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Tendons: Fibrous bands or cords of Connective tissue at the ends of Skeletal muscle fibers that serve to attach the Muscles to bones and other structures.

Motor Exam II

JoVE 10095

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 DTR examination is using a stick figure 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 ref


 Physical Examinations III

Knee Exam

JoVE 10203

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, the knee 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 (ROM). The knee exam continues with tests for ligament or meniscus injury and special testing for patellofemoral dysfunction and dislocation of the patella. The opposite knee should be used as the standard to evaluate the injured knee, provided it has not been previousl


 Physical Examinations III

Wrist and Hand Examination

JoVE 10242

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

The wrist is a complex joint made up of 8 carpal bones and their numerous articulations and ligaments. Overlying the wrist are the tendons and muscles of the hand and fingers. The hand is made up of 5 metacarpal bones, and the tendons that run to the hand overlie these bones. Finally, the fingers consist of 14 phalanges with their articulations held together by collateral ligaments and volar plates. Common mechanisms of both acute and chronic wrist injury include impact, weight bearing (which can occur in gymnastics), twisting, and throwing. Osteoarthritis of the hand commonly affects distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints, while rheumatoid arthritis (RA) is seen in the metacarpophalangeal (MCP) and PIP joints. It is important to compare the injured wrist or hand to the uninvolved side. Key aspects of the wrist and hand exam include inspection, palpation for tenderness or deformity, testing the range of motion (ROM) and strength, neurovascular assessment, ligaments and tendon testing, and the special tests.


 Physical Examinations III

Lateral Canthotomy and Inferior Cantholysis

JoVE 10266

Source: James W Bonz, MD, Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA

Lateral canthotomy is a potentially eyesight-saving procedure when performed emergently for an orbital compartment syndrome. An orbital compartment syndrome results from a buildup of pressure behind the eye; as pressure mounts, both the optic nerve and its vascular supply are compressed, rapidly leading to nerve damage and blindness if the pressure is not quickly relieved. The medial and lateral canthal tendons hold the eyelids firmly in place forming an anatomical compartment with limited space for the globe. In an orbital compartment syndrome, pressure rapidly increases as the globe is forced against the eyelids. Lateral canthotomy is the procedure by which the lateral canthal tendon is severed, thereby releasing the globe from its fixed position. Often, severing of the lateral canthal tendon alone is not enough to release the globe and the inferior portion (inferior crus) of the lateral canthal tendon also needs to be severed (inferior cantholysis). This increases precious space behind the eye by allowing the globe to become more proptotic, resulting in decompression. Most frequently, orbital compartment syndrome is the result of acute facial trauma, with the subsequent development of a retrobulbar


 Emergency Medicine and Critical Care

Ankle Exam

JoVE 10191

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 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: the 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 i


 Physical Examinations III

Neck Exam

JoVE 10180

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

Examination of the neck can be a challenge because of the many bones, joints, and ligaments that make up the underlying cervical spine. The cervical spine is composed of seven vertebrae stacked in gentle C-shaped curve. The anterior part of each vertebra is made up of the thick bony body, which is linked to the body above and below by intervertebral discs. These discs help provide stability and shock absorption to the cervical spine. The posterior elements of the vertebra, which include the laminae, transverse, and spinous processes and the facet joints, form a protective canal for the cervical spinal cord and its nerve roots. The cervical spine supports the head and protects the neural elements as they come from the brain and from the spinal cord. Therefore, injuries or disorders affecting the neck can also affect the underlying spinal cord and have potentially catastrophic consequences. The significant motion that occurs in the neck places the cervical spine at increased risk for injury and degenerative changes. The cervical spine is also a common source of radicular pain in the shoulder. For this reason, the neck should be evaluated as a routine part of every shoulder exam.


 Physical Examinations III

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


 Biology

Isolation and Characterization of Satellite Cells from Rat Head Branchiomeric Muscles

1Department of Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 2Department of Biological Structure, University of Washington School of Medicine, 3Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center

JoVE 52802


 Developmental Biology

Peripheral Vascular Exam

JoVE 10122

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

The prevalence of peripheral vascular disease (PVD) increases with age and is a significant cause of morbidity in older patients, and peripheral artery disease (PAD) is associated with cardiovascular and cerebrovascular complications. Diabetes, hyperlipidemia, hypertension, and tobacco use are important disease risk factors. When patients become symptomatic, they frequently complain of limb claudication, defined as a cramp-like muscle pain that worsens with activity and improves with rest. Patients with chronic venous insufficiency (CVI) often present with lower extremity swelling, pain, skin changes, and ulceration. While the benefits of screening asymptomatic patients for PVD are unclear, physicians should know the proper exam technique when the diagnosis of PVD is being considered. This video reviews the vascular examination of the upper and lower extremities and abdomen. As always, the examiner should use a systematic method of examination, though in practice, the extent of the exam a physician performs depends on their suspicion of underlying PVD. In a patient who has or is suspected to have risk factors for vascular disease, the vascular exam should be thorough, beginning with inspection, fo


 Physical Examinations I

Elbow Exam

JoVE 10207

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

The elbow is a hinged joint that involves the articulation of 3 bones: the humerus, radius, and ulna. It is a much more stable joint than the shoulder, and because of that, the elbow has less range of motion. The elbow and its structures are prone to significant injuries, particularly with repetitive motion. Lateral and medial epicondylitis (also called tennis elbow and golfer's elbow) are two common diagnoses and often occur as a result of occupational activities. When examining the elbow, it is important to remove enough clothing so that the entire shoulder and elbow can be inspected. It is important to compare the injured elbow to the uninvolved side. A systematic evaluation of the elbow includes inspection, palpation, range of motion (ROM) testing, and special tests, including maneuvers to evaluate ligamentous stability and stretch tests to accentuate pain caused by epicondylitis.


 Physical Examinations III

3D Ultrasound Imaging: Fast and Cost-effective Morphometry of Musculoskeletal Tissue

1Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 2Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, Amsterdam Movement Sciences

Video Coming Soon

JoVE 55943


 JoVE In-Press

Isometric and Eccentric Force Generation Assessment of Skeletal Muscles Isolated from Murine Models of Muscular Dystrophies

1Department of Anatomy and Cell Biology, School of Dental Medicine, University of Pennsylvania, 2Department of Physiology, Perelman School of Medicine, University of Pennsylvania, 3Department of Anatomy and Cell Biology, School of Dental Medicine, School of Dental Medicine, University of Pennsylvania

JoVE 50036


 Biology

Shoulder Exam I

JoVE 10173

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

Examination of the shoulder can be complex, because it actually consists of four separate joints: are the glenohumeral (GH) joint, the acromioclavicular (AC) joint, the sternoclavicular joint, and the scapulothoracic joint. The GH joint is primarily responsible for shoulder motion and is the most mobile joint in the body. It has been likened to a golf ball sitting on a tee and is prone to instability. It is held in place by the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis), along with the GH ligaments. The shoulder exam begins with the inspection and palpation of the key anatomic landmarks, followed by an assessment of the patient's range of motion. The opposite shoulder should be used as the standard to evaluate the injured shoulder, provided it has not been previously injured.


 Physical Examinations III

Robotic Mirror Therapy System for Functional Recovery of Hemiplegic Arms

1Department of Biomedical Engineering, Seoul National University College of Medicine, 2Department of Rehabilitation Medicine, Chungnam National University Hospital, 3Interdisciplinary Program for Bioengineering, Seoul National University Graduate School, 4Department of Rehabilitation Medicine, Seoul National University Hospital, 5Seoul National University College of Medicine, 6Institute of Medical and Biological Engineering, Seoul National University

JoVE 54521


 Bioengineering

In Situ Immunofluorescent Staining of Autophagy in Muscle Stem Cells

1Department of Medicine, Institute of Translational Pharmacology, Italian National Research Council, 2Epigenetics and Regenerative Medicine, IRCCS Fondazione Santa Lucia, 3Biological and Environmental Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), 4Department of Life Sciences, University of Modena and Reggio Emilia

JoVE 55908


 Biology

Peripheral Vascular Exam Using a Continuous Wave Doppler

JoVE 10123

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

Peripheral vascular disease (PVD) is a common condition affecting older adults and includes disease of the peripheral arteries and veins. While the history and physical exam offer clues to its diagnosis, Doppler ultrasound has become a routine part of the bedside vascular examination. The video titled "The Peripheral Vascular Exam" gave a detailed review of the physical examination of the peripheral arterial and venous systems. This video specifically reviews the bedside assessment of peripheral arterial disease (PAD) and chronic venous insufficiency using a handheld continuous wave Doppler. The handheld Doppler (HHD) is a simple instrument that utilizes continuous transmission and reception of ultrasound (also referred to as continuous wave Doppler) to detect changes in blood velocity as it courses through a vessel. The Doppler probe contains a transmitting element that emits ultrasound and a receiving element that detects ultrasound waves (Figure 1). The emitted ultrasound is reflected off of moving blood and back to the probe at a frequency directly related to the velocity of blood flow. The reflected signal is detected and transduced to an audible sound with a frequen


 Physical Examinations I

Fabrication of Extracellular Matrix-derived Foams and Microcarriers as Tissue-specific Cell Culture and Delivery Platforms

1Biomedical Engineering Graduate Program, The University of Western Ontario, 2Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, 3Department of Chemical Engineering, Queen's University, 4Department of Chemical & Biochemical Engineering, Faculty of Engineering, The University of Western Ontario

JoVE 55436


 Bioengineering

Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual

1Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, 2Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital of Modena, 3Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital of Verona, 4Artificial Hearing Research, Artorg Center for Biomedical Engineering, University of Bern

Video Coming Soon

JoVE 56390


 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

JoVE 52352


 Medicine

Lower Back Exam

JoVE 10177

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 (ROM) 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).


 Physical Examinations III

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