Lim mwal orthopaedic examination

Discography often yields valuable information, as does radiculography. Nevertheless, it is most important to note that the investigative findings must be interpreted in conjunction with the history and clinical findings. (In a recent study of a control group completely free from symptoms, abnormalities were found in the MRI scans in 57 36 had evidence of disc prolapse, and 21 had spinal stenosis. In addition, among proven cases of disc prolapse the MRI scan is negative in 20 of cases, or shows...

Sacrum Tenderness

Images Prolapsed Intervertebral Disc

Inspection (7) (A) An increase in the lumbar curvature may be normal (especially in women) or be found in association with the prominence of the spine of L5 and the sacrum (B) in spondylolisthesis. It may be secondary to an increased thoracic curvature, or to flexion deformity of the hip(s). Always screen test the hips. 8.8. Inspection (8) From behind Note (A) cafe-au-lait spots, which may suggest neurofibromatosis and associated scoliosis (B) a fat pad or hairy patch suggestive of spina...

Calcaneus

Subtalar Arthritis And Calcaneal

Movements 3 Pronation Ask the patient to turn the feet outwards. The range of movement may be measured in a similar fashion. 3.85 Movements 1 In assessing foot movements, remember that the total range of supination and pronation in the foot is made up of movements that occur in the subtalar joint A-A , the midtarsal joint B-B , and the tarsometatarsal joints C-C . In the latter, the main movements occur in the joints at the bases of the first, fourth and fifth metatarsals. 13.88....

Common causes of pain in the anterior aspect of the lower leg

Note Knock-knee and bow-leg deformities are included with the knee joint. osteitis of the tibia Osteitis of the tibia occurs predominantly in children, with or without a history of previous trauma or sore throat. Pain is intense, tenderness is acute and initially well localized over the metaphyseal area, and there is inability to weightbear. There is systemic upset with fever and tachycardia, and often but not always a polymorph leukocytosis. Admission and investigation with repeated blood...

Anterior tibial compartment syndrome

This is a common complication of fractures of the tibial shaft, but may follow a period of intense lower limb activity hence it is common in athletes. It gives rise to pain in the front of the leg. This is due to oedema and swelling within the confines of the anterior compartment, which lead in turn to ischaemia in the anterior tibial muscles. In severe cases where swelling is progressive there may eventually be muscle necrosis. The leg is diffusely swollen and tender, and the skin has a glossy...

Shortening Of The Achilles Tendon Tendo Calcaneus

Shortening of the Achilles tendon results in plantarflexion of the foot and clumsiness of gait as the heel fails to reach the ground. The more severe degrees of Achilles tendon shortening are accompanied by a tendency to flat foot. In many cases flexion of the knee, by taking the tension off the gastrocnemius, will permit dorsiflexion of the foot. Shortening of the Achilles tendon may occur as an apparently isolated condition with no obvious predisposing cause, but in a great many cases it is...

Deformities of the tibia

Alteration in the normal curvature of the tibia is not uncommon and may be a cause for complaint. The bone may curve convex laterally tibial bowing , convex anteriorly tibial kyphosis , or undergo a rotational deformity tibial torsion . Deformities of these types are particularly likely to occur in infants and young children, when the immature bone may yield under the weight of a relatively heavy child. In the majority of cases no other cause is apparent, and spontaneous correction by the time...

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Bucket Handle Meniscus Recovery

A combines three articulations medial tibiofemoral M , lateral tibiofemoral L and patellofemoral P , which share a common synovial sheath anteriorly, this extends a little to either side 1 of the patella and an appreciable amount proximal to its upper pole 2 . This portion, the suprapatellar pouch, lies deep to the quadriceps muscle. There is little congruency between the articular surfaces of the tibia and femur as a result, there is a well developed system of ligaments...

Tfa vuiniwal ukihopaedic examination

Sed Rate And Ankylosing Spondylitis

Suspected prolapsed intervertebral disc Functional overlay, continued 5 Note the amount of rotation required to produce pain in the back. Now ask the patient to keep his hands firmly at his sides and repeat the major part of the movement will now take place in the legs. Pain occurring with the same amount of apparent rotation again suggests overlay. In many centres, if three or more of the preceding tests are positive surgery is considered to be contraindicated. 8.38. Suspected prolapsed...

Info

Rvad Scoliosis

Radiographs 30 To assess the severity of a scoliotic curve, and to allow its progress to be monitored it is necessary to measure the deformity. The Cobb method is most popular, although it is difficult to obtain consistent results with it. First, find the upper and lower limits of the primary curve by drawing tangents to the bodies and noting where the disc spaces begin to widen on the concavity of the curve. 8.83. Radiographs 31 Now erect perpendiculars from the vertebrae that form the...

Adult Flat Foot

Gradual flattening of the medial longitudinal arch incipient flat foot may occur in those who spend much of the day on their feet. This is often associated with an increase in body weight and the degenerative changes of ageing in the supporting structures of the arch. When these changes are rapid, they give rise to pain 'medial foot strain' . Secondary tarsal arthritic changes may also give rise to pain in long-standing flat foot, and are associated with loss of movement in the foot rigid flat...

Anatomical Features

Midtarsal Joint Movement

Tripod action of the foot To maintain perfect ground contact each foot acts as a tripod, with the legs of the tripod being represented by the calcaneus and the heads of the first and fifth metatarsals. To maintain balance, the centre of gravity in front of S2 must fall within the area covered by one or both feet, and to facilitate this each foot must be capable of movement in two planes. Fig. 13.B. Planes of movement 1 In the x-uxis nearly all of the movement occurs in the ankle, and...

Sinusitis And Osteitis

Rheumatoid Arthritis Flatfoot

Inspection 4 General bone thickening Extensive thickening of bone is characteristic of Paget's disease and longstanding osteitis. In the latter case there are usually other signs, such as scarring or sinuses. 11.5. Inspection 5 Tibial shape Note any abnormal anterior curvature tibial kyphosis , possibly secondary to Paget's disease, malunited fracture, syphilis or rickets. Rickets affects the distal half of both tibia and fibula, and there are associated lateral and torsional deformities....

Osteophyte Formation

Clavicle Arthritis Symptoms

Integrity of the long head of biceps Support the patient's elbow with one hand. Grasp his wrist and ask him to pull toward his shoulder while you resist this movement. If the long tendon of biceps is ruptured, the belly of biceps will appear globular in shape. Compare the two sides. 4.43. Deltoid power Ask the patient to try to keep the arm elevated in abduction while you press down on his elbow look and feel for deltoid contraction. Traction injuries of the axillary nerve resulting in...

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Uncovertebral Osteophytes

Radiographs 5 Look at the disc spaces and the related margins of the vertebrae. Note A disc space narrowing, B anterior lipping, C posterior lipping all typical of cervical spondylosis . Note any evidence of vertebral fusions, D . typical of ankylosing spondylitis. 3.32. Radiographs 6 Note the presence A of an osteophyte or marginal fracture, suggestive of an extension injury of the neck B fracture of a spinous process, suggestive of a flexion injury of the cervical spine. Syringomyelia...

Straight Leg Raising Test

Positive Straight Leg Raising Test

Movements flexion 7 Flexion in the thoracic spine may be measured with the upper point 30 cm from the previous zero mark. Thoracic flexion is not great, and is normally in the order of 3 cm. NB to exclude the possibility of overlay, repeat these measurements with the patient distracted, sitting up, and leaning forward on the examination couch. 8.28. Movements lateral flexion 2 Alternatively, measure the angle formed between a line drawn through Tl, SI and the vertical. The average range...

Lull

Ortolani Test

Gluteal muscles Test the power in gluteus maximus by asking the patient to extend the hip against resistance, at the same time feeling the tone in the contracting muscle. 9.61. Gluteal muscles Test the power of the hip abductors with the patient lying on his side, attempting to abduct the leg against resistance. 9.63. Aspiration The hip may be aspirated by inserting a needle above the trochanter, allowing for femoral neck anteversion. Alternatively, a needle may be passed into the joint...