Internal Medicine (Physical Examination)
Examination of the Locomotor system and of the Peripheral Vessels -extremities
MUDr. Yvona Pospíšilová - IHOK FN Brno a LF MU Brno MUDr. Andrea Křivanová, Ph.D. - IHOK, FN Brno
Examination of the LOCOMOTOR
SYSTEM AND THE PERIPHERAL
VESSELS - extremities
o CHANGES OF THE SKIN
o EXAMINATION OF THE LOCOMOTOR SYSTEM
• Joints
• Spine
o EXAMINATION OF THE PERIPHERAL VESSELS
• Arteries
• Veins
• Lymphatic vessels
Examination of the PERIPHERAL VESSELS - arteries
• Upper extremities
• A. radialis (radial artery) always
• A. radialis (radial artery)
• A. ulnaris (ulnar artery)
A. brachialis (brachial artery)
• A. axilaris (axillary artery)
• Lower extremities
All of them always
• A. femoralis (femoral artery)
• A. poplitea (popliteal artery)
• A. tibialis posterior (posterior tibial artery)
• A. dorsalis pedis (dorsalis pedis artery)
Examination of the PERIPHERAL VESSELS - arteries
• Cyanosis - ischaemic disease of the lower extremities (ischaemic peripheral vascular disease)
Examination of the PERIPHERAL VESSELS - arteries
Examination of the PERIPHERAL VESSELS - arteries
• Raynaud's disease (spasm of small arteries, often with rheumatic or immunologic diseases)
Examination of the PERIPHERAL VESSELS - veins (varices)
Examination of the PERIPHERAL
VESSELS - veins
Varices - varicosity (primary or secondary after deep venous thrombosis
Examination of the PERIPHERAL
VESSELS - veins
Phlebectases (venectases) - „small broomlets" - only a cosmetic defect
Examination of the PERIPHERAL
VESSELS - veins
• Post-phlebotrombotic or post-phlebitic syndrome (after repeated deep venous phlebotrombosis or phlebitis)
Examination of the PERIPHERAL
VESSELS - ulcers
Veins (medial part)
Arteries (lateral part)
Examination of the PERIPHERAL VESSELS
- veins + arteries
• Phlegmasia cerulea dolens (acute massive phlebotrombosis of v. femoralis)
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Examination of the PERIPHERAL VESSELS - lymphatic vessels
Non-pitting oedema, (primary or secondary defficiency)
Examination of the JOINTS
o Coxa vara
o Genua vara and valga
VARA (0)
VALGA (X)
Examination of the JOINTS
Arthritis - inflammation or Arthrosis - degeneration
• Dolor Calor
• Rubor
• Tumor (edema, sweling, osseal hyperplasia, accumalation fluid, thickening of the synovial membrane and capsule of the joint)
Functio laesa
Examination of the JOINTS
• Arthritis - inflammation or Arthrosis - degeneration
• Dolor Calor
• Rubor
• Tumor Functio laesa
Examination of the JOINTS
• Arthritis - inflammation or Arthrosis -degeneration
Heberden's nodes - arthritis Bouchard's nodes - arthrosis
Examination of the JOINTS
• Deformities
o - pathlogic position or pathologic configuration of the articulating bones
o - nodes (knots)
Examination of the SPINE
o Inspection at rest
o Skoliosis (dextro x sinistro) o Kyphosis x lordosis
Examination of the SPINE
o Inspection at rest
o Skoliosis (dextro x sinistro) o Kyphosis x lordosis o Gibbus (humpback)
KYPHOSIS
Kyphotic spine
Normal spine
Examination of the SPINE
o Inspection at rest
o Skoliosis (dextro x sinistro) o Kyfosis x lordosis o Gibbus
Examination of the Spine
o During motion
• Thomayer's distance test
o patient bends forward with knees extended and tries to touch the ground with the fingertips
o normal findings: to 10 cm between the floor and the fingertips
• Shober's distance test
o in an upright patient 10 cm are measured proximally from the intersection between the posterior midline and a line connecting both superior posterior iliac spines
o normal findings: after leaning forward the distance is at least 4 cm longer
Examination of the Spine
o During motion
• Lateroflexion
• Stibor's distance test
o in an upright patient the distance are measured between the intersection between the posterior midline and a line connecting both superior posterior iliac spines and the spinous process of the C7 vertebra
o normal findings: after leaning forward the distance is at least 6 cm longer