The 3-Minute Musculoskeletal & Peripheral Nerve Exam

305 Pages·2008·7.57 MB·English

by  Alan Miller

T 3-M
HE INUTE
M
USCULOSKELETAL
& P
ERIPHERAL
N E
ERVE XAM
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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
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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
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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