Просмотров: 3 679
Candidate of Medicine Khanov A. G. The article is devoted to physical examination of bones, joints and muscles in outpatient practice for doctors of any specialty. The article offers working classification of methods of evaluation of moving function of joints, tests of physical examination with articulate syndrome. It gives definition of global rheumatologic tests. The article offers a set of screening tests for diagnosing of pathology of the musculoskeletal system and particular areas of a human body for establishing provisional rheumatologic (working) diagnosis. Interpretation of the results of examination is also given here. Key Words: rheumatology, physical examination of joints in outpatient practice, classification of methods of evaluation of moving function of joints, classification of tests of physical examination of bones, joints and muscles, definition of conception global tests in rheumatology, a set of global rheumatologic tests for provisional rheumatologic diagnosis and interpretation of the results of examination. Working Classification of Methods of Evaluation of Moving Function of Joints in Outpatient Practice. 1. Examination or visual perception of skeleton and certain joints functions 2. Doing of active and passive movements 3. Functional examination with the help of trials and tests 4. How to estimate the dimension of movement of joints with the help of goniometer (flex meter) Working Classification of Tests of Physical Examination of Bones, Joints and Muscles 1. Global Tests Global test (GT) is a general comprehensive test, research, trial, check. Global tests are tentative screening tests for a certain area or the whole musculoskeletal system of a human body. Doing simple stereotyped movements (bending, squatting) in a certain plane or while passing a certain point in these tests is provocative for emergence of a pain syndrome in a certain group of joints or indicating to the area which demands additional examination to define the type of affection of a joint (joints) and establish provisional rheumatologic (working) diagnosis. *Before establishing the cause of pain on the basis of global tests one can say about the pain in a certain area of a body in the area of a certain joint which can be caused by pathology of the joint structures, periarticular tissues or be a reflected pain. 1. Functional Tests of damaging joints, tendons and muscles. 2. Provocative Tests. Provocation (lat. provocatio) – in medicine action as a diagnostic maneuver leading to a disease state. 3. Stress Test (STT) – load trials, tests in a heavy-weight regimen, trials with additional loads or stress 4. Screening Tests (SCT) – (Eng. Screening, screen – sift, sort) in medicine mass examination for detection a person’s particular disease or symptom. 5. Tests of examination of particular areas of a body, joints and parts of the skeleton (purposeful, problem-oriented) 6.1 Tests on inflammation of joints, periarticular tissues and articular corpuscles. 6.2 Tests of stability of joints and particular joints. 6.3 Tests of estimation of a moving function of joints ( Doing of active and passive movements) 6.4 Tests of compression of nerves. 6.5 Tests of annoyance of nerves. 6.6 Traction muscle tests. 6.7 Isometric (while contraction of muscles without changing of their length) tests. (Tests with “résistance”, “Resistive” tests). 6.8 Combined tests. General Examination of the Body Diagnostic Purpose: To estimate height, mass of a body, length and size of a trunk and limbs, their ratio, form of a column and limbs. To form the view about physical development, carriage, gait of a patient. To pay attention to the usage by the sick of assistants of movement and support (a stick, crutches, a chair, relations or medical staff’s help) Demand: examination is held in “anatomical position”. The body is vertical. Feet are joined across. Arms are dropped along the trunk, palms are outside. Comment. This position is unusual for a person, but it is simple initial for making movements. Pic.1 “Anatomic position” Global Tests Pic.1.1 Test on straightening. Demand: To pull arms, legs and back upwards as much as possible. Pic.1.2 Test in the squatting position. Demand: To sit in the squatting position as low as possible, feet are closely pressed to the floor, head is between knees, arms are bent. Pic1.3 Global test of maximum bending down. Demand: To bend down as much as possible without flexing knees and without coming feet off the floor and try to touch the floor. Hands hang freely in the same distance from feet. Explanation of results: This test characterizes total mobility of movements of a Spinal column which can be reached for account of movements of a column and hip joints. Stiffness of a column can be compensated by sufficient amplitude of movements in hip joints. If you look from one side you can estimate the angulations for account of hip joints and the angulations of the whole trunk. The first angle is acute, tending to the right one. The second angle has a ceiling value while fingers are touching the floor. Pic1.4 Global test with pain in the shoulder (A fast test of a combined movement) Diagnostic Purpose: To estimate the function of joints of a shoulder girdle and partially of an elbow joint. Explanation of results: The onset of the pain while examining and/or the restriction of movement volume reflects a pathologic process either in the shoulder girdle or in the rotatable cuff (muscles, joints of supraspinous, infraspinatus and small round muscles).
- A. The capture of the occiput ( Test “Putting hands behind the head”)
- B. The capture “Knot” ( Test “Putting hands behind the back”)