The spine
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Palpation is useful to locate specific areas of tenderness. Ranges of motion should be assessed. The normal range of motion in the cervical spine is 45° of flexion, 55° of extension, 70° of rotation and 40° of lateral bend. The normal range of motion in the lumbar spine is 40-60° of flexion, 20-35° of extension, 15-20° of lateral bending and 3-18° of rotation. Schober’s test is a simple clinical test to evaluate spinal mobility. A tape measure is used to mark the skin midway between the posterior superior iliac spines and at points 10 cm proximal and 5 cm distal to this mark while the patient is standing. The patient is then asked to bend forward as far as possible and the distance between the two points is measured with the patient in the flexed position. Normally one would expect to see an increase of at least 5 cm between the two points in the erect and flexed positions. A distance of less than 5 cm between these points may indicate ankylosing spondylitis.
Geriatric Assessment and the Physical Examination of the Older Adult
K. Rao Poduri in Geriatric Rehabilitation, 2017
Auscultation of the abdomen is done with the diaphragm the stethoscope. It is best done just lateral to the umbilicus. High-pitched bowel sounds can indicate an ileus or a small bowel obstruction. Abdominal palpation is performed with one’s hands and inquiring about any tender areas that are either avoided or examined at the end of the session. Liver edge is best palpated with the ulnar edge of the hand. Gentle pressure is applied downward as the patient breathes in. A mass in the left or the right lower quadrant should be followed up to exclude the possibility of inflammatory bowel disease, diverticulitis, or colon cancer. Spleen is palpated by asking the patient to roll on to the right side. The hand is placed along the left costal margin and the patient is asked to exhale the soft and hard to palpate. Abdominal ascites can be clinically apparent. Shifting dullness continues to be a very helpful sign. Percussion is started in the midline and the pleximeter (finger on the abdomen) is slowly moved to the flank. Percussion is stopped where the dullness is appreciated and the patient is asked to roll over to the other side. Percussion is recommenced after about 30 seconds. The return of a tympanitic note signifies free fluid, which gravitates to the dependent area of the abdomen.
Physical activity and infectious mononucleosis
Roy J. Shephard in Physical Activity and the Abdominal Viscera, 2017
Clinical attempts to detect an enlarged spleen by palpation and/or percussion are relatively ineffective (Table 8.3). The results of clinical examination vary widely from one observer to another. The coefficient of inter-observer agreement for abdominal palpation as measured by Cohen’s kappa is 0.56-0.70[30]), and for abdominal percussion, kappa is only 0.19-0.41.[31] The reported reproducibility of the clinical information also depends on whether the study is part of a routine examination or is a deliberate and careful experimental assessment,[32] on the method of palpation or percussion that is used, on the obesity of the individuals that are assessed and on the proportion of enlarged spleens present in the sample. Tamayo et al.[38] compared three differing techniques of palpation and three techniques of percussion. The figures cited (Table 8.3) are for the most effective of each of these approaches: ballottement (palpation of the abdominal wall while applying pressure over the spleen from the back) and Castell percussion (noting the difference of tone when percussing over the seventh inter-sternal space during inspiration and expiration). One final but important objection to attempts at clinical estimates of splenomegaly is the risk that over-vigorous palpation of the abdomen could cause the rupture of an infected spleen.[40]
Physiotherapeutic assessment and management of overactive bladder syndrome: a case report
Published in Physiotherapy Theory and Practice, 2023
Bartlomiej Burzynski, Tomasz Jurys, Karolina Kwiatkowska, Katarzyna Cempa, Andrzej Paradysz
Assessment examination of the lumbopelvic hip complex was then carried out with the patient lying on her back and her lower extremities fully extended. The physiotherapist performed palpation assessment in the anterolateral abdominal wall area using both hands. Muscle tension and pain were evaluated. During palpation, the patient reported any pain and defined its intensity using the NRS. The physiotherapist assessed the following areas with results presented in parentheses: 1) musculus rectus abdominis at the level of umbilicus on the left side (7/10) and right side (7/10); 2) musculus psoas major on the left side (0/10) and right side (5/10); musculus iliacus on the left side (0/10) and right side (8/10); 3) musculus transversus abdominis in the middle of the line connecting the anterior superior iliac spine and public symphysis on the left side (4/10) and right side (8/10); and 4) Abdominal palpation showed abnormalities in the tension of muscles generating intra-abdominal pressure, which may cause symptoms of urgency.
More than meets the eye: a case of HCV-induced PAN
Published in Modern Rheumatology Case Reports, 2018
Anand Kumthekar, Bryan Wolf, Randy Woltjer, Pascale Schwab
On arrival, he was afebrile; heart rate was 60 beats/min, and blood pressure 148/84 mmHg. He was distressed due to severe pain in his extremities and had difficulty cooperating with the examination. The left temporal artery was normal appearing, not tender but had a reduced pulse. Carotid arteries were normal without bruits. Cardiopulmonary and abdominal exams were normal. Mild lower extremity pitting oedema was noted without rashes or joint specific tenderness or effusions. Neurologic exam showed a right afferent pupillary defect as well as finger motion vision in the left eye. Cranial nerves were otherwise normal. Muscle groups were tender to palpation with normal tone. Neck flexion and extension was 5/5. Manual motor testing (Table 1) showed mild proximal weakness of the upper extremities with severe weakness of the right hand with inability to fist or abducts his fingers. Lower extremities were weak and painful both proximally and distally. Sensory testing was normal except for decreased pinprick over the right hand and lower extremity allodynia.
Dietary macronutrient composition and central neuropeptide Y injection affect dietary preference and hypothalamic gene expression in chicks
Published in Nutritional Neuroscience, 2018
Betty R. McConn, Mark A. Cline, Elizabeth R. Gilbert
Chicks were injected using a method adapted from Davis et al.22 that does not appear to induce physiological stress.23 The head of the chick was briefly inserted into a restraining device that left the cranium exposed and allowed for freehand injection. Injection coordinates were 3 mm anterior to the coronal suture, 1 mm lateral from the sagittal suture, and 2 mm deep targeting the left lateral ventricle. Anatomical landmarks were determined visually and by palpation. Injection depth was controlled by placing a plastic tubing sheath over the needle. The needle remained at injection depth in the un-anesthetized chick for 10 s post-injection to reduce backflow. Chicks were assigned to treatments at random. Chicken NPY (YPSKPDSPGEDAPAEDMARYYSALRHYINLITRQRY, AnaSpec, San Jose, CA, USA) was dissolved in artificial cerebrospinal fluid24 as a vehicle for a total injection volume of 5 μl with 0.06% Evans Blue dye to facilitate injection site localization. After data collection, the chick was decapitated and its head sectioned along the frontal plane to determine the site of injection. Any chick without dye present in the lateral ventricle system was eliminated from analysis. Sex of chicks was determined visually by dissection and numbers of chicks for each experiment are stated in the figure captions.
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