환자의 Thumb(무지)를 flexion한 위치에서 Wrist을 강하게 Ulna(척측)으로 internal rotation(내전)하면 Radius의 원위 외측에 pain 유발 --> most pathognomic but no diagnostic
2014년 12월 31일 수요일
2014년 6월 12일 목요일
sustained clonus
Video Description
Significant and multiple beats of clonus in the left foot of a patient with cervical myelopathy.
Dimar et al review 104 patients with cervical myelepathy. They found 10 (9.6%) had sustained clonus at presentation. Here is the breakdown of other physical exam findings on presentation: "66 patients (63.5%) reported gait disturbance, 18 (17.3%) had handwriting changes, 33 (31.7%) complained of deterioration of dexterity, 56 (53.8%) had grasp weakness, 7 (6.7%) had bowel and bladder complaints, 27 (26.0%) had a positive Hoffmann sign, 10 (9.6%) had sustained clonus, and 10 (9.6%) had a positive Babinski sign."
Dimar JR 2nd, Bratcher KR, Brock DC, Glassman SD, Campbell MJ, Carreon LY. Instrumented open-door laminoplasty as treatment for cervical myelopathy in 104 patients. Am J Orthop (Belle Mead NJ). 2009 Jul;38(7):E123-8. PubMed PMID: 19714281. Level of Evidence: 2. PMID: 19714281 (Link to Pubmed)
Dimar et al review 104 patients with cervical myelepathy. They found 10 (9.6%) had sustained clonus at presentation. Here is the breakdown of other physical exam findings on presentation: "66 patients (63.5%) reported gait disturbance, 18 (17.3%) had handwriting changes, 33 (31.7%) complained of deterioration of dexterity, 56 (53.8%) had grasp weakness, 7 (6.7%) had bowel and bladder complaints, 27 (26.0%) had a positive Hoffmann sign, 10 (9.6%) had sustained clonus, and 10 (9.6%) had a positive Babinski sign."
Dimar JR 2nd, Bratcher KR, Brock DC, Glassman SD, Campbell MJ, Carreon LY. Instrumented open-door laminoplasty as treatment for cervical myelopathy in 104 patients. Am J Orthop (Belle Mead NJ). 2009 Jul;38(7):E123-8. PubMed PMID: 19714281. Level of Evidence: 2. PMID: 19714281 (Link to Pubmed)
Hoffman's Positive
Video Description
Hoffmann's test is a physical exam maneuver that is sensitive but not very specific for cervical myelopathy.
There are two methods to perform. The first is to hold and secure the middle phalanx of the long finger and then "flick" the distal phalanx into an extended position. Involuntary contraction of the thumb IP joint is a positive test.
The second way is to support the distal phalanx (examiners finger under distal phalanx) of the long finger and then "flick" the distal phalanx into an extended position. Involuntary contraction of the thumb IP joint is a positive test.
Malanga et al found the existing literature does not address interexaminer reliability but appears to indicate fair sensitivity and fair to good specificity for the Hoffman's sign.
References:
Malanga GA, Landes P, Nadler SF. Provocative tests in cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003 Apr;6(2):199-205. Level of Evidence: 5 - Other. PMID: 16883381 (Link to Pubmed)
There are two methods to perform. The first is to hold and secure the middle phalanx of the long finger and then "flick" the distal phalanx into an extended position. Involuntary contraction of the thumb IP joint is a positive test.
The second way is to support the distal phalanx (examiners finger under distal phalanx) of the long finger and then "flick" the distal phalanx into an extended position. Involuntary contraction of the thumb IP joint is a positive test.
Malanga et al found the existing literature does not address interexaminer reliability but appears to indicate fair sensitivity and fair to good specificity for the Hoffman's sign.
References:
Malanga GA, Landes P, Nadler SF. Provocative tests in cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003 Apr;6(2):199-205. Level of Evidence: 5 - Other. PMID: 16883381 (Link to Pubmed)
2014년 6월 11일 수요일
DIAL Test
Dial test
- 앙와위 또는 복와위에서 시행
- 경골의 외회전 정도를 측정
- 75~ 90도 굴곡위에서보다 0~30도의 굴곡위에서 더 큰 후방 불안정성이 있고 외회전 불안정성이 있으면 주로 후외측이 손상되었음을, 75~90도에서 더 큰 후방 불안정성이 있고 외회전 불안정성이 미미하면 후방 십자 인대의 단독 손상을 의심해야함
- 후방 십자 인대의 완전 파열과 이와 동반된 후외방 불안정성이 있으면 모든 각도에서 후방 불안정성, 외회전,내반 불안정성이 크게 증가
- 슬관절의 과신전과 내반 불안정성이 크게 있을 경우 후외측인대 외에도 전방 십자 인대의 동반 파열 또한 의심해봐야 함
ref) 대한정형외과학 P 706
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