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Degrees of Freedom of Upper Limb

December 20, 2012 by Leave a Comment

A degree of freedom is a plane of movement. The concept of degrees of freedom is central to kinematics.

Consider a ship moving.It is moving in three dimensions.

  • First, up and down in a vertical plane
  • Second, left and right in a horizontal plane;
  • Third backward and forward, also in a horizontal plane.

Each of these corresponds to one degree of freedom.

Within each of these planes, or axes of movement, an object can rotate thus adding a degree of freedom in each plane and making a total of 3 rotational degrees of freedom.

Human upper limb has been studied in detail and degrees of freedom are important for constructing upper limb prosthetics especially the robotic prosthetics. [Read more...]

Filed Under: Basics, Clinical Evaluation, Traction-Aids-Appliances Tagged With: ,

What is Terry Thomas Sign

September 19, 2012 by Leave a Comment

The Terry Thomas sign refers to an increase in the scapholunate space on an AP radiograph of the wrist (or coronal CT). [See image below]

Terry Thomas Sign In Wrsit

Terry Thomas Sign In Wrsit


The sign is named after well-known British comic Terry Thomas (1911 – 1990) who had frontal dental diastema (a large gap between his two front teeth) 1.

Terry Thomas

Terry Thomas

It is also be known as the David Letterman sign for the same reason.

Filed Under: Clinical Evaluation, Wrist Injuries Tagged With: , , ,

Shuck Test or Ballottement Test For Wrist Instability

September 18, 2012 by Leave a Comment

Shuck test or Shear test, also called Ballottement test is done for lunatotriquetral instability

Test

The test is performed by applying a dorsally directed pressure to the pisiform  and a palmarly directed pressure to the lunate [Lunate can be palpated beyond  dorsal and ulnar corner of the radius.]

The maneuver results in a shearing stress on lunatotriquetral joints and vector across the lunotriquetral joint.

A creptation or clicking associated with reproduction of pain is indicative of lunatotriqutral dissociation.

The triquetrum is displaced dorsally and palmarly on the lunate.

The test may be false negative in cases of ligamentous laxity.

Here is a nice demonstration of Shuck test.

YouTube Preview Image
Filed Under: Clinical Evaluation, Wrist Injuries Tagged With: , , ,

Scaphoid Shift Test or Watson Test For Wrist Instability

September 18, 2012 by Leave a Comment

Watson test or Scaphoid shift test is a wrist provocative stress test done for Scapholunate instability.

Test

Watson test is a combination of pain and a palpable clunk when the wrist is brought from ulnar deviation into radial deviation while pressure is applied to the palmar aspect of the scaphoid tubercle.  [See Video below]

Importance

This test indicates but is not absolutely specific for scapholunate dissociation. A false positive result can also be obtained in individuals with lax ligaments

 

Here is a video demonstration of the test

YouTube Preview Image
Filed Under: Clinical Evaluation, Wrist Injuries Tagged With: , ,

Hawkins Kennedy Test For Shoulder Impingement

October 15, 2011 by Leave a Comment

Hawkins and Kennedy test is of shoulder impingement. It identifies impingement of greater tuberosity against the coraco- humeral ligament, trapping and structures which intervene.

Position

Sitting

Test

With patient sitting, the the arm and elbow is flexed at to 90°, supported by the examiner. The examiner then stabilizes proximal to the elbow with their outside hand and with the other holds just proximal to the patient’s wrist. It is then quickly move the arm into internal rotation.

[Read more...]

Filed Under: Clinical Evaluation Tagged With: , ,

Clinical Photograph of Limited Abduction Demonstrated By Crosslegged Sitting

October 9, 2011 by Leave a Comment

Crosslegged sitting is a very common posture in Asian countries. It is also a very good method to assess the hip movements like flexion and abduction.

Limitation of abduction is demonstrated by following clinical photograph.

limited abduction reulting in incomplete crosslegged sitting

We commonly use this method in busy OPD hours to quickly screen the patients

Filed Under: Clinical Evaluation, Images Tagged With: , , ,

Clinical Photogrpah Demonstrating Stiffness of Elbow

September 16, 2011 by Leave a Comment

An example to show stiffness of left elbow. Note the full flexion in right elbow.

Limitation of elbow movements

Demonstarion of Limited Motion of Left elbow

The left elbow is comparatively less flexed showing stiffness.

Filed Under: Clinical Evaluation, Images Tagged With: , , ,

Evaluation Of A Patient Of Idiopathic Adolescent Scoliosis

May 20, 2011 by Leave a Comment

The evaluation begins with a thorough history as is the dictum in medical evaluation procedures and it is followed by complete physical examination and neurological examination. This is followed by radiographic evaluation

In physical examination, after the general physical examination, the spine is examined and characteristics of the deformity are recorded.

The height of the patient while standing and while sitting should be measured and recorded. These measurements can be compared with future measurements in follow up to determine changes in the patient’s total height and whether any change is caused by growth of the lower extremities or by an increase or a decrease in the height of the trunk.

A detailed physical and neurological examination would help to rule out any neoplasm or a neurological disorder as the cause of scoliosis. [Read more...]

Filed Under: Clinical Evaluation, Scoliosis, Spine Tagged With: , , ,

What Is A Neurogenic Shock?

July 2, 2009 by Leave a Comment

Neurogenic shock is a type of shock caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls.

This results in loss of background sympathetic stimulation, which is responsible for maintenence of tone of blood vessels. As a result of loss of vascular tone, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure. [Read more...]

Filed Under: Clinical Evaluation, Spine Injuries Tagged With: , ,

Approach To The Patient With Hip Pain

February 21, 2008 by 10 Comments

Hip pain is quite a cause for concern when it occurs. A systematic approach to the hip would help to delineate the plausible causes.

The first thing that is done for examining the hip is observation of the gait. This is done the moment patient comes in without making him cautious.

A careful clinical history would narrow the possibilities of diagnoses which are then furthe r narrowed in examination in usual sequence. [Read more...]

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