REIDER PART 1 13
Terms and Techniques Bruce Reider
The body of this book is dividcd into chapters, each focused on an anatomie segment including a major joint or portion of the spine. This division is somewhat arbitrary because anatomie struetures and patients’ symptoms often overlap adjacent body segments. For example, the hip joint and the lumbar spine are both inti-mately related to the pelvis, and the thigh could be included with the hip or the knee. To minimize redun-dancy, the materiał from such overlap areas is assigned to one chapter and cross-referenced in other chapters in which it is relevant.
Sonic confusion can arise owing to conflicts between the anatomie and the common names for the limb segments. Anatomists use the terms upper extremity and upper limb to describe the structure popularly known as the arm, and lower extremity and lower limb are used to identify what is commonly known as the leg. The confusion is greater when the individual segments of the limbs are identified. Anatomically, the terms forearm and thigh correspond to their popular meanings, whereas arm is used to describe the segment of the upper limb between the shoulder and the elbow and /eg for the segment of the lower limb between the knee and the ankle. Because this usage conflicts with the popular meanings of thesc terms, the contributors chose to use the term upper arm for the limb segment between the shoulder and the elbow and lower leg for the limb segment between the knee and the ankle (Fig. 1-1) in an attempt to avoid confusion.
In generał medicine, the physical examination is usu-ally divided into sections: inspection, palpation, percus-sion, auscultation, and manipulation or special tests. This structure has been modified for this text. Auscultation and percussion were eliminated as major components of the examination process for various reasons. Auscultation is rarely used in the orthopaedic examination, except to detect bruits due to vascular constrictions or ancurysms. Similarly, because limbs are not hollow, percussion is not uscful, as it is for delineating the size of organs in the chest and abdomen. When percussion is used, it is prima-rily to elicit a Tinel sign from a peripheral nerve.
Each chapter, therefore, is designed to follow a generał organization: Inspection: Surface Anatomy, Alignment, Gait, Rangę of Motion; Palpation; and Manipulation: Muscle Testing, Sensation Testing, Reflex Testing, Stability Testing, and Miscellaneous Special Tests, the last of which focuses on tests for abnormal joint laxity, nerve compres-sion, joint contracture, tendinitis, and other conditions particular to each body segment.
■ INSPECTION
The first part of any physical examination is a visual inspection of the area of the patients complaint. This is so immediate and automatic that it is often done almost unconsciously. The examiner observes the out-ward appearance of the body part, how it is carried or aligned, how it is used in functional activities such as walking, and the rangę through which it is able to move, if applicable. The Inspection section of each chapter presents an organized mental checklist, because the morę that this process is conducted consciously, the morę valuable the information that is obtained from it will be.
Surface Anatomy
Each Surface Anatomy section takes the reader on a visual tour of the surface of the area to be examined. Most chapters describe the appearance of the body part from each of the traditional anatomie perspectives: anterior, poste-rior, lateral, and medial. The exact order varies according to the requiremcnts of the particular body part described. These terms are applied with the assumption that the patient is in the classic anatomie position (see Fig. 1-1). When they are used to describe relative position, anterior means toward the front of the body, posterior toward the rcar of the body, medial toward the midline of the body, and lateral away from the midline of the body. Although these same four terms can be applied to the wrist and hand, their use in that portion of the anatomy can be
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