my-spine.ppt

Physical ExaminationSpine and ExtremitiesLi LinaSkeletal spine l7 cervical vertebrael12 thoracic(dorsal)vertebrae l5 lumbar vertebrae l5 sacral vertebraea l4 coccygeal vertebraePhysical curveslThe cervical curve:concave backwards,C2-T2lThe thoracic curve:convex backwards,T2-T12lThe lumbar curve:concave backwards,T12-the lumbosacral jointlThe pelvic curve:convex backwards and downward,extends from the lumbosacral joint to the tip of the coccyxPhysical curvesspinelprotecting for the spinal cord lholding up the weightlmaintaining the posture lsupporting axis of the movementSpinal examinationInspection PalpationPercussion direct percussion indirect percussion Examination of the mobilities of the cervical and lumbar spineInspection（1）lAsk the patient in a standing positionlFirst,look from behind Normal:a straight spineAbnormal:ScoliosisInspection(1)normalScoliosislDefinition:A lateral curvature of the spine ScoliosisSigns of scoliosisScoliosislCauses:fault sitting posturePoliomyelitisRicketscongenital deformities pleural adhesionspoliomyelitislAtrophic paresis of the right leg resulting from poliomyelitisRickets sufferers in 1900congenital deformityInspection（2）l Press index and middle finger on the patients spinous process from top to bottom rapidlylInspect the red line the skin shows lThis can indicate lateral curvature of the spine(scoliosis).Inspection（3）lInspect from the sideNormal:phyical curvesAbnormality:KyphosislordosiskyphosislDefinition:Abnormally increased convexity in the curvature of the thoracic spine as viewed from the sidel.kyphosisl A tomb painting of ancient Egypt showing a gardener with kyphosiskyphosiskyphosislCauses:Ricketstuberculosis,fracture or tumor of vertebraankylosing spondylitis degenerative changeAnkylosing spondylitisAnkylosing spondylitisAnkylosing spondylitisChanges in spine with age LordosislDefinition:an inward curvature of a portion of the vertebral columnLordosislordosislCauses:a large amount of ascitestumors of the abdominal cavitytuberculosis of the hip joint late pregnancy.Late pregnancypalpationlTechnique:With thumb,press firmly on the patients spinous processes from top to bottom.Then,palpate the paraspinal muscles laterally to the spinous process.lNormal:no tendernesspalpationlAbnormality:tenderness appear in some arealCauses:tuberculosis,fracture of vertebraprotrusion of the intervertebral disc(Herniated Disc)acute strain or injury of the muscles of the backFractured VertebraNormal Vertebrafracture of vertebraprotrusion of the intervertebral disc(Herniated Disc)direct percussionlTechnique:directly percusses every spinous processes with a percussion hammer.(mainly used in the lumbar and thoracic vertebra).lNormal:No percussion pain.direct percussionlAbnormal:percussion pain appear in some spinous processes.lCauses:TB or fractureprotrusion of the intervertebral disc indirect percussionTechnique:lAsk patient in a seated position.l Place the patients left hand on top of their head lMake a partial fist to percuss on the patients left hand with hypothenar eminencel Note the patients painful appearance.Examination of the cervical spine motion:.extensionflexionLateral flexionrotationExamination of the lumbar spine motion:extensionflexionLateral flexionrotationThe normal active rangesflexionextensionLateral bendingrotationCervical spine45454560Lumbar spine45353045lCauses:TuberculosisTumorfracture ligament lesion.Limitation of spine movementFocus in lPhysical curveslKyphosislLordosislScoliosisLimb and jointKoilonychia（spoon nails）lDefinition:Fingernail like tablespoon,center concave,edge cock up,nails become thin,surface rough.l causes:iron deficiency anaemia.AcropachylDefinition:Extremity of fingers and toes become hyperplasia and plump as club.AcropachylMechanism:end of limbs have chronic hypoxia,metabolism handicap.lCauses:lung abscessBronchiectasislung cancersome heart diseases.lung abscessBronchiectasisFusiform swelling of the jointslDefinition:a fairly symmetric involvement of the proximal interphalangeal(PIP)and metacarpophalangeal(MCP)joints bilaterally.lCauses:rheumatoid arthritis Fusiform swelling of the jointsPIP and MIP jointsRheumatoid arthritisRheumatoid arthritisDugas signTechnique:ask the patient put the hand of the injured side on the opposite shoulderAbnormality:the hand cant touch the shoulder or the elbow cant approach the chest normallySignification of abnormality:the dislocation of the shoulder.Shoulder dislocationl Shoulder dislocationBallottement for a floating patellalTechnique:The patient is in a supine position with leg straight and muscles relaxed.Firmly grasp the thigh just above the superior margin of the patella and slide the hand downward along the sides of the femur.(so that any effusion is forced behind the patellar)When reach the upper pole of the patella,keep your hand there and maintain pressureUsing the index&middle fingers of the other hand,push the patella down gentlyBallottement for a floating patellaMilk the superpatella pouchPatella tapBallottement for a floating patellalAbnormalty:In the presence of an effusion,a palpable tap and a transmitted impulse will be feltFocus in lKoilonychialAcropachylWhat does mean if the patient has fusiform swelling of the joints?Thank you