The document discusses dermatomes and myotomes, which are areas of skin and muscles controlled by specific spinal nerve roots. It provides details on how to test dermatomes using pinprick and light touch tests and myotomes using resistance tests of specific muscle groups to evaluate nerve root damage. Key points covered include the spinal levels innervating different body areas, procedures for upper and lower limb dermatome and myotome tests, and diagrams illustrating test points and dermatome maps.
This document discusses the anatomy and clinical evaluation of median nerve injuries as well as various management strategies. It describes the anatomy of the median nerve and its branches that innervate different muscle groups in the arm and hand. Clinical presentations of high and low median nerve palsies are outlined. Surgical techniques for restoring function are proposed, including nerve transfers to regain opposition, sensation, flexion and pronation. Tendon transfers are also mentioned to help with opposition and finger flexion.
This document discusses ultrasound therapy and properties of ultrasound. It defines ultrasound as sound waves with frequencies above the human hearing range. Therapeutic ultrasound uses frequencies between 0.5 to 5 MHz. Ultrasound is produced using the piezoelectric effect where crystals expand and contract when electric current is passed through. Key ultrasound properties discussed are intensity, beam uniformity, duty cycle, frequencies, and effective radiating area. Near and far ultrasound fields are also explained.
Entrapment neuropathy of the upper limborthoprince
1. Entrapment neuropathies occur when nerves are compressed, most commonly the median nerve at the carpal tunnel or the ulnar nerve at the elbow.
2. Symptoms depend on the affected nerve but typically begin with tingling and pain, followed by numbness and possible muscle weakness.
3. Carpal tunnel syndrome results from median nerve compression at the wrist and is the most common upper limb neuropathy. Treatment involves splinting, injections, or surgery to release the transverse carpal ligament.
Microwave diathermy is a therapeutic modality that uses electromagnetic waves to generate heat in tissues for treating musculoskeletal conditions. It works by causing movement of ions and water molecules when its high frequency waves are absorbed by tissues. The document discusses the physics behind microwave diathermy, its applications and effectiveness in treating conditions like muscle strains and joint injuries, appropriate treatment parameters, safety considerations and precautions for its use.
Elbow examination and its clinical applied Deepak Jangre
This document provides an overview of the anatomy and examination of the elbow and its clinical applications. It describes the elbow as a compound synovial hinge joint made up of three joints: the humeroulnar joint, humeroradial joint, and superior radioulnar joint. It outlines the ligaments, muscles, nerves, arteries, and range of motion involved in the elbow. The document provides guidance on inspecting, palpating, and evaluating the range of motion of the elbow during a physical examination. Key assessment points include observing deformities, muscle wasting, swelling, and tenderness and evaluating the three point bony relationship between the medial epicondyle, lateral epicondyle, and olecran
This document discusses various aspects of posture including definitions of different types of posture, muscle involvement in maintaining posture, postural reflexes, factors affecting posture, and descriptions and causes of some common postural deviations like kyphosis, lordosis, scoliosis, etc. Key points include:
- Posture is the body position maintained by muscle activity and reflexes in response to stimuli from muscles, eyes, ears and joints. Both static and dynamic posture involve integration of postural reflexes.
- Good posture allows maximum efficiency with minimal effort while poor posture causes unnecessary muscle strain and reduces function.
- Common postural deviations include kyphosis (rounded back), lordosis (swayback), and scoliosis
This document discusses the anatomy and clinical evaluation of median nerve injuries as well as various management strategies. It describes the anatomy of the median nerve and its branches that innervate different muscle groups in the arm and hand. Clinical presentations of high and low median nerve palsies are outlined. Surgical techniques for restoring function are proposed, including nerve transfers to regain opposition, sensation, flexion and pronation. Tendon transfers are also mentioned to help with opposition and finger flexion.
This document discusses ultrasound therapy and properties of ultrasound. It defines ultrasound as sound waves with frequencies above the human hearing range. Therapeutic ultrasound uses frequencies between 0.5 to 5 MHz. Ultrasound is produced using the piezoelectric effect where crystals expand and contract when electric current is passed through. Key ultrasound properties discussed are intensity, beam uniformity, duty cycle, frequencies, and effective radiating area. Near and far ultrasound fields are also explained.
Entrapment neuropathy of the upper limborthoprince
1. Entrapment neuropathies occur when nerves are compressed, most commonly the median nerve at the carpal tunnel or the ulnar nerve at the elbow.
2. Symptoms depend on the affected nerve but typically begin with tingling and pain, followed by numbness and possible muscle weakness.
3. Carpal tunnel syndrome results from median nerve compression at the wrist and is the most common upper limb neuropathy. Treatment involves splinting, injections, or surgery to release the transverse carpal ligament.
Microwave diathermy is a therapeutic modality that uses electromagnetic waves to generate heat in tissues for treating musculoskeletal conditions. It works by causing movement of ions and water molecules when its high frequency waves are absorbed by tissues. The document discusses the physics behind microwave diathermy, its applications and effectiveness in treating conditions like muscle strains and joint injuries, appropriate treatment parameters, safety considerations and precautions for its use.
Elbow examination and its clinical applied Deepak Jangre
This document provides an overview of the anatomy and examination of the elbow and its clinical applications. It describes the elbow as a compound synovial hinge joint made up of three joints: the humeroulnar joint, humeroradial joint, and superior radioulnar joint. It outlines the ligaments, muscles, nerves, arteries, and range of motion involved in the elbow. The document provides guidance on inspecting, palpating, and evaluating the range of motion of the elbow during a physical examination. Key assessment points include observing deformities, muscle wasting, swelling, and tenderness and evaluating the three point bony relationship between the medial epicondyle, lateral epicondyle, and olecran
This document discusses various aspects of posture including definitions of different types of posture, muscle involvement in maintaining posture, postural reflexes, factors affecting posture, and descriptions and causes of some common postural deviations like kyphosis, lordosis, scoliosis, etc. Key points include:
- Posture is the body position maintained by muscle activity and reflexes in response to stimuli from muscles, eyes, ears and joints. Both static and dynamic posture involve integration of postural reflexes.
- Good posture allows maximum efficiency with minimal effort while poor posture causes unnecessary muscle strain and reduces function.
- Common postural deviations include kyphosis (rounded back), lordosis (swayback), and scoliosis
The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel bone. It is the thickest and strongest tendon in the body. Achilles tendinitis is inflammation of the Achilles tendon caused by overuse, especially in athletes. Common symptoms include pain in the back of the ankle when walking or exercising. Treatment involves rest, ice, stretching, orthotics, and eccentric exercises.
Special test for dermatomes and myotomesTafzz Sailo
The document discusses dermatomes and myotomes, which are areas of skin and muscles innervated by specific spinal nerve roots. It provides detailed instructions for testing dermatomes using pinprick and light touch tests and myotomes using resistance tests of individual muscle groups to evaluate potential nerve root injuries. Key points include identifying the spinal nerve roots that innervate specific areas of the upper and lower limbs and correlating weaknesses to the likely injured nerve roots. Diagrams depict dermatome and myotome maps to guide the clinical tests.
This ppt is regarding the general concept of normal endfeel. this is designed for the particularly physiotherapy profession. for student and clinician to understand and better concept of endfeel
This document discusses tendon transfers in the hand to restore function after nerve injuries or irreparable muscle injuries. It outlines the principles and indications for tendon transfers, including restoring function and balance. Specific procedures are described to address median, radial, and ulnar nerve palsies. Donor tendon options and techniques are discussed for procedures like opponensplasty, anti-clawing, adductorplasty, and transfers to restore thumb and finger flexion/extension. The goal of tendon transfers is to reconstruct missing functions based on what is available while considering bony stability, soft tissue balance, and ranges of motion.
Patellar tendinopathy, also known as jumper's knee, is a chronic overuse injury caused by repetitive stress on the knee extensor mechanism from activities like jumping, running, and kicking. It results from microtears in the patellar tendon from forces that are 3 times greater than normal during movements like acceleration, deceleration, takeoff, and landing. Symptoms include dull aching knee pain after exercise that worsens with sitting or stairs. Treatment focuses on eccentric strengthening exercises and bracing to promote healing of the tendon.
The document provides information about taping techniques used in physiotherapy. It discusses:
1) The principles and purposes of taping, which include immobilizing joints to reduce pain and aid recovery while allowing some functional mobility.
2) The various materials used for taping like tape, underwrap, adhesive remover, scissors, powder, pads, and adhesive spray.
3) Different taping techniques like Kinesio taping, McConnell taping, Mulligan taping and their specific applications and characteristics.
4) Guidelines for proper taping including cleaning the skin, applying underwrap to sensitive skin, and positioning the joint in its range of motion.
This document discusses elasticity and different elastic materials used in physiotherapy. It defines elasticity as the property of an object to regain its original shape after being distorted by a force. Hooke's law states that strain is proportional to stress. Springs, rubber elastic, and sorbo rubber possess elasticity. Springs can be used individually, in parallel to have the same weight but lower resistance, or in series to have double the resistance but the same weight. Rubber elastic and sorbo rubber are also compressible and extensible materials useful for resistance in physiotherapy.
This document discusses different types of muscle contractions that can occur during physical therapy. It describes isometric contractions where the operator and patient forces match so no movement occurs. It also describes isotonic eccentric contractions where the operator force overcomes the patient's effort, moving the joint in the opposite direction. The effort of the patient should be 20% of their strength and held for 7-10 seconds.
Peripheral joint mobilization and manipulation refers to manual therapy techniques used to treat joint impairments and range of motion limitations. Techniques include passive movements, self-mobilization exercises, and mobilization with movement performed by a therapist. Variables like speed, amplitude, and direction are used. Mobilization techniques are classified by grade based on factors like oscillation rate and amplitude. Precautions are taken with certain conditions, and techniques are selected based on a patient's examination and evaluation.
Tennis elbow, also known as lateral epicondylitis, is a painful condition affecting the tendinous tissue originating from the lateral epicondyle of the humerus. It commonly results from repetitive wrist extension and forearm pronation motions as seen in tennis players. Physical examination reveals tenderness over the lateral epicondyle with resisted wrist extension. Initial treatment involves rest, ice, NSAIDs, bracing, and physical therapy. Surgical release of the affected tendon is considered if non-operative treatment fails after 6-12 months.
Basic concepts of Manual Muscle Testing (MMT)JebarajFletcher
Manual muscle testing is a procedure used to evaluate muscle strength. It involves manually applying resistance against a patient's movement through their available range of motion. There are several types of manual muscle tests including tests of individual muscles, muscle groups, and functional tests. The results are often graded on a scale like the Oxford scale. Manual muscle testing provides important information for diagnoses, evaluating treatment effectiveness, and tracking patient progress. It requires skill and standardization to obtain reliable results.
Tennis elbow (Rpitative injury of lateral epicondyle)Iram Anwar
Lateral epicondylitis, also known as tennis elbow, is an overuse injury causing pain at the outside of the elbow. It results from repetitive microtrauma to the tendons that connect the forearm muscles to the lateral epicondyle. The pathology involves tendon breakdown and inflammation. Risk factors include repetitive arm motions from activities like tennis, manual labor, or keyboard use. Patients experience pain at the lateral elbow that is worsened by gripping or lifting. Examination finds tenderness over the lateral epicondyle and positive Cozen's, Mill's, and Maudsely's tests. Treatment involves rest, bracing, exercises and other conservative measures, with corticosteroid injection or surgery as potential options
The document discusses rotator cuff injuries, providing information on anatomy, causes, symptoms, diagnosis and treatment. It describes the rotator cuff muscles, how injury can result from impingement or overuse, and common symptoms like shoulder pain. Physical exams like empty can and lift-off tests help identify injuries. Imaging like x-rays and ultrasound can diagnose conditions like tears or calcification. Surgery may be needed for severe, unresponsive tears of the rotator cuff tendons.
Therapeutic ultrasound uses sound waves to treat injuries and other conditions. It can be used for imaging, physical therapy, and tissue destruction. Ultrasound works through thermal and non-thermal effects. Thermal effects include increased tissue flexibility and blood flow through localized heating. Non-thermal effects include cavitation and mechanical alterations to cell membranes. Common uses are for joint and muscle issues, reducing pain and spasms, and accelerating wound healing. Precautions must be taken to avoid sensitive areas and ensure safe operation. Clinical decision making considers the injury stage, pathology location, needed tissue heating, and implants.
1. Neural tissue mobilization (NTM) is a clinical technique that applies the mechanics and physiology of the nervous system and how it relates to and integrates with the musculoskeletal system.
2. NTM uses specific movements and positions to assess nerve mobility and elicit symptoms in order to determine the source of a patient's pain. Common tests include the median, ulnar, and radial nerve tests.
3. A positive NTM test is indicated by reproduction of the patient's clinical symptoms that change with structural differentiation. NTM can help diagnose neurogenic causes of pain and guide effective treatment.
The document discusses various aspects of shoulder biomechanics during pulling movements. It considers whether pulling is better characterized as a translational or rotational movement, and what factors influence this. Some key points discussed include:
- Pulling involves elements of both translation and rotation, and the contribution of each depends on variables like grip width and bar height.
- The scapula and trunk play an important role in distributing forces. Proper scapular stability is important for injury prevention.
- Slow, heavy pulls with the elbow passing the trunk line can overload small rotator cuff muscles if other joints don't move together. Lighter loads or explosive movements may reduce this.
- Push-pull strength ratios
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by painful and limited range of motion in the shoulder. It most commonly affects individuals between 40-65 years old and is more prevalent in females. The condition involves a loss of shoulder movement, making common motions like reaching into back pockets or combing hair difficult. Frozen shoulder progresses through acute, chronic, and subacute stages distinguished by differences in pain levels and range of motion limitations. It can be primary/idiopathic or secondary to other disorders like diabetes or thyroid disease. Examination reveals significant reduction of both active and passive shoulder elevation and external rotation.
The document discusses wound healing and various modalities used to promote wound healing such as ultrasound, laser, ultraviolet light, and pulsed shortwave diathermy. It covers the normal phases of wound healing including inflammatory, proliferation and maturation phases. Factors that can inhibit wound healing and importance of wound measurement are summarized. Electrical stimulation modalities like high voltage pulsed current and low voltage pulsed current are described along with their proposed mechanisms of action in accelerating wound healing. Placement and treatment procedures for electrical stimulation are also outlined.
This document discusses several laws governing radiation, including reflection, refraction, absorption, and the inverse square law. Reflection occurs when rays encounter a medium they cannot pass through, refracting at the same angle. Refraction causes rays to bend when passing between media at different angles depending on density. Absorption involves rays being absorbed by media, with the amount depending on factors like wavelength and incidence angle. The inverse square law states that intensity decreases with the square of the distance from the radiation source.
Anatomy of the lower extremities - name, origin & insertion and innervationStavros Litsos
Anatomy of the lower extremities - name, origin & insertion and innervation. Notes from Bsc in Physiotherapy - Oslo University College (HiOA).
Stavros Litsos
Øystein Mjelde Skipenes
Sophie was diagnosed with Alzheimer's disease at age 51 after exhibiting early signs of memory loss and word-finding difficulties. Neuropsychological assessments conducted over 18 months showed a gradual decline in her cognitive abilities, with scores falling below average ranges. Brain scans found mild atrophy and ventricle enlargement. She was given a diagnosis of probable Alzheimer's disease. Sophie lived at home with support for 4 years before being placed in hospice care, where her condition rapidly deteriorated until she became mute. Post-mortem examination confirmed Alzheimer's disease as the cause of her dementia.
The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel bone. It is the thickest and strongest tendon in the body. Achilles tendinitis is inflammation of the Achilles tendon caused by overuse, especially in athletes. Common symptoms include pain in the back of the ankle when walking or exercising. Treatment involves rest, ice, stretching, orthotics, and eccentric exercises.
Special test for dermatomes and myotomesTafzz Sailo
The document discusses dermatomes and myotomes, which are areas of skin and muscles innervated by specific spinal nerve roots. It provides detailed instructions for testing dermatomes using pinprick and light touch tests and myotomes using resistance tests of individual muscle groups to evaluate potential nerve root injuries. Key points include identifying the spinal nerve roots that innervate specific areas of the upper and lower limbs and correlating weaknesses to the likely injured nerve roots. Diagrams depict dermatome and myotome maps to guide the clinical tests.
This ppt is regarding the general concept of normal endfeel. this is designed for the particularly physiotherapy profession. for student and clinician to understand and better concept of endfeel
This document discusses tendon transfers in the hand to restore function after nerve injuries or irreparable muscle injuries. It outlines the principles and indications for tendon transfers, including restoring function and balance. Specific procedures are described to address median, radial, and ulnar nerve palsies. Donor tendon options and techniques are discussed for procedures like opponensplasty, anti-clawing, adductorplasty, and transfers to restore thumb and finger flexion/extension. The goal of tendon transfers is to reconstruct missing functions based on what is available while considering bony stability, soft tissue balance, and ranges of motion.
Patellar tendinopathy, also known as jumper's knee, is a chronic overuse injury caused by repetitive stress on the knee extensor mechanism from activities like jumping, running, and kicking. It results from microtears in the patellar tendon from forces that are 3 times greater than normal during movements like acceleration, deceleration, takeoff, and landing. Symptoms include dull aching knee pain after exercise that worsens with sitting or stairs. Treatment focuses on eccentric strengthening exercises and bracing to promote healing of the tendon.
The document provides information about taping techniques used in physiotherapy. It discusses:
1) The principles and purposes of taping, which include immobilizing joints to reduce pain and aid recovery while allowing some functional mobility.
2) The various materials used for taping like tape, underwrap, adhesive remover, scissors, powder, pads, and adhesive spray.
3) Different taping techniques like Kinesio taping, McConnell taping, Mulligan taping and their specific applications and characteristics.
4) Guidelines for proper taping including cleaning the skin, applying underwrap to sensitive skin, and positioning the joint in its range of motion.
This document discusses elasticity and different elastic materials used in physiotherapy. It defines elasticity as the property of an object to regain its original shape after being distorted by a force. Hooke's law states that strain is proportional to stress. Springs, rubber elastic, and sorbo rubber possess elasticity. Springs can be used individually, in parallel to have the same weight but lower resistance, or in series to have double the resistance but the same weight. Rubber elastic and sorbo rubber are also compressible and extensible materials useful for resistance in physiotherapy.
This document discusses different types of muscle contractions that can occur during physical therapy. It describes isometric contractions where the operator and patient forces match so no movement occurs. It also describes isotonic eccentric contractions where the operator force overcomes the patient's effort, moving the joint in the opposite direction. The effort of the patient should be 20% of their strength and held for 7-10 seconds.
Peripheral joint mobilization and manipulation refers to manual therapy techniques used to treat joint impairments and range of motion limitations. Techniques include passive movements, self-mobilization exercises, and mobilization with movement performed by a therapist. Variables like speed, amplitude, and direction are used. Mobilization techniques are classified by grade based on factors like oscillation rate and amplitude. Precautions are taken with certain conditions, and techniques are selected based on a patient's examination and evaluation.
Tennis elbow, also known as lateral epicondylitis, is a painful condition affecting the tendinous tissue originating from the lateral epicondyle of the humerus. It commonly results from repetitive wrist extension and forearm pronation motions as seen in tennis players. Physical examination reveals tenderness over the lateral epicondyle with resisted wrist extension. Initial treatment involves rest, ice, NSAIDs, bracing, and physical therapy. Surgical release of the affected tendon is considered if non-operative treatment fails after 6-12 months.
Basic concepts of Manual Muscle Testing (MMT)JebarajFletcher
Manual muscle testing is a procedure used to evaluate muscle strength. It involves manually applying resistance against a patient's movement through their available range of motion. There are several types of manual muscle tests including tests of individual muscles, muscle groups, and functional tests. The results are often graded on a scale like the Oxford scale. Manual muscle testing provides important information for diagnoses, evaluating treatment effectiveness, and tracking patient progress. It requires skill and standardization to obtain reliable results.
Tennis elbow (Rpitative injury of lateral epicondyle)Iram Anwar
Lateral epicondylitis, also known as tennis elbow, is an overuse injury causing pain at the outside of the elbow. It results from repetitive microtrauma to the tendons that connect the forearm muscles to the lateral epicondyle. The pathology involves tendon breakdown and inflammation. Risk factors include repetitive arm motions from activities like tennis, manual labor, or keyboard use. Patients experience pain at the lateral elbow that is worsened by gripping or lifting. Examination finds tenderness over the lateral epicondyle and positive Cozen's, Mill's, and Maudsely's tests. Treatment involves rest, bracing, exercises and other conservative measures, with corticosteroid injection or surgery as potential options
The document discusses rotator cuff injuries, providing information on anatomy, causes, symptoms, diagnosis and treatment. It describes the rotator cuff muscles, how injury can result from impingement or overuse, and common symptoms like shoulder pain. Physical exams like empty can and lift-off tests help identify injuries. Imaging like x-rays and ultrasound can diagnose conditions like tears or calcification. Surgery may be needed for severe, unresponsive tears of the rotator cuff tendons.
Therapeutic ultrasound uses sound waves to treat injuries and other conditions. It can be used for imaging, physical therapy, and tissue destruction. Ultrasound works through thermal and non-thermal effects. Thermal effects include increased tissue flexibility and blood flow through localized heating. Non-thermal effects include cavitation and mechanical alterations to cell membranes. Common uses are for joint and muscle issues, reducing pain and spasms, and accelerating wound healing. Precautions must be taken to avoid sensitive areas and ensure safe operation. Clinical decision making considers the injury stage, pathology location, needed tissue heating, and implants.
1. Neural tissue mobilization (NTM) is a clinical technique that applies the mechanics and physiology of the nervous system and how it relates to and integrates with the musculoskeletal system.
2. NTM uses specific movements and positions to assess nerve mobility and elicit symptoms in order to determine the source of a patient's pain. Common tests include the median, ulnar, and radial nerve tests.
3. A positive NTM test is indicated by reproduction of the patient's clinical symptoms that change with structural differentiation. NTM can help diagnose neurogenic causes of pain and guide effective treatment.
The document discusses various aspects of shoulder biomechanics during pulling movements. It considers whether pulling is better characterized as a translational or rotational movement, and what factors influence this. Some key points discussed include:
- Pulling involves elements of both translation and rotation, and the contribution of each depends on variables like grip width and bar height.
- The scapula and trunk play an important role in distributing forces. Proper scapular stability is important for injury prevention.
- Slow, heavy pulls with the elbow passing the trunk line can overload small rotator cuff muscles if other joints don't move together. Lighter loads or explosive movements may reduce this.
- Push-pull strength ratios
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by painful and limited range of motion in the shoulder. It most commonly affects individuals between 40-65 years old and is more prevalent in females. The condition involves a loss of shoulder movement, making common motions like reaching into back pockets or combing hair difficult. Frozen shoulder progresses through acute, chronic, and subacute stages distinguished by differences in pain levels and range of motion limitations. It can be primary/idiopathic or secondary to other disorders like diabetes or thyroid disease. Examination reveals significant reduction of both active and passive shoulder elevation and external rotation.
The document discusses wound healing and various modalities used to promote wound healing such as ultrasound, laser, ultraviolet light, and pulsed shortwave diathermy. It covers the normal phases of wound healing including inflammatory, proliferation and maturation phases. Factors that can inhibit wound healing and importance of wound measurement are summarized. Electrical stimulation modalities like high voltage pulsed current and low voltage pulsed current are described along with their proposed mechanisms of action in accelerating wound healing. Placement and treatment procedures for electrical stimulation are also outlined.
This document discusses several laws governing radiation, including reflection, refraction, absorption, and the inverse square law. Reflection occurs when rays encounter a medium they cannot pass through, refracting at the same angle. Refraction causes rays to bend when passing between media at different angles depending on density. Absorption involves rays being absorbed by media, with the amount depending on factors like wavelength and incidence angle. The inverse square law states that intensity decreases with the square of the distance from the radiation source.
Anatomy of the lower extremities - name, origin & insertion and innervationStavros Litsos
Anatomy of the lower extremities - name, origin & insertion and innervation. Notes from Bsc in Physiotherapy - Oslo University College (HiOA).
Stavros Litsos
Øystein Mjelde Skipenes
Sophie was diagnosed with Alzheimer's disease at age 51 after exhibiting early signs of memory loss and word-finding difficulties. Neuropsychological assessments conducted over 18 months showed a gradual decline in her cognitive abilities, with scores falling below average ranges. Brain scans found mild atrophy and ventricle enlargement. She was given a diagnosis of probable Alzheimer's disease. Sophie lived at home with support for 4 years before being placed in hospice care, where her condition rapidly deteriorated until she became mute. Post-mortem examination confirmed Alzheimer's disease as the cause of her dementia.
This document discusses the anatomy and functions of the spinal cord, including sensory and motor functions. It describes the ascending tracts that carry sensory information in the dorsal, lateral, and ventral white columns. Several spinal cord syndromes are summarized, including complete transverse cord lesion, Brown-Sequard syndrome, central spinal cord lesion, posterior column syndrome, and anterior spinal syndrome. Causes and features of each syndrome are provided. Treatment options for spinal cord injuries are mentioned, such as glucocorticoids, neurotrophins, stem cell implantation, and future brain computer interface devices.
Professor Tony Elliott presents information on dementia and Alzheimer's disease, including:
1) Dementia is characterized by memory loss and functional decline, while Alzheimer's is the most common cause of dementia.
2) The prevalence of dementia doubles every 5 years after age 65, affecting 5% of those over 65 and up to 32% of those over 90.
3) The brain changes in Alzheimer's include plaques, tangles, and loss of connections between neurons.
4) Risk factors include age, family history, and genetic factors like ApoE4, while preventative factors include diet, exercise, and mental activity.
This document provides a detailed outline for examining a patient with paraplegia. It begins with the history of present illness including date of onset, mode of onset, precipitating factors, and evolution of paralysis. It then discusses the patient's past medical history, family history, and sensory symptoms. The remainder of the document outlines the physical examination, including assessments of the spine, nervous system, motor functions, sensory functions, reflexes, and other body systems.
SO GUYS ONCE AGAIN HERE I PRESENT U THE OWN MADE PRESENTATION ON THE TOPIC DEMENTIA I HOPE U LIKE THAT IT IS BEEN USEFUL U WHILE MAKING PSYCHIATRIC PRESENTATION
La paraplejía es una enfermedad en la que la parte inferior del cuerpo queda paralizada y sin funcionalidad, normalmente como resultado de una lesión medular o enfermedad congénita como la espina bífida. Las causas incluyen lesiones traumáticas como fracturas vertebrales, tumores, mielitis transversa y esclerosis múltiple. Los grados de paraplejía se clasifican por la ubicación de la lesión medular y determinan la capacidad funcional residual del paciente.
Localizaiton of level of lesion in paraplegiaAbino David
This document discusses spinal cord lesions and their effects. It describes how lesions can cause different types of paralysis or loss of function depending on the level and completeness of the lesion. It also discusses how lesions at different spinal levels correspond to specific vertebral levels and dermatomes. The document examines various ways to localize the level of a spinal cord lesion, including sensory loss, reflex changes, muscle weakness, and bladder/bowel dysfunction.
Paraplegia is defined as impairment of motor function in the lower extremities, with or without sensory involvement, and is usually caused by involvement of the spinal cord, nerves supplying the lower limbs, or muscles directly. It is classified as spastic or flaccid depending on the affected part of the nervous system and resulting muscle tone. Common causes include spinal cord injuries, infections, tumors, and vascular disorders. A thorough history, neurological examination, and imaging tests are used to diagnose the condition and determine the specific cause and level of spinal involvement.
The document discusses various types of dementia, their causes and symptoms. It describes Alzheimer's disease, vascular dementia, dementia caused by Parkinson's disease, Huntington's disease, Pick's disease, Creutzfeldt-Jakob disease, Wernicke-Korsakoff syndrome, normal pressure hydrocephalus, mixed dementia, and dementia not otherwise specified. Symptoms include memory loss, confusion, problems with language and motor skills. Causes include neurological disorders, traumatic brain injuries, infections, substance abuse, and unknown etiologies.
This document provides an overview of dementia, including:
- The DSM-IV criteria for diagnosing dementia which requires memory impairment plus deficits in other cognitive domains as well as functional impairment.
- The most common causes of dementia, with Alzheimer's disease accounting for 70% of cases and vascular dementia 10-15%.
- Methods for diagnosing dementia including clinical assessments, neuropsychological testing, brain imaging, and lab tests to identify reversible causes.
- Approaches to managing dementia focusing on reducing cognitive and behavioral symptoms, slowing progression, and treating underlying conditions. Pharmacological options include cholinesterase inhibitors and memantine to alleviate symptoms.
The document discusses spinal nerves, cervical plexus, brachial plexus, lumbosacral plexus, myotomes, and dermatomes. It provides details on common dermatomal levels from C5 to S1 and describes tests to evaluate muscle function for different neurologic levels from C5 to S1. The tests involve having the patient resist various motions to assess muscles innervated by each nerve root level.
This document discusses dermatomes and myotomes, which relate to the sensory and motor innervation of the body by spinal nerve roots. It provides detailed information on:
- The anatomy and distribution of dermatomes for each spinal nerve from C1 to S5.
- Clinical tests for dermatomes using pinprick and light touch at key points on the body.
- The muscles (myotomes) innervated by each spinal nerve root from C1 to S1.
- Clinical tests of myotomes through resisted movement exercises to evaluate motor function.
Myotomes refer to groups of muscles innervated by individual spinal nerve roots. There are 31 spinal nerves that innervate specific myotomes controlling voluntary muscle movement. Myotome testing is performed during neurological exams to identify compromised nerve roots by assessing weakness in associated myotome muscles. The document outlines techniques for testing the strength of key muscle groups controlled by cervical, thoracic, and lumbar myotomes to identify potential lesions affecting specific spinal nerve roots.
This document summarizes how to assess muscle strength through physical examination of different muscle groups. It provides instructions on positioning and resisting the patient's movements to test individual muscles. For each muscle or group, it identifies the main peripheral nerve, segmental spinal nerve supply, and recommended tests of strength. The assessment covers muscles of the shoulder, arm, forearm, hand, trunk, and hip and lower limb.
The document provides guidance on performing a neurological assessment to identify abnormalities. The assessment involves gathering information on symptoms, medical history, and conducting a mental status exam, cranial nerve assessment, reflex testing, motor and sensory exams, and evaluating coordination and gait. The goal is to screen for neurological disorders and determine the location and components affected. The assessment uses basic equipment and involves systematically testing various reflexes, sensations, strengths, and movements.
The document provides guidance on performing a neurological examination. It outlines assessing the cranial nerves, reflexes, motor system, and sensory system. The cranial nerve examination involves testing each nerve individually. Reflex testing grades reflexes on a scale from 0 to 4. The motor exam evaluates muscle strength on a scale from 0 to 5. Finally, the sensory exam tests sensations like pain, touch, and position sense. The goal is to identify which parts of the neurological system may be affected.
This document provides information about examining the motor system, including anatomy of motor pathways in the brain and spinal cord, inspection of muscles, and testing of muscle tone, power, and specific muscles. It describes how to examine muscles of the shoulder, elbow, wrist/hand, hip, and other areas, including specific tests to evaluate individual muscles like deltoid, biceps, gluteus maximus, and others. The document provides detailed instructions on posture and resistance for testing each muscle.
Lower limb neurological examination frequently appears in OSCEs. You’ll be expected to pick up the relevant clinical signs using your examination skills. This lower limb neurological examination OSCE guide provides a clear, concise, step-by-step approach to performing a neurological examination of the lower limb
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
The document provides guidance on performing a neurological examination, including inspection, assessment of tone, power/strength, reflexes, and coordination. It describes how to examine the upper limbs, testing muscle strength for different actions like shoulder abduction, arm flexion, and wrist flexion. Reflexes like biceps, triceps, and brachioradialis are also discussed. The document then provides similar guidance for examining the lower limbs, outlining techniques to assess tone and check for ankle clonus.
The document discusses injuries to the median and ulnar nerves. The ulnar nerve supplies muscles in the forearm and hand and injuries can result in claw hand deformity. Causes include nerve compression or damage from fractures or injuries. Treatment involves anti-inflammatory medications, exercises, or nerve transposition surgery. Median nerve injury symptoms depend on the location, and can include weakness of thumb and hand muscles or all forearm and hand muscles. Non-surgical treatment focuses on rest and immobilization while surgery may involve carpal tunnel release.
This document provides an outline for examining the extremities and back. It details the key steps for inspection, palpation, range of motion testing, vascular examination, and special tests of the major joints. The examination involves inspecting for signs of injury or deformity, palpating for tenderness or deformity, assessing active and passive range of motion, checking pulses, capillary refill, and lymph nodes, and performing clinical tests for conditions like rotator cuff injuries, knee ligament tears, or nerve root compression. Special attention should be given to anatomy and comparing both sides of the body.
The document provides guidance on performing a motor system examination, including assessing muscle bulk, tone, power, and coordination. It outlines how to examine the muscles of the neck, shoulders, arms, trunk and legs. Key points covered include testing specific muscle groups, identifying patterns of weakness, avoiding misleads, and grading scales for muscle tone. The examination involves inspection, palpation, specific movements against resistance and evaluation of posture and gait.
This document discusses the anatomy, motor and sensory innervation, and injuries of the median nerve. It provides detailed information on:
1) The anatomy of the median nerve from its origins in the brachial plexus through the arm, forearm, and hand.
2) The muscles innervated by the median nerve in the forearm and hand.
3) The sensory distribution of the median nerve in the hand and fingers.
4) Types of median nerve injuries including high injuries proximal to the elbow and low injuries in the distal forearm, and the clinical signs associated with each.
5) Tests to assess median nerve function including testing specific muscles and sensory areas.
1.Anatomy
a.Course
b.Motor distribution
c.Sensory distribution
2.Common sites affected
3.Level of median nerve injury
4.Clinical feature with various test performed
5.Various syndromes related to median nerve
6.Treatment
7.Summary
Brachial plexus injuries can occur in both children during difficult births when the baby's shoulders become impacted and in adults from high-energy trauma to the neck or shoulder region. These injuries range from nerve stretch to complete avulsion and are evaluated based on neurological exam and special tests to determine the specific roots or trunks injured and appropriate treatment. Management may involve conservative therapy, surgery to repair or graft injured nerves, or tendon transfers for permanent nerve damage.
Brachial plexus injuries can occur in both children during birth due to shoulder dystocia and in adults due to high-energy trauma. Examination of brachial plexus injuries involves assessing muscle strength, sensation, and reflexes to determine the level and severity of injury. Treatment may include physical therapy, nerve grafts, nerve transfers, or tendon transfers depending on the specific nature of the injury.
This document summarizes the steps for examining a patient's motor and sensory systems. It outlines how to assess muscle tone, reflexes, strength, coordination, and sensation. The motor exam evaluates muscles for wasting, fasciculations, and abnormalities in tone. Reflexes like biceps, triceps, knee, and ankle jerks are tested. Strength is graded from 0-5. Coordination is tested using finger-nose, heel-shin, and rapid alternating movements. Sensation is assessed over dermatomes for pain, temperature, vibration and fine touch. The goal is to localize signs to upper or lower motor neuron lesions.
This document discusses tendon transfer and physical therapy management. It outlines the principles of tendon transfer including using a donor tendon with sufficient strength and excursion. Indications for tendon transfer include muscle paralysis, imbalance, or rupture. Physical therapy involves protective, mobilization, and resistive phases to regain range of motion and strengthen transferred muscles. Examples provided include management of ulnar and radial nerve injuries through tendon transfers and postoperative rehabilitation.
This document discusses median nerve injuries, including:
- The anatomy and functions of the median nerve in the forearm and hand.
- Clinical assessment of median nerve function through specific muscle tests.
- Common median nerve compression syndromes like carpal tunnel syndrome.
- Classification of nerve injuries and management options for median nerve injuries.
The document provides guidance on performing a rheumatological examination. It describes examining various joints including the temporomandibular joint, hands, wrists, elbows, knees, cervical spine, shoulders, and neck. For each joint, it outlines inspecting for abnormalities, palpating for tenderness, swelling, and crepitus, and testing the range of motion. The examinations are to be performed systematically and carefully with the patient's comfort in mind.
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2. What is Dermatomes?
Dermatomes are areas on the surface of the skin that are control by specific
nerve roots from the spinal cord
Skin (sensation) is innervated by a single nerve roots called the
dermatomes
What is myotomes?
Myotomes correspond to muscles that are controlled by specific nerve roots
from the spinal cord
Muscles (movement) are innervated by singe nerve roots called myotomes
•Nerves and nerve roots are typically injured by compression or stretching
forces
•When a nerve root is damaged a deficit may occur in the corresponding
limb
•The evaluation of nerve root damage can be done by testing dermatomes
and myotomes
3. Dermatome (sensory) test:
Pinprick test
• Gently touches the skin with the pin or back end and
asks the patient whether it feels sharp or blunt
Light touch test
• Dabbing a piece of cotton wool on an area of skin
Pain sensation (pin prick) and light
touch sensation (cotton wool)
4. • Test for abnormalities in sensitivity by pin or cotton.
• The patient should close his/her eyes and give the therapist feedback
with regards to various stimuli.
• All tests should be done on a specific dermatomes and should be
compared bilaterally.
• The sensory function of touch involves sensing surfaces and their
textures and qualities.
• Pinprick test and light touch test
• Both test should be demonstrated to the patient first.
• Both test begin distally and then move proximally
Procedure
5.
6. Upper Body Test Ponits
C2 - Occipital Protuberance
C3 - Supraclavicular Fossa
C4 - Acromioclavicular Joint
C5 - Lateral Antecubital Fossa
C6 - Thumb
C7 - Middle Finger
C8 - Little Finger
T1 - Medial Antecubital Fossa
T2 - Apex of Axilla
Lower Body Test Points
L1 - Upper Anterior Thigh
L2 - Mid Anterior Thigh
L3 - Medial Femoral Condyle
L4 - Medial Malleolus
L5 - Dorsum 3rd MTP Joint
S1 - Lateral Heel
S2 - Popliteal Fossa
S3 - Ischial Tuberosity
S5 - Perianal Area
Test Dermatomes at dots
FRONT
7. BACK Upper Body Test Ponits
C2 - Occipital Protuberance
C3 - Supraclavicular Fossa
C4 - Acromioclavicular Joint
C5 - Lateral Antecubital Fossa
C6 - Thumb
C7 - Middle Finger
C8 - Little Finger
T1 - Medial Antecubital Fossa
T2 - Apex of Axilla
Lower Body Test Points
L1 - Upper Anterior Thigh
L2 - Mid Anterior Thigh
L3 - Medial Femoral Condyle
L4 - Medial Malleolus
L5 - Dorsum 3rd MTP Joint
S1 - Lateral Heel
S2 - Popliteal Fossa
S3 - Ischial Tuberosity
S5 - Perianal Area
8. Upper Body Test Ponits
C2 - Occipital Protuberance
C3 - Supraclavicular Fossa
C4 - Acromioclavicular Joint
C5 - Lateral Antecubital Fossa
C6 - Thumb
C7 - Middle Finger
C8 - Little Finger
T1 - Medial Antecubital Fossa
T2 - Apex of Axilla
9. V1 - Ophthalmic Division of Trigeminal Nerve (Upper Face)
V2 - Maxillary Division of Trigeminal Nerve (Mid Face)
V3 - Mandibular Division of Trigeminal Nerve (Lower Face)
11. Myotome (motor) test:
What is myotomes?
Myotomes correspond to muscles that are controlled by specific nerve
roots from the spinal cord
Muscles (movement) are innervated by singe nerve roots called
myotomes
12.
13. C1 Myotome Upper cervical flexion
C2 Myotome Upper cervical extension/ Neck Rotation
C3 Myotome Cervical lateral flexion
C4 Myotome Shoulder shrugs (upper trapezious)
C5 Myotome Shoulder abduction and external rotation (infraspinatus)
C6 Myotome Elbow flexion and wrist extension
C7 Myotome Elbow extension and wrist flexion
C8 Myotome Thumb extension and ulnar deviation
T1 Myotome Finger adduction and abduction
L1 Myotome Hip flexion
L2 Myotome Hip flexion (also adduction and medial rotation)
L3 Myotome Leg/knee extension
L4 Myotome Dorsiflexion
L5 Myotome Great/Big toe extension
S1 Myotome Ankle plantar flexion and eversion/knee flexion
S2 Myotome Ankle plantar flexion and knee flexion
S3 Myotome None
S4 Myotome Bladdar and rectum
Myotomes and Differentiating Nerve Lesions
14. Cervical Plexus: C1-C4 nerve roots innervate the diaphragm, shoulder and neck.
Brachial Plexus : C5-T1 nerve roots innervate the upper limbs
Lumbosacral Plexus: L1- L5, S2 nerve roots innervate the lower extremity
15. Upper Extremity Nerve Routes
C4 tested with resisted shoulder shrugs/elevation
C5 tested with resisted shoulder abduction
C6 tested with resisted elbow flexion/ wrist extension
C7 tested with resisted wrist flexion
C8 tested with resisted thumb extension
T1 fingers abduction & adduction
Lower Extremity Nerve Routes
The quick test for the lower extremity, to rule out a nerve root injury is to have the
athlete do a squat.
L1-L2 tested with resisted hip flexion
L3 tested with resisted knee extension
L4 tested with resisted foot dorsi flexion
L5 tested with resisted great toe extension
S1/S2 tested with plantar flexion
16. The Motor System (myotomes) Test of
Upper limb and Lower limb
• Note the position of the body that the patient assumes when sitting on the
examination table.
• Paralysis or weakness may become evident when a patient assumes an
abnormal body position.
• A central lesion usually produces greater weakness in the extensors than in
the flexors of the upper extremities, while the opposite is true in the lower
extremities: a greater weakness in the flexors than in the extensors
17. Systematically examine all of the major muscle groups of the
body.
For each muscle group:
1.Note the appearance or muscularity of the muscle (wasted, highly
developed, normal).
2.Feel the tone of the muscle (flaccid, clonic, normal).
3.Test the strength of the muscle group.
•Since this rating scale is skewed towards weakness, many clinicians
further subclassify their finding by adding a + or -, e.g., 5- or 3+
18. 0 No muscle contraction is detected
1
A trace contraction is noted in the muscle by palpating the muscle
while the patient attempts to contract it.
2
The patient is able to actively move the muscle when gravity is
eliminated.
3
The patient may move the muscle against gravity but not against
resistance from the examiner.
4
The patient may move the muscle group against some resistance from
the examiner.
5
The patient moves the muscle group and overcomes the resistance of
the examiner. This is normal muscle strength.
Muscle Strength Grading:
19. Starting with the deltoids, ask the patient to raise both their arms in front of
them simultaneously as strongly as then can while the examiner provides
resistance to this movement. Compare the strength of each arm.
The deltoid muscle is innervated by the C5 nerve root via the axillary nerve.
C5- Shoulder
20. • Next, ask the patient to extend and raise both arms in front of them. Ask the
patient to keep their arms in place while they close their eyes and count to 10.
Normally their arms will remain in place. If there is upper extremity weakness
there will be a positive pronator drift, in which the affected arm will pronate
and fall. This is one of the most sensitive tests for upper extremity weakness.
Pronator drift is an indicator of upper motor neuron weakness. In upper motor
neuron weakness, supination is weaker than pronation in the upper extremity,
leading to a pronation of the affected arm.
The patient to the left does not have a pronator drift.
C5- Shoulder
21. C6- Elbow flexion
Test the strength of lower arm flexion by holding the patient's wrist from above
and instructing them to "flex their hand up to their shoulder". Provide resistance
at the wrist. Repeat and compare to the opposite arm. This tests the biceps
muscle.
The biceps muscle is innervated by the C5 and C6 nerve roots via the
musculocutaneous nerve.
22. Test the strength of wrist extension by asking the patient to extend their wrist
while the examiner resists the movement. This tests the forearm extensors.
Repeat with the other arm.
The wrist extensors are innervated by C6 and C7 nerve roots via the radial
nerve. The radial nerve is the "great extensor" of the arm: it innervates all the
extensor muscles in the upper and lower arm.
C6- Wrist Extension
23. C7- Elbow extension
Now have the patient extend their forearm against the examiner's resistance.
Make certain that the patient begins their extension from a fully flexed position
because this part of the movement is most sensitive to a loss in strength. This
tests the triceps. Note any asymmetry in the other arm.
The triceps muscle is innervated by the C6 and C7 nerve roots via the radial
nerve.
24. C8- Finger Flexion
Examine the patient's hands. Look for intrinsic hand, thenar and hypothenar muscle
wasting.
Test the patient's grip by having the patient hold the examiner's fingers in their fist
tightly and instructing them not to let go while the examiner attempts to remove
them. Normally the examiner cannot remove their fingers. This tests the forearm
flexors and the intrinsic hand muscles. Compare the hands for strength asymmetry.
Finger flexion is innervated by the C8 nerve root via the median nerve.
25. C8- Finger abduction & adduction
Test the intrinsic hand muscles once again by having the patient abduct or "fan
out" all of their fingers. Instruct the patient to not allow the examiner to compress
them back in. Normally, one can resist the examiner from replacing the fingers.
Finger abduction or "fanning" is innervated by the T1 nerve root via the ulnar
nerve.
26. C8 & T1- Thumb Opposition
To complete the motor examination of the upper extremities, test the strength of
the thumb opposition by telling the patient to touch the tip of their thumb to the
tip of their pinky finger. Apply resistance to the thumb with your index finger.
Repeat with the other thumb and compare.
Thumb opposition is innervated by the C8 and T1 nerve roots via the median
nerve.
27. L1 & L2 : Hip Flexion
Proceeding to the lower extremities, first test the flexion of the hip by asking the
patient to lie down and raise each leg separately while the examiner resists.
Repeat and compare with the other leg. This tests the iliopsoas muscles.
Hip flexion is innervated by the L2 and L3 nerve roots via the femoral nerve.
28. Test extension at the knee by placing one hand under the knee and the other on
top of the lower leg to provide resistance. Ask the patient to "kick out" or extend
the lower leg at the knee. Repeat and compare to the other leg. This tests the
quadriceps muscle.
Knee extension by the quadriceps muscle is innervated by the L3 and L4 nerve
roots via the femoral nerve.
L3: Knee Extension
29. L4: Ankle Dorsiflexion
Test dorsiflexion of the ankle by holding the top of the ankle and have the patient
pull their foot up towards their face as hard as possible. Repeat with the other
foot. This tests the muscles in the anterior compartment of the lower leg.
Ankle dorsiflexion is innervated by the L4 and L5 nerve roots via the peroneal
nerve.
30. L5: Great toe extension
Ask the patient to move the large toe against the examiner's resistance "up
towards the patient's face". This tests the extensor halucis longus muscle.
The extensor halucis longus muscle is almost completely innervated by the L5
nerve root
31. S1&s2: Ankle plantar flexion and
eversion/knee flexion
Holding the bottom of the foot, ask the patient to "press down on the gas pedal" as
hard as possible. Repeat with the other foot and compare. This tests the
gastrocnemius and soleus muscles in the posterior compartment of the lower leg.
Ankle plantar flexion is innervated by the S1 and S2 nerve roots via the tibial nerve.
Test flexion at the knee by holding the knee from the side and applying
resistance under the ankle and instructing the patient to pull the lower leg
towards their buttock as hard as possible. Repeat with the other leg. This tests
the hamstrings.
The hamstrings are innervated by the L5 and S1 nerve roots via the sciatic
nerve.
41. L1 to S5
Lower Limb Muscles
L1/2 Hip Flexors
L3 Knee Extensors
L4 Ankle Dorsiflexors
L5 Long Toe Extensors
S1/2 Ankle Plantarflexors
42. Complete and Incomplete Spinal Cord Injury:
An incomplete injury means that the ability of the spinal cord to convey messages to
or from the brain is not completely lost; some sensation and movement is possible
below the level of injury.
A complete injury is indicated by a total lack of sensory and motor function below
the level of injury. But the absence of motor and sensory function below the injury
site does not necessarily mean that there are no remaining intact axons or nerves
crossing the injury site, just that they do not function appropriately following the
injury.