Clinical Tests for the Musculoskeletal System PDF
Preview Clinical Tests for the Musculoskeletal System
Clinical Tests for the Musculoskeletal System Examinations—Signs—Phenomena Klaus Buckup, M.D. Klinikum Dortmund OrthopedicHospital Dortmund Germany 521illustrations Thieme Stuttgart·NewYork Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. LibraryofCongressCataloging-in-PublicationData isavailablefromthepublisher Thisbookisanauthorizedtranslationofthe2ndGermaneditionpublishedandcopy- righted2000byGeorgThiemeVerlag,Stuttgart,Germany.TitleoftheGermanedition: Klinische Tests an Knochen, Gelenken und Muskeln: Untersuchungen – Zeichen – Phänomene Translator:JohnGrossman,Berlin,Germany Illustrators:DetlevMichaelis,Friedrichsdorf,Taunus,Germany; BarbaraJunghähnel,Dortmund,Germany Importantnote:Medicineisanever-changingscienceundergoingcontinualdevelop- ment.Researchandclinicalexperiencearecontinuallyexpandingourknowledge,in particularourknowledgeofpropertreatmentanddrugtherapy.Insofarasthisbook mentionsanydosageorapplication,readersmayrestassuredthattheauthors,editors, andpublishershavemadeeveryefforttoensurethatsuchreferencesareinaccordance withthestateofknowledgeatthetimeofproductionofthebook. Nevertheless,thisdoesnotinvolve,imply,orexpressanyguaranteeorresponsibilityon thepartofthepublishersinrespecttoanydosageinstructionsandformsofapplica- tionsstatedinthebook.Everyuserisrequestedtoexaminecarefullythemanufac- turers’leafletsaccompanyingeachdrugandtocheck,ifnecessaryinconsultationwitha physicianorspecialist,whetherthedosageschedulesmentionedthereinorthecontra- indicationsstatedbythemanufacturersdifferfromthestatementsmadeinthepresent book.Suchexaminationisparticularlyimportantwithdrugsthatareeitherrarelyused orhavebeennewlyreleasedonthemarket.Everydosagescheduleoreveryformof applicationusedisentirelyattheuser’sownriskandresponsibility.Theauthorsand publishersrequesteveryusertoreporttothepublishersanydiscrepanciesorinaccur- aciesnoticed. Someoftheproductnames,patents,andregistereddesignsreferredtointhisbookare infactregisteredtrademarksorproprietarynameseventhoughspecificreferenceto thisfactisnotalwaysmadeinthetext.Therefore,theappearanceofanamewithout designationasproprietaryisnottobeconstruedasarepresentationbythepublisher thatitisinthepublicdomain. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation,orcommercializationoutsidethenarrowlimitssetbycopyrightlegisla- tion,withoutthepublisher’sconsent,isillegalandliabletoprosecution.Thisappliesin particulartophotostatreproduction,copying,mimeographing,preparationofmicro- films,andelectronicdataprocessingandstorage. ©2004GeorgThiemeVerlag Rüdigerstrasse14,70469Stuttgart,Germany http://www.thieme.de ThiemeNewYork,333SeventhAvenue, NewYork,NY10001USA http://www.thieme.com TypesettingbyprimustypeHurlerGmbH,Notzingen PrintedinGermanybyAppl,Wemding ISBN3-13-136791-1(GTV) ISBN1-58890-241-2(TNY) 12345 Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Preface to the English Edition Advancementsin orthopedicshave occurred atarapid pace in recent years.Whereasnew modalitiessuchasultrasound,computed tomog- raphy,andmagneticresonanceimagingareoccasionallyabletohelpus make precise orthopedic diagnoses more rapidly, meticulous history taking and thorough clinical examination remain crucial to any treat- ment. Everymedicalspecialtyhasitsownparticularexaminationmethods. In orthopedics and trauma surgery, these include examination of the jointsincombinationwithpreciserangeofmotiontestinginthetrunk and extremities and evaluation of the musculature. There are many standardized examination methods or teststhatcan aid in evaluating musculoskeletaldysfunction. Myaim was to applymy knowledge and experience to the task of compilingdescriptionsofthesemanytestsandgroupingthemaccord- ingtothevariousregionsofthebody.Thebookalsoincludeschapters on the evaluation of posture deficiencies, thrombosis, and arterial is- chemicdisorders.Eachtestisdescribedstepbystep,beginningwiththe patient’s initial position. Each of these descriptions also discusses the evaluation of the test and the possible diagnosis that the test may provide. Drawingshave been included with each testto illustrate the steps in the examination. Some tests for certain disorders differ only slightlyfromoneanother.Ihaveincludedthemnonethelessasmyown experiencehasshownthatadiagnosiscanoftenbemadeonlyonthe basisofseveraltypicaltestsforadisorder. Thebookisintendedasapracticalguidetofacilitateexaminationof thepatientand to helpthephysician diagnosemusculoskeletaldisor- ders and injuries more rapidly. Several editions in various languages haveshownthatreadersarehighlyinterestedinathoroughdescription ofstandardizedexaminationmethodsintheformoftests. TheindividualchaptershavebeenrevisedfortheEnglisheditionand newtestshavebeenincluded. Dortmund,May2004 KlausBuckup Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Bone and Joint Decade 2000–2010 OnJanuary13,2000,theWorldHealthOrganization(WHO)atitshead- quarters in Geneva declared the first decade of the new millennium “BoneandJointDecade.” Gro Harlem Brundtland, physician and former Norwegian Prime MinisterandDirector-GeneraloftheWHO,statedattheopeningcere- monythatboneandjointdisordershadalreadybecomethemaincause ofpersistentpainandphysicalimpairments. Giventhecurrentdemographicdevelopment,thenumberofpeople overtheageof50sufferingfromsuchdisorderswilldoubleinthenext 20 years. The WHO initiative aims to increase public awareness of musculoskeletaldisorders,improvetheirpreventionandmanagement, and promote opportunities for further education and research in this field. ThisbookrepresentsmycontributioninsupportoftheWHOinitia- tiveBoneandJointDecade2000–2010. KlausBuckup Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Contents Spine ...................................................... 1 RangeofMotionoftheSpine(Neutral-ZeroMethod) ........... 2 Fingertips-to-FloorDistanceTestinFlexion ................. 2 Table1Functiontests:spine .............................. 4 Table2Overviewoffunctiontestsofthespine .............. 5 OttSign ................................................. 5 SchoberSign............................................. 5 Skin-RollingTest(KiblerFoldTest)......................... 6 ChestTests ................................................. 7 SternumCompressionTest ................................ 7 RibCompressionTest..................................... 7 ChestCircumferenceTest ................................. 8 SchepelmannTest ........................................ 9 CervicalSpineTests ......................................... 10 ScreeningofCervicalSpineRotation ....................... 10 TestofHeadRotationinMaximumExtension ............... 11 TestofHeadRotationinMaximumFlexion ................. 12 TestofSegmentalFunctionintheCervicalSpine ............ 13 Soto-Halltest ............................................ 14 PercussionTest .......................................... 14 O’DonoghueTest ......................................... 15 ValsalvaTest............................................. 16 SpurlingTest ............................................ 16 CervicalSpineDistractionTest............................. 17 ShoulderPressTest....................................... 18 TestofMaximumCompressionoftheIntervertebralForamina 18 JacksonCompressionTest ................................. 19 IntervertebralForaminaCompressionTest .................. 20 FlexionCompressionTest ................................. 20 ExtensionCompressionTest............................... 21 ThoracicandLumbarSpineTests ............................. 22 AdamForwardBendTest ................................. 22 KyphosisTestonHandsandKnees......................... 22 TestofSegmentalFunctionintheThoracicSpineinExtension 23 ProneKneeFlexionTest .................................. 23 Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. VIII Contents SpinousProcessTapTest .................................. 24 PsoasSign................................................ 25 LasègueStraightLegDropTest ............................. 25 SpringingTest ............................................ 27 HyperextensionTest ...................................... 27 SupportedForwardBendTest(BeltTest) .................... 29 HooverSign .............................................. 30 SacroiliacJoint ............................................. 30 Table3Functionandprovocationtestsofthesacroiliacjoint .. 31 LigamentTests ........................................... 31 SpringingTest ............................................ 33 PatrickTest(FabereSign) .................................. 34 Three-PhaseHyperextensionTest .......................... 34 SpineTest................................................ 36 StandingFlexionTest ..................................... 38 SacroiliacMobilizationTest ................................ 39 SacroiliacJointSpringingTest .............................. 40 DerbolowskySign......................................... 41 GaenslenSign ............................................ 41 IliacCompressionTest..................................... 42 MennellSign ............................................. 43 YeomanTest ............................................. 44 LaguerreTest............................................. 44 SacroiliacStressTest ...................................... 45 AbductionStressTest ..................................... 46 NerveRootCompressionSyndrome .......................... 46 Table4Signsofradicularsymptoms ........................ 48 LasègueSign(StraightLegRaisingTest) ..................... 49 BonnetSign(PiriformisSign)............................... 50 LasègueTestwiththePatientSeated ....................... 51 ContralateralLasègueSign(Lasègue–Moutaud–MartinSign) .. 51 BragardTest.............................................. 52 LasègueDifferentialTest................................... 53 DuchenneSign ........................................... 54 ThomsenSign ............................................ 55 KernigTest............................................... 56 TiptoeandHeelWalkingTest .............................. 56 BrudzinskiSign ........................................... 57 ReverseLasègueTest(FemoralNerveLasègueTest) .......... 58 Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Contents IX Shoulder .................................................. 59 RangeofMotionoftheShoulder(Neutral-ZeroMethod) ........ 61 Table5Functiontests:shoulder ........................... 62 OrientationTests ........................................... 63 QuickTestofCombinedMotion ........................... 63 CodmanSign ............................................ 63 PalmSignTestandFingerSignTest ........................ 65 BursitisTests ............................................... 65 Bursae .................................................. 65 BursitisSign ............................................. 66 DawbarnTest............................................ 66 RotatorCuff(ImpingementSymptoms) ....................... 67 Zero-DegreeAbductionTest............................... 70 JobeSupraspinatusTest................................... 70 SubscapularisTest........................................ 71 Lift-OffTest.............................................. 72 InfraspinatusTest ........................................ 73 TeresTest ............................................... 73 NonspecificSupraspinatusTest ............................ 75 DropArmTest ........................................... 75 LudingtonSign........................................... 76 Apley'sScratchTest ...................................... 76 PainfulArc .............................................. 77 NeerImpingementSign................................... 78 HawkinsImpingementSign ............................... 79 NeerImpingementInjectionTest .......................... 80 AcromioclavicularJoint ...................................... 80 PainfulArc .............................................. 81 ForcedAdductionTest .................................... 82 ForcedAdductionTestonHangingArm .................... 82 TestofHorizontalMobilityoftheLateralClavicle............ 83 DugasTest .............................................. 83 LongHeadoftheBicepsTendon.............................. 84 NonspecificBicepsTendonTest............................ 84 Abbott-SaundersTest..................................... 84 SpeedTest............................................... 85 SnapTest................................................ 86 YergasonTest............................................ 86 HueterSign.............................................. 87 TransverseHumeralLigamentTest......................... 88 Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. X Contents ThompsonandKopellHorizontalFlexionTest (Cross-BodyAction) ....................................... 88 LudingtonTest ........................................... 89 LippmanTest............................................. 89 DeAnquinTest............................................ 89 GilcrestTest .............................................. 89 BeruSign ................................................ 90 DugaSign ................................................ 90 TractionTest ............................................. 90 CompressionTest ......................................... 90 ShoulderInstability ......................................... 91 AnteriorApprehensionTest ................................ 92 ApprehensionTest(Supine)................................ 93 RoweTest................................................ 94 ThrowingTest ............................................ 94 LeffertTest ............................................... 94 AnteriorandPosteriorDrawerTest ......................... 95 Gerber-GanzAnteriorDrawerTest ......................... 96 PosteriorApprehensionTest(PosteriorShiftandLoadTest) ... 97 Gerber-GanzPosteriorDrawerTest ......................... 98 PosteriorApprehensionTestwiththePatientStanding ....... 99 FukudaTest .............................................. 100 SulcusSign ............................................... 100 InferiorApprehensionTest................................. 101 RelocationTest(FulcrumTest) ............................. 102 Elbow ..................................................... 103 RangeofMotionoftheElbow(Neutral-ZeroMethod) .......... 104 FunctionTests.............................................. 104 OrientationTests ........................................... 104 HyperflexionTest ......................................... 104 SupinationStressTest ..................................... 105 VarusStressTest.......................................... 105 ValgusStressTest......................................... 106 EpicondylitisTests .......................................... 106 ChairTest ................................................ 106 BowdenTest ............................................. 107 ThomsonTest ............................................ 107 MillTest ................................................. 108 MotionStressTest ........................................ 109 Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Contents XI CozenTest .............................................. 109 ReverseCozenTest ....................................... 110 Golfer’sElbowSign....................................... 111 ForearmExtensionTest ................................... 111 CompressionSyndromeTests ................................ 112 TinelTest................................................ 112 ElbowFlexionTest ....................................... 113 SupinatorCompressionTest ............................... 114 Wrist,Hand,andFingers ................................... 115 RangeofMotionintheHand(Neutral-ZeroMethod) .......... 116 FunctionTests .............................................. 118 TestsoftheFlexorTendonsoftheHand .................... 118 MuckardTest ............................................ 119 FinkelsteinTest .......................................... 120 GrindTest ............................................... 121 LinburgTest ............................................. 121 Bunnell-LittlerTest ....................................... 122 WatsonTest ............................................. 123 ReaganTest ............................................. 124 ScapholunateBallottementTest ........................... 124 StabilityTestoftheThumb................................ 125 CompressionNeuropathiesoftheNervesoftheArm ........ 126 TestsofMotorFunctionintheHand ....................... 127 RadialNervePalsyScreeningTest.......................... 129 ThumbExtensionTest .................................... 130 SupinationTest .......................................... 131 TinelSign ............................................... 132 MedianNervePalsyScreeningTest ........................ 132 OchsnerTest............................................. 133 CarpalTunnelSign ....................................... 134 PhalenTest .............................................. 134 NailSign ................................................ 135 LuethyBottleTest ........................................ 135 ReversePhalenTest ...................................... 136 PronationTest ........................................... 137 FromentSign ............................................ 137 UlnarNervePalsyScreeningTest .......................... 138 IntrinsicTest ............................................ 139 OTest................................................... 139 WristFlexionTest........................................ 140 Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license.
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