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Old 06-17-2013
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Hammer and Otoscope Physical Exam of Neck Pain Case

what should we do in Neck pain
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Old 06-17-2013
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Some things I can think of are ROM, check for tenderness, sensation in neck area and down the arms, probably DTRs of arms and legs.
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Depends on the history-age, sex & differential you are considering.
I would likely do MSE & Limited Neuro (UE).
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Quote:
Originally Posted by shima View Post
what should we do in Neck pain
shima it's in FA case 43
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Quote:
Originally Posted by usramt View Post
shima it's in FA case 43
those exams are just crazy , do we need to do all of them
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Old 06-18-2013
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Quote:
Originally Posted by shima View Post
those exams are just crazy , do we need to do all of them
I worry more about being able to remember which one is which and how to write the names correctly.
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Old 06-18-2013
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The approach I use to every MSK case is the Mneumonic:

In PROM with MRS P..

In PROM is what you do in the given joint with pain:
In - Inspection
P - Palpation
ROM - Range of motion

MRS P is what you do bellow the joint with a given problem:
M - Motor exam (Neuro test for strength)
R - Reflexes
S - Sensibility
P - Pulses distal do the joint affected

Sometimes you need to take MRS P for a walk to assess the gait..

So, that would be the basic for every MSK case, but there would be also some special tests depending upon the region, like for a knee pain you'd perform a lachman, drawer tests and etc..
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Old 06-18-2013
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Quote:
Originally Posted by shima View Post
those exams are just crazy , do we need to do all of them
No, just focused exam.
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Old 06-23-2013
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I dis the same case today..in neck- inspect, check for any point tenderness,thyroid,lymph gland enlargement, ROM and kernig or brudzinki ( only 1 I did because there was no c/o fever)..I also checked for visual acuity but did not do fundoscopy
Then strength and checkd for sharp and dull sensation in upper ext, pain sensation in both arms and muscle strength..same for lower ext and reflexes
Also check for cranial nerves ESP 11 and 10 ..then resp exam ( just auscultation) ..
I think these are enough..if u have more time u can do Lhermitte sign too..I didn't do any cvs or abd exam
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Quote:
Originally Posted by aaru20 View Post
I dis the same case today..in neck- inspect, check for any point tenderness,thyroid,lymph gland enlargement, ROM and kernig or brudzinki ( only 1 I did because there was no c/o fever)..I also checked for visual acuity but did not do fundoscopy
Then strength and checkd for sharp and dull sensation in upper ext, pain sensation in both arms and muscle strength..same for lower ext and reflexes
Also check for cranial nerves ESP 11 and 10 ..then resp exam ( just auscultation) ..
I think these are enough..if u have more time u can do Lhermitte sign too..I didn't do any cvs or abd exam
Lhermitte sign, should I do it. or is too dangerous, or right it in the work up
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Quote:
Originally Posted by shima View Post
Lhermitte sign, should I do it. or is too dangerous, or right it in the work up
I can't think of a good reason to do it (neither will I mention it in PNs since it is not something which is prohibited or too complicated/time consuming). I'll just ignore it since it is way too non-specific.
Also, Never do kernig's and brudzinski both since you are testing for the same thing i.e. meningeal irritation. So, just do kernig's or brudzinski. Personally, I'll do brudzinski since it is easier to do.
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