behind 2. Palpate the front and back of the neck with the patient seated and the examiner behind.

Examination of the Neck

Examination of the Neck 3. Assess neck flexion(屈) by asking the patient to touch their chest with their chin.(下巴) 4. Assess extension(伸) by asking the patient to look up and as far back as possible

Examination of the Neck

Examination of the Neck 5. Assess lateral flexion (侧弯)to both sides by asking the patient to touch their shoulder with their ear. 6. Assess rotation(旋转) by asking the patient to look over their shoulder, to the left and right. 7. Begin the neurological assessment of the upper limb by examining the motor(运动) system. This involves asking the patient to assume (采取)a certain position and not let you overcome it. Begin with shoulder abduction.

8. Shoulder adduction.(外展)腋神经

9. Elbow extension.(伸)桡神经 10. Elbow flexion(屈)肌皮神经

Examination of the Neck 11. Wrist flexion(屈)and extension 12,Finger extension(伸)and Finger flexion(屈) 桡神经、正中神经、尺神经,radial ,median, ulnar

14. Thumb (拇指)abduction.(外展) 15. Finger abduction

16. Elicit(引出) the reflexes of the upper limb beginning with the biceps(二头肌)jerk. 17. Triceps(三头肌) jerk 18. Brachioradialis(桡) jerk..

19. Hoffmann征和Babinski征 20 . Test sensation of the upper limb and determine the distribution(分布) of any loss

Examination of the Back 1. Observe the patient as a whole, front and back. 2. Ask the patient to walk on their toes. 3. Ask the patient to walk on their heels.(跟)

Examination of the Back 4. Back extension.

Examination of the Back 5. Back flexion.(屈) 瑞-舒(Wright-Schober)。 6. Bony Excursion: measure the distance between two bony points when standing. 7 Ask the patient to flex forward, the bony points should move at least 5 cm. 8. Lateralflexion

瑞-舒(Wright-Schober)测试法 测定脊柱前弯时的伸长率,即嘱受试者作立正姿势,以髂嵴为中心,在其上10cm及下5cm处各作一标志,测量两点间距离。正常人弯腰时的两点距离较直立时的15cm增加4~8cm(图3-8-3)。该检查法可对幼年强直性脊柱炎病人进行动态观察

Examination of the Back 9. Rotation (make sure to anchor(固定) pelvis) 10. FABER test. (4字试验),Flexion knee ,Abduction ,External Rotation hip. Press firmly on the knee. Pain in the groin suggests a hip problem and pain in the back refers to the sacroiliac(骶髂) joint. 11 Lasegue征(Straight leg ranging) ,dorsiflexion (背伸)increases the sciatic stretch. Watch for pain and limitation. (2 photos) 12. Femoral stretch test: Hip extension and passive flexion of the knee. Watch for pain and limitation

FABER test. (4字试验), Lasegue征(Straight leg ranging) Femoral stretch test:

髋外展外旋试验或“4 ”字试验 FABER test 检查时仰卧,一侧下肢伸直,将对侧足置于伸直侧膝上向下压,如同侧骶髂关节或髋关节疼痛时为阳性,说明骶髂关节或髋关节有病变,但如果腹股沟处有剧烈牵拉痛,应考虑为股内收肌纤维炎或肌腱、肌肉损伤引起,与骶髂关节无关

直腿抬高试验 为神经根受刺激的表现。检查时嘱病人仰卧,两下肢伸直,医师一手置于膝关节上,使下肢保持伸直,另一手将下肢抬起。正常人可抬高70°以上,如抬高不到30 °,即出现由上而下的放射性疼痛。见于坐骨神经痛,腰椎间盘突出或骶神经根炎等。为增加坐骨神经牵拉强度可被动使踝关节背屈,如有椎间盘突出症时,坐骨神经的疼痛将明显加剧,此方法又称为直腿抬高加强试验

拾物试验 检查患者的脊柱活动,可使其拾取一件放在地上的物品,观察脊柱的活动是否正常。腰椎有病变拾物要屈曲两侧膝、髋关节而腰挺直

屈颈试验(Lindner test),患者仰卧,两下肢自然伸直,医者一手按压患者于胸前,一手置于枕后托住后枕部,托枕之手缓缓用力使患者头部尽量前屈,这时如出现腰痛伴单侧或双侧下肢放射性疼痛即为阳性。

跟臀试验(ely test) 俯卧位,患侧屈膝,使足根靠近臂部,这时股神经与股前侧肌群受到牵拉而出现大腿前方放射痛。本试验在腰大肌脓肿,脊柱强直,股四头肌挛缩,骶髂关节病变时,也有疼痛,请注意鉴别

跟臀试验(ely test)

腰骶关节试验 极度屈曲两髋及膝使臀部离床,腰部被动前屈。下腰部软组织劳损或腰骶椎有病变时则感疼痛,为阳性,椎间盘突出病人常为阴性

Examination of the Back A Neurological examination including: 13. Knee extension. 14. Kneeflexion 15. Knee jerk reflex 16. Ankle jerk reflex.

Examination of the Back 17. Sensation 18. Pain on compression of the head can often be attributed to non-organic pathology.(非器质性病变)

Examination of the Back

四肢关节 Upper extremities Lower extremities

四肢的一般检查 常见病症: 1. 肢端肥大:垂体肿瘤,生长激素分泌过多引起的肢端肥大症和巨人症。 2. 肌肉萎缩:神经营养因素 废用性 肌炎 3. 骨折和关节脱位:骨折专有体征-畸形,反常活动, 骨擦音和骨擦感。

四肢的一般检查 常见病症: 4. 水肿:静脉回流受阻-静脉血栓形成等。 淋巴回流受阻-象皮肿。指压后无组织凹陷。 4. 水肿:静脉回流受阻-静脉血栓形成等。 淋巴回流受阻-象皮肿。指压后无组织凹陷。 5. 肝掌:掌侧的红斑,与雌激素有关,为肝功能减退 的临床表现之一。 6. 杵状指、趾: 好发与呼吸系统疾病和心血管系统疾病 及营养障碍性疾病,与缺氧,代谢障碍,中毒等 有关。单侧的见于锁骨下动脉瘤。 7. 匙状指:也称反甲。缺铁性贫血,风湿热等

Examination of the Shoulder 1. Observe the whole patient, front and back. (2 photos) 2. Observe the shoulder. 3. Observe the axilla.(腋窝)

Examination of the Shoulder 4. Palpate for tenderness over the sterno-clavicular(胸锁) joint, clavicle, acromioclavicular(肩锁)joint, acromion process (肩峰), supraspinatus tendon(岗上肌腱) and the tendon of the long head of biceps.

5. Observe shoulder abduction from in front and behind, through the entire range of movement. Note the presence of difficulty in initiation or a painful arc. (3 photos)

Examination of the Shoulder 6. Secure (固定)the scapula(肩胛骨) to assess gleno-humeral(肩肱) movement. 7. Assess flexion and extension(屈伸运动). ( no photos) 8. Assess external rotation (外旋)with elbows in to the sides and flexed(屈) to 90º . 9. Assess internal rotation by asking the patient to place both hands behind the head.

Examination of the Shoulder 10. Assess internal rotation(内旋) by asking the patient to reach over their opposite shoulder, behind the neck and behind the back. (3 photos)

Examination of the Shoulder

Examination of the Shoulder 11. Test biceps function by asking the patient to flex the elbow against resistance.

Examination of the Elbow 1. Observe the whole patient, front and back, looking especially for deformity(畸形)(肘外、内翻) 三点关系(肱骨内,外上髁和尺骨鹰嘴) 肘后三角:异常-肘关节脱位。 正常-肱骨髁上骨折。 携带角:即10-15度的外翻角。 肘外翻:大于15度。 肘内翻:小于0度。

2. Feel for tenderness(痛点)

Examination of the Elbow Accentuate the pain of tennis elbow. 4. Tennis elbow: point tenderness. 5. Tennis elbow: pain on resisted extension. 6. Tennis elbow: pain on passive stretch Golf elbow?

Examination of the Elbow 伸肌腱牵拉试验(Mills征)、

7. Examine extension.(伸) 8. Examine flexion(屈)

9. Examine supination.(旋前) 10. Examine pronation(旋后)

11. Provocative(刺激) test for Cubital Tunnel(尺神经根管) Syndrome (puts tension on ulnar nerve at elbow). Tinel 征

12. Palpate the ulnar nerve.

Examination of the Wrist and Hand 1. Observe the hand positioned on a pillow(垫子) or a table. Ensure you have adequate(足够) exposure. 2. Observe the palm(掌) of the hand. 3. Observe the dorsum(背) of the hand.

Examination of the Wrist and Hand

Examination of the Wrist and Hand 4. Review the anatomy of the hand noting the tip of the styloid(茎状) process(突), the anatomical snuffbox(鼻烟窝) bordered by extensor pollicis brevis(拇短伸肌腱) and extensor pollicis longus tendons (拇长伸肌腱), and the head of the ulna.(尺骨头) 5. Feel for tenderness. (no photos) 6. Test active movements of the wrist. (no photos)

Examination of the Wrist and Hand 7. A useful method for screening of flexion and extension of the wrists. (2 photos) 8. Test passive movements of the wrist beginning with extension(伸). 9. Flexion(屈).

Examination of the Wrist and Hand

Examination of the Wrist and Hand 10. Radial deviation.(桡偏) 11. Ulnar deviation.(尺偏) 12. Pronation.(手掌向下) 13. Supination. (手掌向上)

Examination of the Wrist and Hand

Examination of the Wrist and Hand 15. Test thumb abduction.(外展) 16. Test thumb adduction.(内收) 17. Test opposition.(对掌)

Examination of the Wrist and Hand

Examination of the Wrist and Hand 18. Observe movement of fingers from extension to flexion. (2 photos) 19. Test flexor digitorum profundus (指深屈肌腱)function by holding the proximal interphalangeal joint(近节指间关节PIP) extended(伸直) and asking the patient to flex the finger. Successful finger flexion indicates the tendon is intact(完整). 20. Test flexor digitorum superficialis(指浅屈肌键) function by holding the other fingers extended while asking the patient to flex the finger being tested. Successful flexion indicates the tendon is intact.

Examination of the Wrist and Hand

Examination of the Wrist and Hand 21. Assess joint hyperextension. 22. Axial(纵向) compression test. 23. Asses ulnar nerve function with Froment's test. 24. Asses ulnar nerve/interosseus(骨间) muscle function by asking the patient to abduct their fingers while slowly pushing the hands together until the weaker one collapses

Examination of the Wrist and Hand

嘱患者用患侧食指与拇指捏夹一张纸,患侧因拇内收肌瘫痪,无法完成此动作,而用指间关节屈曲代偿,为典型的Froment征阳性。

Examination of the Hip 1. Observe the whole patient. 2. Trendelenburg test (normal).(先髋单足独站试验) 3. Positive Trendelenburg Test. 4. Ask the patient to walk and observe their gait. (no photo) 5. Test iliopsoas(髂腰肌) function by asking the patient to lift their thigh (大腿)off the seat against resistance.

- 病人抬起健侧腿,如果患侧下肢可以单独站立,同时健侧臀部皱褶及髂骨翼均上提,为阴性,如果健侧臀部皱褶及髂骨翼均下降,则为阳性。 +

6. Ensure the Anterior Superior Iliac Spines(髂前上嵴) are horizontal

Examination of the Hip 7. Check the position of the medial malleoli.(踝) 8. Measure from the ASIS(髂前上嵴) to the medial malleoli. (3 photos) 9. Measure the distance from the xiphisternum(剑突) to the medial malleoli. 10. Feel for the femoral head. It is deep to the femoral pulse. (No photo) 下肢总长度的测量有2种,1是骨性长度,测量从髂前上棘至内踝下尖的距离;2是表面长度,测量从脐至内踝下尖的距离。

Examination of the Hip

Examination of the Hip 11. Thomas Test: Flex both hips to eliminate the lumbar lordosis(腰椎前突), Extend the hip you are examining and if it is normal it should return to the bed. A fixed flexion deformity of the hip will not allow it to extend to the neutral position. (2 photos

托马斯征 髋关节的屈曲挛缩可以由腰椎的前突来代偿,当平卧而将健侧髋,膝极度屈曲,可使腰部放平而使腰紧贴床面,此时患侧髋关节的屈曲畸形即可以显示,此为托马斯征阳性。记录患肢与床面的角度。

Examination of the Hip

Examination of the Hip 12. Check the patient is not compensating (代偿)with a lumbar lordosis(前突). 13. Check the ASIS are horizontal again. Anchor leg over the edge of the bed and abduct the other hip. 14. Assess adduction(内收).

Examination of the Hip 14. Assess adduction. 15. Internal rotation

Examination of the Hip

Examination of the Knee 1. Observe the patient as a whole. 2. Observe the knee joint front and back. Note any genu valgum (外翻)(a slight degree of which is normal) or genu varum(内翻). 3. Observe knee from side. Note any genu recurvatum 4. Ask the patient to squat(下蹲)

Examination of the Knee

Examination of the Knee 5. Assess patellae tracking from extension to flexion. Note quadriceps(四头肌) action. 6. Patellar apprehension test. Apply lateral pressure to patellar as the patient flexes the knee. Observe facial expressions for fear of impending dislocation. 推髌实验(patellar apprehension test)来检查髌骨的稳定性,特别是在髌骨脱位及半脱位时更有意义 7. Observe the knee with the patient lying on the bed.

Examination of the Knee

Examination of the Knee 8. Pick a bony landmark(标记) on the knee and measure a fixed distance from it to the approximate centre of the quadriceps. 9. Measure the circumference of the of the knee and leg. 10. Feel the temperature of the knee and leg. 11. Soloman's test. Lift the patella away from the femur. In synovial thickening it will be hard to grasp

Examination of the Knee

Examination of the Knee 12. Effusion Tap Test(浮髌试验). Push sharply on the patella and with an effusion it will strike the femur and bounce back. 13. Effusion: Feel for fluid fluctuance

Effusion Tap Test(浮髌试验). Patellar apprehension test

Examination of the Knee 14. Anterior drawer test. Femur should not move forward significantly unless the anterior cruciate ligament is torn. 15. Posterior drawer test. (Posterior cruciate)

Examination of the Knee

Examination of the Knee 16. MacMurrays test. Place the thumb and finger on the joint line. Watching the patients face for pain, flex the leg, externally rotate the foot, abduct and extend leg to test for medial meniscal "clicks".

Examination of the Knee

回旋挤压试验(Mc Murray试验): 夫欧契(Fouche)试验:

Examination of the Ankle and Foot Observe patient as a whole from front and back. 1. Check for inversion内翻(tibialis function) and eversion外翻

Examination of the Ankle and Foot 2. Thompson's test for AT(achilles tendon). 3. Check pulses, sensation, reflexes

-- 腓肠肌挤压试验-跟腱断裂

谢谢