The 3-Minute Musculoskeletal & Peripheral Nerve Exam PDF
Preview The 3-Minute Musculoskeletal & Peripheral Nerve Exam
T 3-M HE INUTE M USCULOSKELETAL & P ERIPHERAL N E ERVE XAM This page intentionally left blank T 3-M HE INUTE M USCULOSKELETAL & P ERIPHERAL N E ERVE XAM (cid:2) (cid:2) (cid:2) AlanMiller,MD PainFellow JeffersonPainCenter ThomasJeffersonUniversityHospital Philadelphia,Pennsylvania KimberlyDiCuccioHeckert,MD StrokeRehabilitationFellow KesslerMedicalRehabilitationResearchandEducationCenter UniversityofMedicineandDentistryofNewJersey Newark,NewJersey BrianA.Davis,MD AssociateProfessor DepartmentsofPhysicalMedicineandRehabilitation andAnesthesiologyandPainManagement PM&RDirector SportsandSpineCarePrograms DavisMedicalCenter UniversityofCalifornia Sacramento,California NewYork AcquisitionsEditor:R.CraigPercy CoverDesign:GaryRagalia Copyeditor:JoannWoy Compositor:PatriciaWallenburg Printer:MalloyLitho Visitourwebsiteatwww.demosmedpub.com ©2009DemosMedicalPublishing,LLC.Allrightsreserved.Thisbookisprotected bycopyright.Nopartofitmaybereproduced,storedinaretrievalsystem,ortrans- mittedinanyformorbyanymeans,electronic,mechanical,photocopying,record- ing,orotherwise,withoutthepriorwrittenpermissionofthepublisher. Medicineisanever-changingscience.Researchandclinicalexperiencearecontinu- allyexpandingourknowledge,inparticularourunderstandingofpropertreatment anddrugtherapy.Theauthors,editors,andpublisherhavemadeeveryeffortto ensurethatallinformationinthisbookisinaccordancewiththestateofknowledge atthetimeofproductionofthebook.Nevertheless,theauthors,editors,andpub- lisherarenotresponsibleforerrorsoromissionsorforanyconsequencesfrom application of the information in this book and make no warranty,express or implied,withrespecttothecontentsofthepublication.Everyreadershouldexam- inecarefullythepackageinsertsaccompanyingeachdrugandshouldcarefullycheck whetherthedosageschedulesmentionedthereinorthecontraindicationsstatedby themanufacturerdifferfromthestatementsmadeinthisbook.Suchexaminationis particularlyimportantwithdrugsthatareeitherrarelyusedorhavebeennewly releasedonthemarket. LibraryofCongressCataloging-in-PublicationData Miller,Alan,1978– The3-minutemusculoskeletal&peripheralnerveexam/AlanMiller,Kimberly DiCuccioHeckert,BrianA.Davis. p.;cm. Includesbibliographicalreferencesandindex. ISBN-13:978-1-933864-26-6(pbk.:alk.paper) ISBN-10:1-933864-26-5(pbk.:alk.paper) 1. Musculoskeletalsystem—Examination.2. Nerves,Peripheral—Examination. I. DiCuccioHeckert,Kimberly.II.Davis,BrianA.III.Title.IV.Title:Three-minute musculoskeletalandperipheralnerveexam. [DNLM:1.MusculoskeletalDiseases—diagnosis.2.PeripheralNervousSystem Diseases—diagnosis.3.MusculoskeletalSystem—physiopathology.4.Peripheral Nerves—physiopathology.5.PhysicalExamination—methods.WE141M647z2009] RC925.7.M555 2009 616.70076—dc22 2008019619 SpecialdiscountsonbulkquantitiesofDemosMedicalPublishingbooksare availabletocorporations,professionalassociations,pharmaceuticalcompanies, healthcareorganizations,andotherqualifyinggroups.Fordetails,pleasecontact: SpecialSalesDepartment DemosMedicalPublishing 11W.42ndStreet,15thFloor NewYork,NY10036 Phone:800–532–8663or212–683–0072 Fax:212–941–7842 Email:[email protected] MadeintheUnitedStatesofAmerica 091011 5432 IwouldliketothankmybeautifulwifeCarly,wonderfulsonAlex, andMomandDad.Iloveyouallandthankyouforyourloveand support.Guy,thankyouforbeingamentorandvaluedfriend. —Alan ThanksAlan,foraskingmetowritethisbookwithyou.Ithank God for granting me the privilege to care for patients and for leadingmetothegreatestfieldinmedicine.I’dliketodedicate this book to the patients who have made my work meaningful, myteachersandmentorswhofosteredmypassion,myfamilyfor theirendlesssupport,andmyhusbandChrisforhisconstantlove andencouragement. —Kimberly Iwouldliketothankmywonderfulwife,EdithBautista,MD,and myincrediblechildren,GabrielleandNathaniel,fortheirsupport duringthisproject.Iwouldespeciallyliketoposthumouslythank Dr.ScottNadlerforteachingmetheskillsthatarepresentedin thisbook. —Brian Theauthorswishtoacknowledgetheteachingandmentorshipof Gerald J. Herbison, MD as providing the inspiration for this book.Hisapproachtotheexaminationandphysicaldiagnosisof patients serves as a foundation for all Jefferson graduates throughout their careers.This book reflects the authors’strong desire to assure that his methods are widely available and pre- served for future physicians.We express our thankful apprecia- tiontoDr.Herbisonforhisguidance,trainingandcommitment totheeducationofphysicians. AlanMiller,MD KimberlyDiCuccioHeckert,MD (cid:2) (cid:2) (cid:2) ACKNOWLEDGMENTS Wewouldliketoacknowledgethefollowingindividuals,without whom this work would not be possible: Nethra Ankam, MD; Anna M. Barrett, MD; Steve Dana; Mehul Desai, MD; Carolyn Forsman,MD;JeffGehret,DO;StanleyJacobs,MD;BrianKucer, MD;RalphMarino,MD;AndrewMcArdle;JohnL.Melvin,MD; CarlyMiller,MD;CraigPercy;andC.R.Sridhara,MD. • Illustrations in Chapters 1 through 8 were created by Steve Dana,UniversityofCaliforniaatDavis,Mediaworks. • AllphotographsweretakenbyAlanMiller,MD. • ThebackandhipexaminationinChapters1and2weredevel- oped largely from materials originally created by Gerald J. Herbison,MD,ThomasJeffersonUniversityHospital. • Figures of the brachial plexus (page 148) and lumbosacral plexus(page155)arecourtesyofAndrewMcArdle(posters@ ajmcardle.me.uk). • Chapter5wasadaptedfrommaterialsgenerouslyprovidedby CarsonSchneck,MD,TempleUniversityHospital. • Chapter 6 was adapted with permission from the American Spinal Injury Association: International Standards for Neurological Classification of Spinal Cord Injury with the assistanceofRalphMarino,MDandLesleyHudson. • TheauthorswishtothanktheUniversityof Washingtonand Drs.CarolTietzandDanGraneyfortheuseof theirmuscu- loskeletal images. These illustrations, which appear on pages 226–237,arefromtheUniversityofWashingtonMusculoskeletal Atlas:AMusculoskeletalAtlasoftheHumanBody,CarolTeitz, MDandDanGraney,PhD,©2003–2004. • The Department of Rehabilitation Medicine at Thomas JeffersonUniversityHospitalprovidedassistanceinthedevel- opmentofthemanuscriptforthisbook. ACKNOWLEDGMENTS (cid:2) vii • Theauthorsalsowishtoacknowledgethegenerouscontribu- tionoffundingforillustrationsandartworkprovidedbythe Department of Physical Medicine and Rehabilitation at the UniversityofCaliforniaatDavis. viii (cid:2) ACKNOWLEDGMENTS (cid:2) (cid:2) (cid:2) CONTENTS Introduction xi QuickReferenceGuidebyDiagnosis xiii 1 JointExamination 1 2 MuscularExamination 87 3 ReflexExamination 125 4 PeripheralNerveExamination 143 5 GaitandPosture 167 6 SpinalCordInjuryExamination 183 7 ReferenceTablesandResources 195 8 MusculoskeletalAtlas 221 9 MuscleTables 239 Index 269 CONTENTS (cid:2) ix
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