1/25/99

Orthopedics III

 

Dermatomes

T1--medial arm along w/ T1 intercostal space

T2--axillary region along w/ T2 intercostal space

 

examine myotomes, dermatomes and reflexes

 

Reflexes

-superficial abdominal reflexes

-T10 is umbilicus

-light stroke w/ metal end of reflex hammer from lateral edge toward umbilicus--muscle contraction will pull umbilicus towards starting point--check all 4 quadrants

-2+ is bilaterally normal

 

Myotomes

T10, 11 & 12--Beevor's Sign--watch the umbilicus

     -patient is supine, due a 1/2 sit up

     -pulling of mm superior and inferior

     -umbilicus should not move

    

T6--weak mm, umbilicus will deviate to the opposite quadrant

     -nonspecific test

    

 

HIPPIRONEL

-H-history/consultation

     -chief compliant

     -HPI

     -OPPQRSTB (bruising)

     -current medical history

     -surgical history

     -past medical history

     -social history

-I-inspection

     -look at the patient

     -postural analysis

     -skin lesions, scars

     -bruising

-P-palpation

     -heat

     -muscle spasm

     -light touch

     -sp, tp

     -static palpation

-P-percussion

     -spinous percussion

     -patient slightly flexed

-lightly down spinous, then down mamillary/tp and paraspinal muscle--rule out a fracture--vibratory motion through the fracture into perioesteum

     -E--x-ray, go straight there if + spinous percussion

-I-instrumentation--physDx

     -blood pressure

-R-ROM-range of motion

     -active--patient does it

     -passive

     -resisted

-O-orthopedic testing

-N-neurologic testing

     -dermatomes

     -myotomes

     -reflexes

-E-x-ray

-L-lab testing

 

-before ROM you will have 90% of information for a Dx

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