Nicholas Ch02 Static Examination
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2 Osteopathic Static Musculoskeletal Examination The osteopathic structural examination has both static and dynamic components. The physician will normally use static examination as a method to discern obvious structural asymmetries of osseous and myofascial origin and extrapolate from that information to determine etiologies that affect function. Therefore, on visual examination alone, a physician can postulate what the subsequent specific dynamic examination will elicit. Observance of gait may preface the static examination, as the patient can be observed walking into the examination room. A number of conditions produce obvious antalgic and asymmetric tendencies, such as osteoarthritis of the hips and knee, degenerative discogenic spondylosis of the lumbar spine, and acute problems, including strains and sprains. The visual observance of gait and the associated static examination (which may be performed either before or after gait evaluation) will help the physician understand the patient's medical and psychological status and also help avoid portions of the examination that may be painful or in other ways detrimental to the patient. These types of scrutiny affect the patient less than dynamic examinations with physical contact and therefore are less likely to cause pain or damage the patient. As an example, a patient with the asymmetric findings illustrated in Figure 2.1 (see p. 10 ) could be reasonably expected to exhibit motion restriction and motion asymmetry in the thoracic and lumbar spine with restrictions in lumbar side bending to the left and midthoracic side bending to the right. These findings would also cause the physician to be concerned with right and left latissimus dorsi, psoas, and erector spinae tension asymmetries affecting range of motion of the hip, pelvis, and shoulder girdle ( Fig. 2.1 ). Therefore, the physician should observe the patient in posterior, anterior, and lateral (sagittal and coronal plane) views to develop the most complete understanding of the patient's physical makeup before performing the remainder of the examination. These views may be started at the feet or at the head. We generally recommend starting at the feet, as that is the gravitational contact point. The static musculoskeletal (structural) examination uses superficial anatomic landmarks that help the physician “see the forest for the trees.” Sometimes slight asymmetries are missed, but aligning two or
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Transcript of Nicholas Ch02 Static Examination
2 Osteopathic Static Musculoskeletal ExaminationThe osteopath ic s tructural examinat ion has both stat ic and dynamic components. The phys ic ian wi l l normal ly use stat ic examinat ion as a method to discern obv ious s tructura l
asymmetr ies of osseous and myofasc ia l or ig in and ext rapolate f rom that in format ion to determine et io log ies that af fect funct ion. Therefore, on v isual examinat ion alone, a
phys ic ian can postu late what the subsequent speci f ic dynamic examinat ion wi l l e l ic i t .Observance of gai t may preface the stat ic examinat ion, as the pat ient can be observed
walk ing into the examinat ion room. A number of condi t ions produce obv ious anta lg ic and asymmetr ic tendencies, such as osteoarthr i t is o f the hips and knee, degenerat ive
discogenic spondylos is o f the lumbar sp ine, and acute problems, inc luding st ra ins and spra ins. The visual observance of gai t and the associated stat ic examinat ion (which may be
performed e i ther before or a f ter ga i t eva luat ion) wi l l help the physic ian understand the pat ient 's medica l and psychological s ta tus and a lso help avoid por t ions of the examinat ion
that may be painfu l or in other ways detr imenta l to the pat ient . These types of scrut iny af fect the pat ient less than dynamic examinat ions wi th physica l contact and therefore are
less l ikely to cause pain or damage the pat ient .As an example, a pat ient wi th the asymmetr ic f ind ings i l lust ra ted in Figure 2.1 (see p. 10 )
could be reasonably expected to exhib i t mot ion restr ic t ion and mot ion asymmetry in the thoracic and lumbar sp ine wi th restr ic t ions in lumbar s ide bending to the lef t and
midthorac ic s ide bending to the r ight . These f indings would a lso cause the physic ian to be concerned with r ight and lef t la t iss imus dors i , psoas, and erector sp inae tension
asymmetr ies af fect ing range of mot ion of the hip, pe lv is , and shoulder gi rd le ( Fig. 2 .1 ) .Therefore, the physic ian should observe the pat ient in poster ior, anter ior , and la teral
(sagi t ta l and coronal plane) v iews to develop the most complete understanding of the pat ient 's physica l makeup before performing the remainder o f the examinat ion. These v iews
may be star ted at the feet or at the head. We genera l ly recommend start ing at the feet , as that is the gravi ta t ional contact po int .
The stat ic musculoskeleta l (st ructural ) examinat ion uses super f ic ia l anatomic landmarks that he lp the phys ic ian “see the forest for the t rees. ” Sometimes sl ight asymmetr ies are
missed, but a l ign ing two or three landmarks makes the asymmetry obvious. Some anatomic landmarks are impor tant for f ind ing spina l vertebral levels. The sp ine of the scapula is
typica l ly a t the leve l of T3, and the in fer ior angle of the scapula is typica l ly at the leve l of the sp inous process of T7 and transverse processes of T8 ( Fig. 2 .2 ) . Some landmarks
assist in locat ing a more cl in ical ly impor tant landmark. The masto id process and angle of the mandible are commonly used to help the nov ice palpate the C1 transverse process ( Fig.
2.3 ) . Other landmarks, such as the coracoid process, b ic ip i ta l groove of the humerus, and greater and lesser tuberos i t ies of the humerus, he lp d is t inguish one tendon from another,
hence d i f ferent ia te between a rotator cuf f syndrome and another somat ic problem ( Fig. 2.4 ) . The most commonly used landmarks tend to be the ones that determine hor izonta l
symmetry or asymmetry (Figs. 2.5 , 2.6 , 2.7 , 2.8 , 2.9 ) . Landmarks such as the t ib ia l tuberos i t ies, anter ior super ior i l iac sp ines, poster ior super ior i l iac sp ines, i l iac crests ,
n ipp les, shoulders at the acromioclav icular jo int , ear lobes, and eyes as hor izonta l leve ls plane are of ten used for th is purpose.
Asymmetry is one of the three measurable components of somat ic dysfunct ion ( tenderness or sens i t iv i ty be ing more subject ive) and therefore is one of the bas ic s teps to develop the
diagnosis for somat ic dysfunct ion.
Figure 2.7. Anterior view points of reference.
Figure 2.8. Posterior view points of reference.
Figure 2.9. Lateral view points of reference and midgravity line.
