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Category: Rehabilitation

Examination of the Knee

Examination of the Knee

Inspection Inspection is only possible with adequate exposure. Begin by placing the patient in shorts or tying the gown up above the knee. The patient's gait should be observed first. Pay attention to the positioning of the knee on both the medial/lateral plane (valgus vs. varus) and the anterior/posterior plane (extension lag vs. knee recurvatum). Also, observe the joint above and below. Be sure to note any restrictions in the hip or ankle motion. Look at the foot for evidence…

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Examination of the Lumbar Spine

Examination of the Lumbar Spine

Inspection The examination of the low back, like the other areas of the body, should begin as the patient enters the office and examination room. Watch how the patient moves while walking and how he or she moves changing positions. The patient's posture should be noted. The patient should be in a gown that opens in the back for full exposure. Look at the muscle bulk and symmetry of the low back. Also look at the skin for scarring or…

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Examination of the Shoulder

Examination of the Shoulder

Inspection Inspection of the shoulder requires that the shoulder be exposed and the patient appropriately draped. The shoulder "joint" actually consists of four different joints: sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic. Three of the joints are true joints, while the scapulothoracic joint is not a true articulating joint lined with cartilage. It is important to visualize each of the joints. Begin by inspecting the normal bony prominences and muscle bulk. The most obvious changes can be seen in the acromioclavicular joint….

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Examination Of the Cervical Spine

Examination Of the Cervical Spine

Inspection Inspection of the neck begins upon meeting the patient. Look to see if the patient moves the shoulders when he or she turns the neck, a sign of decreased range of motion, or if he or she winces with certain motions. Take note of the patient's relaxed posture as changes to improve poor posture can be easily addressed in therapy. As the examination proceeds, the clinician should make sure that the neck is properly exposed for evaluation. Look at…

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Functional History

Functional History

The rehabilitation evaluation of chronic disease often shows lost function. Through the functional history, the physician characterizes the disabilities that have resulted from disease and identifies remaining capabilities. The functional history is considered part of the history of the present illness by some physicians and a separate segment of the patient interview by others. The examiner must know not only the functional status associated with the present illness but also the level of function at one or more times before…

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Patient History

Patient History

Tiếng Việt >> Ordinarily, the patient history is obtained in an interview of the patient by the physician. If communication disorders and cognitive deficits are encountered during the rehabilitation evaluation, additional collaborative information must be obtained from significant others accompanying the patient. The spouse and family members are valuable resources. The physician also may find it necessary to interview other caregivers, such as paid attendants, public health nurses, and home health agency aides.  The major components of the history are…

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Overview of Clinical Evaluation

Overview of Clinical Evaluation

Tiếng Việt >> As with other branches of medicine, the cornerstone of rehabilitation medicine is a meticulous and germane patient evaluation. Therapeutic intervention must be based on proper patient assessment. The disability cannot be isolated from preexisting and concurrent medical problems. Although the rehabilitation evaluation encompasses all elements of the general medical history and physical examination, its scope is more comprehensive; thus, the rehabilitation evaluation provides a broader perspective.  Evaluation of Function  Medical diagnosis concentrates on the historical clues and…

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Coccyx Injections

Coccyx Injections

Coccyx pain (coccydynia) apparently occurs far less commonly than lumbosacral pain. Coccydynia can be a severe and persistent pain, causing significant suffering, frustration, and functional limitations (199). These patients often have a history of coccyx trauma (e.g., from a fall or childbirth) resulting in contusions, fractures, dislocations, or other injuries. However, other cases are idiopathic. Typical symptoms include focal tailbone pain, particularly worse with sitting and sometimes immediately worse upon going from sit-to-stand (199). Careful screening should seek to exclude…

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Metatarsal Joint Injection

Metatarsal Joint Injection

Tiếng Việt >> Indications This injection procedure is used to diagnose and treat Morton’s metatarsalgia and Morton’s neuroma. Techniques After informed consent is obtained, the patient is positioned for optimal access to the dorsal aspect of the foot. The metatarsal joint interspaces are palpated for swelling and tenderness. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1-in. (2-cm), 25-gauge needle…

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Discography (Diagnostic Disc Injection)

Discography (Diagnostic Disc Injection)

Although still controversial, discography (diagnostic intervertebral disc injection) is both an imaging study and a provocative physiologic study for determining whether an intervertebral disc is in fact a pain generator in a given patient (Table 68-7). Inserting a spinal needle into the center of the intervertebral disc and injecting contrast dye provides both physiologic information on whether a degenerative disc is painful and on anatomic features of the intervertebral disc. There is currently no other method to establish reliably whether…

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