objective neuromuscular exam - structure

1. Working Hypothesis

2. Plan & Consent

3. Look :

3.1. General Obs

3.2. Acute Obs

4. Neurological screen

5. Feel - Palpation

6. Move :

6.1. A.P.R

6.2. specialised tests

6.3. functional tests

7. Review

detail

1. working hypothesis - based on subjective exam....

2. advice and consent - given and obtained

3. look

1. general obs watch patient walk in and sit down

2. acute obs s.s.d.a.b.s

symmetry/posture swelling discolouration

atrophy/muscle bulk bone defects/deformity

scars

5. feel - palpation

everything from s.s.d.a.b.s plus

temperature

tenderness ( indurated or weak areas )

crepitus

6. move

active

passive

resisted

background to a.p.r. compare - be aware of fixed joints - be aware of paralysis

specialised tests

functional tests

review - have i got all info - have i made comparisons - have i got divergent measurements - can i report findings

General Principles of examination

general principles

look feel move

look = symmetry s.s.d.a.b.s.

swelling

discolouration

atrophy

bone defects

scars

feel = temperature

tenderness

crepitus

move = active a.p.r compare fixed or paralysis

passive

resisted

compare

look for fixed joints

paralysis

specialised tests

muscle testing

muscle tests

5 normal power

4 against resistance

3 gravity present

2 gravity removes

1 flicker

0 no movement

Pain (petty and moore)

following gifford (1998)

pain can be classified as nociceptive (mechanical, inflammatory,ischaemic) peripheral, autonomic, and affective - obviously more than one mechanism may co-exist.

mechanical pain - due to mechanical force on nociceptors - eg lengthening or compressing tissue which contains nociceptors. Particular movements aggravate and ease - sometimes referred to as on/off pain.

Inflammatory nociceptors - due to injury to tissue, producing an inflammatory reaction. The release of chemicals into the tissues sensitivises the nociceptors and produces pain. Characterised by redness, oedema and heat. Diurnal pattern stiffness worse at night and in morning, benefitial effects of anti-inflammatory medication. Absense of trauma.

Musculoskeletal Assesment Form

My assesment form can be viewed online and or downloaded as an word file. It reflects work undertaken in class and also my reading of Petty & Moore's text. The form anticipates its use in a musculoskeletal assesment.

It is designed not only to be used once in client assesment ( filling in each section by number) but it is also to provide ease of reference and use in any future assesments - the material once recorded in numerical order is automatically presented on the form in a way which will be immedietly useful to anyone who sees the client again.