This document provides guidance on performing a musculoskeletal examination. It outlines examining the joints, spine, and other areas in 3 stages: collecting subjective information like pain history, performing an objective physical examination, and assessing range of motion. Key steps are described, such as inspecting alignment, palpating for abnormalities, and testing specific movements to evaluate joints like the shoulder, elbow, wrist, hip, knee, and ankle. Special tests are also outlined to help diagnose conditions like tennis elbow or impingement. The overall goal is to accurately assess musculoskeletal symptoms, severity, and develop a treatment plan.
Knee pain is an extremely common complaint, and there are many causes.
Family physicians, Orthopedic surgeons and internist, Pediatricians and other doctors frequently encounter patients with knee pain.
Knee pain is an extremely common complaint, and there are many causes.
Family physicians, Orthopedic surgeons and internist, Pediatricians and other doctors frequently encounter patients with knee pain.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
2. INTRODUCTION
Musculoskeletal Symptoms are a major cause of pain and
Disability
Musculo skeletal are the Single most important cause of disabilty,
requiring considerable,health and Social service resouce.
Objectives of peforming a Musuloskettal disease assesment are
1) To make accurate Dignosis
2) To asscess the sevirity and consequence of the condition.
3) To construct a clear management plan.
4. Assessment of Musculo Skeltal System
1) Subjective Data: History
2)Objectives Data: Physical Examination
5. History
Pain
Site:
Onset:
-Pain from traumatic injury is usually immidiate
Exacerbated by movements like Haemtosis (bleeding in
joint)
-Inflmatory arthritis can develop 24hors
- Crystal athritis cause acute/severe
- -joint sepsis cause pain that develps over 1-2 days.
6. Charterstic of pain
Bone pain: Deep or boring pain worse at Night.
Localised pain : Tumour – Osteonecrosis
Fracture pain: Sharp and Stabbing
Muscle Pain: stiffness / aching agrivated by use of
affected muscle.
Shoting pain:Impingment of peripheral nerve or root
Ex: Buttock pain ……………….
7. Associate complaints
Swelling
Redness of joints
Past Medical History : Note any past episodes of
musciloskeletal involvement,extra-articular disease ,
any fractures and anu comorbidities such as Diabectuc
etc.
Drug History: Any
8. Physical Examination
General Principle
Firstly, examine the patient’s over all appearnce for
features such as pallor,rash,skin tightening and hair
changes.
Skin, Nail and Soft tissues.
Weight loss, muscle loss,fever and lymphadenopathy are
all features of systemic involment in inflammatory
arthritis and connective tissue disease
9. GALS
Gait:
Ask the patient to
walk ahead in a
straight line, then
turn and walk
back towords you.
Look for
Smoothmess and
Symetery of the
gait.
10. Arms
Stand in front of
patient
Inspect the dorsum of
the hands and check
for extension of joints
11. Legs
Ask the patient to
lie supine on the
cough
Palpate each knee
for
warm.swelling,nd
patellar tap
12. Spine
Stand behind the
partient , asscess the
strighness of spine
and muscle bulk and
symmetry in the
trunk,legs,ankle and
foot.
Stand beside the
patient, ask them to
bend down and try to
touch their toes, wtc
13. Detailed examination
Gait
Gait is the Cyclical pattern of Musculoskeletal motion that
carries the body forwords.
Normal gait is Smooth, symmetrical
It has phase
1. Stance : this phase is from foot stike to toe off,when
foot is on the ground and load bearing.
2. Swing: thus phase is fom toe-off to foot strike ,when the
foot clars the grounds.
14. Examination:
Ask the patient to walk barefoot in stright line,then repeat
the shoes.
Observe the patiennt from behind, front andfrom side.
Evaluvate what happens at each level (foot,ankle,knee,hip,
pelvis and spine)during both tance and swing phases.
15. To observe
Pain:
Structral changes:Assess the limb-length dispencery
- other structural changes producing an abnormal gait
include joint fusion ,bone malunionand contracture.
Weakness:it may be due to nerve or muscle pathology.Ex:
pain full hip joint problems in osteparthritis.
Weak hip abductos as in poliomylities or after hip
replacment.
Strctursl hip joint : congenitsl dislocztion.
16. SPINE
The Spine is divided into
Cervical Spine
Thoracic
Lumbar
Sacral
17. INSPECTION OF SPINE
Ask the aptient to undress down to their underwear
Inspect from the front , sides and behind ideally with patient
sitting and standing.
Perticularly, pigmentation,abnormal hair growth etc.
Alignment of the neck and shoulder symmetry.
Kyphosis( thoracic spine curves giving a round shouldered
appearance)
Lordosis ( lumbar spine curves pushing abdomen out, seen in
late stages of pregancy)
Scoliosis ( thoracic and lumbar spine curve laterally forming S
or C shaped)
18. Palpation
Palpate the shoulder and neck muscles for tenderness.
Palpate each of the spinal process nothing any prominance
or steps
Palpate the paraspinal muscles for tenderness or spasm.
Palpate the sacroiliac joints.
19. Movements of the
cervical spine
Flexion
Extension
Flexion- ask the patient
to touch their chin to
their chest normal about
45degree.
Extension – ask the
patient to look upwords
and back – normal
about 45 degree.
20. Movements of the
cervical spine
Lateral flexion-
ask the patient to
touch their ears to
their shoulders,
without raising the
shoulders. Normal
45 degree.
21. thoracolumbar spine
Flexion
The patient is asked to
touch their toes whilst
keeping their knees
straight.
Extension- is assessed by
asking the patient to
bend back as far as
possible.
from above. Lateral
flexion- ask the patient
to place a hand on the
outer thigh and to run
the hand down that side
without bending
Rotation: assessed with
the patient seated on low
stool and viewed
24. Strech test:
Femoral nerve
A:pain may be
triggeed by knee
flexion alobe.
B: pain may be
triggered by knee
flexion in
combination with hip
extension.
25. Sciatic nerve
:Flip test
A; Divert the patient
attention to the
tendon reflexes
B; thw patient with
physical nerve root
compression cannot
permi full extension
of the leg.
26. Stretch test :
Sciatic neve
A; straight leg raising
limited by the tension
of the root over a
prolapsed disc.
B: tension is
increased by
dorsiflexion of the
foot
27. Stretch test :
Sciatic neve
C: Root tension is
relived by flexion at
the knee.
D;
Pressure over the
popliteal fossa bears
on the posterior tibial
nerve causing pain
locally and radiation
into the back.
29. Inspection
The hip joint is not visible externally, but inspect ( ideally
with patient standing) for any deformity.
Palpation
Palapte bony prominance such as anterior iliac spine and
iliac crest to ensure they are anatomically where they
should be.
30. Movements of hip joint
Flexion
Extension
Abduction
Adduction
Internal & external rotation
31. Flexion – with the patient lying supine and the knee flexed
passively flex the hip joint- app 115degree
Extension
With the patient lying prone support the knee and with a
hand on the buttock passively extend the joint app
30degree. Abduction- apprix 45 degrees
Adduction- judged by carrying limb immediately in front
of the other app.30degree
32. Rotation
The person flex the knee and hip
The knee is held in one hand and the foot in other hand.
External rotation is achived by passivly moving the foot
medially.
Internal rotation is tested by moving the foot laterally
33. knee
Inspection
Swelling may detected by a loss of the medial and lateral
dimples suggestive of an effusion.
Palpation
Presence/absence of patella and its mobility
Collateral ligaments
tenderness
34. Knee movements
Active Flexion- the knee is flxed with one hand resting
on the patella app135degee
Active Extension- the leg is straightened to its fullest
exent
37. Ankle and foot
INSPECTION
Foot and ankles ideally with patient standing and
more carefully with thepatient supine.
Palpation
Palpate the tenderness perticularly over bony
priminance placing thumbs on sole of foot and finger
tips on dorsum.
Assess the metatarsophlangal joints by gently
squeezing between index finge and thumb.
39. Movements of ankle
Dorsiflexion- ak the patient to bend their foo down into
plante tendon 50degree
Planter flexion- ask the person to bend the foot upwods
into dorsiflexion.
i.e foot medially and laterally.
40. Thomson test
Squeeze the calf
just distal to the
level of maximum
cicumference. If
the achilles tendon
intact, flexion of
the foot will occur.
41. Molder's sign for
matron's neuroma
Squeeze the
metatarsal heads
together with one
hand ,at the same
time putting pressure
on the interdigital
space with your hand
, the pain of the
neucroma will be
localised.
42. Hands and wrist joint
Inspection
Bith the hands and wrist as one
Inspect the front ,back and sides of all joints
Compare sides
Palpation
Palpate jointd between finger and thumb.
