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Ankle Joint: The joint that is formed by the inferior articular and malleolar articular surfaces of the Tibia; the malleolar articular surface of the Fibula; and the medial malleolar, lateral malleolar, and superior surfaces of the Talus.
 JoVE Medicine

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

1Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, 2Department of Sport, Health and Exercise Science, University of Hull, 3Academic Vascular Department, Hull Royal Infirmary, Hull and East Yorkshire Hospitals, 4Department of Vascular Surgery, Addenbrookes Hospital


JoVE 51077

 JoVE Medicine

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

1Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), College of Medicine, University of Arizona, 2Department of Medicine, Division of Infectious Disease, College of Medicine, University of Arizona, 3Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine


JoVE 54275

 Science Education: Essentials of Physical Examinations III

Ankle Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The ankle and foot provide the foundation for the body and the stability needed for our upright posture and ambulation. Because of its weight-bearing function the ankle joint is a common site of injury among athletes and in the general population. Ankle injuries occur as a result of both acute trauma and repetitive overuse (such as running). The ankle is a fairly simple joint, consisting of the articulation between the distal tibia and talus of the foot, along with the fibula on the lateral side. The ankle is supported by numerous ligaments, most notably the deltoid ligament on the medial side, and laterally by three lateral ligaments (anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL)). Physical examination of the ankle and the patient history (including the mechanism of the injury and the location of pain provide diagnostic information that helps the physician to pinpoint specific structures involved in an injury, and are essential for determining the severity of the injury and the subsequent diagnostic steps. When examining the ankle, it is important to closely compare the injured ankle to the uninvolved side. Essential components of the ankle exam in

 Science Education: Essentials of Physical Examinations III

Knee Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The knee is a hinged joint that connects the femur with the tibia. It is the largest joint in the body and due to its location in the middle of the lower leg it is subjected to a variety of traumatic and degenerative forces. Examination of the knee can be quite complex, owing to the fact it is an inherently unstable joint held together by various ligaments and supported by menisci, which act as shock absorbers and increase the contact area of the joint. In addition, the patella lies in front of the knee acting as a fulcrum to allow the forceful extension of the knee needed for running and kicking. As the largest sesamoid bone in the body, it is a common source of pain related to trauma or overuse. When examining the knee, it is important to remove enough clothing so that the entire thigh, knee, and lower leg are exposed. The exam begins with inspection and palpation of key anatomic landmarks, followed by an assessment of the patient's range of motion. The knee exam continues with tests for ligament or meniscus injury and the special testing for patellofemoral dysfunction and dislocation of patella. The opposite knee should be used as the standard to evaluate the injured knee, provided it too has not been previously injur

 JoVE Bioengineering

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

1Department of Veterans Affairs (VA) Rehabilitation Research and Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, 2Department of Veterans Affairs (VA) Spinal Cord Injury Service, James J. Peters VA Medical Center


JoVE 54071

 Science Education: Essentials of Physical Examinations III

Motor Exam I

JoVE Science Education

Source: Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

Abnormalities in the motor function are associated with a wide range of diseases, from movement disorders and myopathies to strokes. The motor assessment starts with observation of the patient. When the patient enters the examination area, the clinician observes their ability to walk unassisted and their speed and coordination while moving. Taking the patient's history provides an additional opportunity to observe for evidence of tremors or other abnormal movements, such as chorea or tardive dyskinesia. Such simple but important observations can yield valuable clues to the diagnosis and helps to focus the rest of the examination. The motor assessment continues in a systematic fashion, including inspection for muscle atrophy and abnormal movements, assessment of muscle tone, muscle strength testing, and finally, the examination of the muscle reflexes and coordination. The careful systematic testing of the motor system and the integration of all the findings provide insight to the level at which the motor pathway is affected, and also help the clinician to formulate the differential diagnosis and determine the course of the subsequent evaluation and treatment.

 Science Education: Essentials of Lab Animal Research

Blood Withdrawal II

JoVE Science Education

Source: Kay Stewart, RVT, RLATG, CMAR; Valerie A. Schroeder, RVT, RLATG. University of Notre Dame, IN

The collection of blood from mice and rats for analysis can be done through a variety of methods. Each method of collection has variations in the type of restraint required, the invasiveness of the procedure, and the necessity of a general anesthetic.1Historically, the use of the retro-orbital sinus cavity has been used, but not without debate. The controversy related to the potential tissue damage,or even blindness,caused by retro-orbital bleeds has led to the development of facial and submandibular vein bleeding methods in mice.Blood collection from the saphenous vein in both mice and rats is another technique that has been developed. These procedures do not require anesthesia and therefore are suitable when the use of anesthetics may confound blood results or other data.

 Science Education: Essentials of Physical Examinations III

Motor Exam II

JoVE Science Education

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

There are two main types of reflexes that are tested on a neurological examination: stretch or deep tendon reflexes, and superficial reflexes. A deep tendon reflex (DTR) results from the stimulation of a stretch-sensitive afferent from a neuromuscular spindle, which, via a single synapse, stimulates a motor nerve leading to a muscle contraction. DTRs are increased in chronic upper motor neuron lesions (lesions of the pyramidal tract) and decreased in lower motor neuron lesions and nerve and muscle disorders. There is a wide variation of responses and reflexes graded from 0 to 4+ (Table 1). DTRs are commonly tested to help localize neurologic disorders. A common method of recording findings during the DTRs examination is using of a stick ure diagram. The DTR test can help distinguish upper and lower motor neuron problems and can assist in localizing nerve root compression as well. Although the DTR of nearly any skeletal muscle could be tested, the reflexes that are routinely tested are: brachioradialis, biceps, triceps, patellar, and Achilles (Table 2). Superficial reflexes are segmental reflex responses that result from stim

 JoVE Biology

High-Throughput, Multi-Image Cryohistology of Mineralized Tissues

1Department of Reconstructive Sciences, University of Connecticut Health Center, 2Department of Computer Science and Engineering, University of Connecticut, 3Department of Orthopaedic Surgery, University of Connecticut Health Center, 4Department of Orthopaedics, University of Rochester


JoVE 54468

 JoVE Medicine

In Vivo Optical Imaging of Brain Tumors and Arthritis Using Fluorescent SapC-DOPS Nanovesicles

1Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, 2Division of Human Genetics, University of Cincinnati College of Medicine, 3Department of Radiology, University of Cincinnati College of Medicine, 4Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 5Solid Tumor Biology Program, James Comprehensive Cancer Center, The Ohio State University Medical Center, 6Department of Neurological Surgery, James Comprehensive Cancer Center, The Ohio State University Medical Center


JoVE 51187

 JoVE Medicine

Generation of Organ-conditioned Media and Applications for Studying Organ-specific Influences on Breast Cancer Metastatic Behavior

1London Regional Cancer Program, London Health Sciences Centre, 2Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, 3Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, 4Department of Oncology, Schulich School of Medicine & Dentistry, Western University, 5Lawson Health Research Institute


JoVE 54037

 Science Education: Essentials of Physical Examinations III

Lower Back Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The back is the most common source of pain in the body. Examination of the back can be a challenge due to its numerous structures including the bones, discs, ligaments, nerves, and muscles - all of which can generate pain. Sometimes, the location of the pain can be suggestive of etiology. The essential components of the lower back exam include inspection and palpation for signs of deformity and inflammation, evaluation of the range of motion of the back, testing the strength of the muscles innervated by the nerves exiting in the lumbar-sacral spine, neurological evaluation, and special tests, including the Stork test and Patrick's test.

 Science Education: Essentials of Physical Examinations III

Hip Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The hip is a ball and socket joint that consists of the femoral head articulating with the acetabulum. When combined with the hip ligaments, it makes for a very strong and stable joint. But, despite this stability, the hip has considerable motion and is prone to degeneration with wear and tear over time and after injury. Hip pain can affect patients of all ages, and it can be associated with various intra- and extra-articular pathologies. Anatomic location of pain in the hip region can often provide initial diagnostic clues. Essential aspects of the hip exam include an inspection for asymmetry, swelling, and gait abnormalities; palpation for areas of tenderness; range of motion and strength testing; a neurological (sensory) exam; and additional special diagnostic maneuvers to narrow down the differential diagnosis.

 JoVE In-Press

Combining Intravital Fluorescent Microscopy (IVFM) with Genetic Models to Study Engraftment Dynamics of Hematopoietic Cells to Bone Marrow Niches

1Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, 2Indiana Center for Biological Microscopy, Department of Medicine, Indiana University School of Medicine, 3Department of Pediatrics, Indiana University School of Medicine

Video Coming Soon

JoVE 54253

 JoVE In-Press

Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease

1Institute of Imaging Science, Vanderbilt University, 2Department of Radiology and Radiological Sciences, Vanderbilt University, 3Department of Biomedical Engineering, Vanderbilt University, 4Department of Molecular Physiology and Biophysics, Vanderbilt University, 5Department of Physical Medicine and Rehabilitation, Vanderbilt University, 6Department of Physics and Astronomy, Vanderbilt University

Video Coming Soon

JoVE 52352

 JoVE Medicine

Myo-mechanical Analysis of Isolated Skeletal Muscle

1Cardiovascular Research Institute, University of California San Francisco, 2Department of Pediatrics, University of California San Francisco, 3Department of Biology, San Francisco State University, 4Department of Medicine, University of California San Francisco, 5Eli and Edythe Broad Center of Regeneration Medicine & Stem Cell Research, University of California San Francisco


JoVE 2582

 Science Education: Essentials of Physical Examinations III

Sensory Exam

JoVE Science Education

Source: Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

A complete sensory examination consists of testing primary sensory modalities as well as cortical sensory function. Primary sensory modalities include pain, temperature, light touch, vibration and joint position sense. Whereas the sensation of the face is discussed in the video of the cranial nerve examination as are the special senses of smell, vision, taste, and hearing. Pain and temperature information from skin to thalamus is mediated by the spinothalamic tract. The spinothalamic fibers decussate (cross over) 1-2 spinal nerve segments above the point of entry and then travel up to the brainstem until they synapse on various nuclei in thalamus. From the thalamus, information is the relayed to the cortical areas such as postcentral gyrus, also known as the primary somatosensory cortex. Afferent fibers transmitting vibration and proprioception travel up to medulla in the ipsilateral posterior columns as fasciculus gracilis and fasciculus cuneatus, which carry information from the lower limbs and upper limbs, respectively. Subsequently the afferent projections cross over and ascend to thalamus and from there to the primary somatosensory cortex. The p

 JoVE Biology

Assessment of Calcium Sparks in Intact Skeletal Muscle Fibers

1Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, 2Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, 3Department of Molecular Biophysics and Physiology, Rush University Medical Center, 4Department of Internal Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center


JoVE 50898

 JoVE Neuroscience

Flat Mount Imaging of Mouse Skin and Its Application to the Analysis of Hair Follicle Patterning and Sensory Axon Morphology

1Department of Molecular Biology and Genetics, Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, 2Department of Neuroscience, Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, 3Department of Ophthalmology, Howard Hughes Medical Institute, Johns Hopkins University School of Medicine


JoVE 51749

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