1、专 业 外 语,吉林大学中日联谊医院骨科王 刚,主要内容,Examination of Specific JointsElbow examinationWrist examinationSciatica examinationHip symptomHip examination,Part 1 Tennis ElbowP621,肘关节检查最后一段，网球肘查体,Tennis elbow(网球肘), also known as lateral epicondylitis（外上髁炎）, is a common condition characterized by pain in the region
2、of the lateral epicondyle（外上髁） of the humerus（肱骨）. The pain radiates down the extensor（伸肌） surface of the forearm.,Patients with tennis elbow often experience pain when attempting to open a door or when lifting a glass. To test for tennis elbow, the examiner should flex the elbow and fully pronate（手
3、掌向下，旋前） the hand. Pain over the lateral epicondyle while extending the elbow is diagnostic of tennis elbow.,Another test involves having the patient clench（紧握） the fist, dorsiflex（背伸） the wrist, and extend the elbow. Pain is elicited（引出） by trying to force the dorsiflexed hand into palmar（掌侧的，掌的） fl
4、exion.,Vocabulary,Tennis elbow(网球肘)lateral epicondylitis（外上髁炎）epicondyle（上髁）humerus（肱骨）extensor（伸肌）,vocabulary,pronate（手掌向下，旋前）supinate（手掌向上，旋后）clench（紧握）dorsiflex（背伸）elicit（引出）palmar（掌侧的，掌的）,单词复习,Tennis elbowlateral epicondylitisepicondylehumerusextensor,单词复习,pronatesupinateclenchdorsiflexelicitpal
5、mar,Part 1 详解,Tennis elbow(网球肘), also known as lateral epicondylitis（外上髁炎）, is a common condition characterized by pain in the region of the lateral epicondyle（外上髁） of the humerus（肱骨）. The pain radiates down the extensor（伸肌） surface of the forearm.,Patients with tennis elbow often experience pain wh
6、en attempting to open a door or when lifting a glass. To test for tennis elbow, the examiner should flex the elbow and fully pronate（手掌向下，旋前） the hand. Pain over the lateral epicondyle while extending the elbow is diagnostic of tennis elbow.,Another test involves having the patient clench（紧握） the fi
7、st, dorsiflex（背伸） the wrist, and extend the elbow. Pain is elicited（引出） by trying to force the dorsiflexed hand into palmar（掌侧的，掌的） flexion.,Part 2 Carpal Tunnel SyndromeP622 腕关节检查最后一段，腕管综合征查体,When the diagnosis of carpal tunnel syndrome(腕管综合征) is suspected, a sharp tap or pressure directly over the
8、 median nerve（正中神经） may reproduce(复制，重现) the paresthesias(感觉异常) of carpal tunnel syndrome, called Tinels sign（Tinel 征）.,Another useful test is for the examiner to stretch the median nerve by extending the patients elbow and dorsiflexing (背屈)the wrist. The development of pain or paresthesias suggests
9、 the diagnosis.,A third test entails(需要，使必要) the patient holding both wrists in a fully palmar-fixed（固定在掌屈） position for 2 minutes. The development or exacerbation（加剧，恶化） of paresthesias（感觉异常） is suggestive of carpal tunnel syndrome.,vocabulary,carpal tunnel syndrome(腕管综合征)carpal （腕骨的）tunnel （隧道）syn
10、drome (综合征)median nerve（正中神经）reproduce(复制，重现)paresthesia (感觉异常),vocabulary,Tinels sign（Tinel 征）dorsiflex (背屈)entails(需要，使必要)palmar-fixed（固定在掌屈）exacerbation（加剧，恶化）paresthesia（感觉异常）,单词复习,carpal tunnel syndromecarpal tunnel syndrome median nervereproduceparesthesia,单词复习,Tinels signdorsiflex entailspalm
11、ar-fixedexacerbationparesthesia,Part 2 详解,When the diagnosis of carpal tunnel syndrome(腕管综合征) is suspected, a sharp tap or pressure directly over the median nerve（正中神经） may reproduce the paresthesias(感觉异常) of carpal tunnel syndrome, called Tinels sign（Tinel 征）.,Another useful test is for the examine
12、r to stretch the median nerve by extending the patients elbow and dorsiflexing (背屈)the wrist. The development of pain or paresthesias suggests the diagnosis.,A third test entails(需要，使必要) the patient holding both wrists in a fully palmar-fixed（固定在掌屈） position for 2 minutes. The development or exacerb
13、ation（加剧，恶化） of paresthesias（感觉异常） is suggestive of carpal tunnel syndrome.,注意预防腕管综合征,Part 3 SciaticaP624, 最后一段 坐骨神经痛查体,Pain from entrapment（神经卡压） of the sciatic nerve is called sciatica（坐骨神经痛）. Patients with sciatica describe pain, burning, or aching in the buttocks radiating（放射） down the posterior
14、 （后方）thigh to the posterolateral aspect of the calf（小腿）. Pain is worsened by sneezing, laughing, or straining(用力) at stool（大便）.,One of the tests for sciatica is the straight leg raising test(直腿抬高试验). The patient is asked to lie supine（仰卧位） while the examiner flexes the extended leg to the trunk（躯干）
15、at the hip. The presence of pain is a positive test.,The patient is asked to plantarflex (跖屈) and dorsiflex（背屈） the foot. This stretches the sciatic nerve even more. If sciatica is present, this test reproduces(复制重现) pain in the leg. The test is illustrated in Figure 20-40,vocabulary,entrapment（神经卡压
16、）In criminal law,entrapmentis a practice whereby a law enforcement agent induces a person to commit a criminal offense that the person would have otherwise been unlikely to commit.,sciatica（坐骨神经痛）radiate（放射）posterior （后方）calf（小腿）,vocabulary,strain(用力)stool（大便）straight leg raising test(直腿抬高试验)supine（
17、仰卧位）prone (俯卧位)trunk（躯干）,vocabulary,plantarflex(跖屈) plantar 跖侧的dorsiflex（背屈） dorsal 背侧的reproduces(复制重现),单词复习,entrapmentsciaticaradiateposterior calf,单词复习,strainstoolstraight leg raising testsupineprone trunk,单词复习,plantarflex plantar dorsiflex dorsalreproduces,Part 3 详解,Pain from entrapment（神经卡压） of
18、the sciatic nerve is called sciatica（坐骨神经痛）. Patients with sciatica describe pain, burning, or aching in the buttocks radiating（放射） down the posterior （后方）thigh to the posterolateral aspect of the calf（小腿）. Pain is worsened by sneezing, laughing, or straining(用力) at stool（大便）.,One of the tests for s
19、ciatica is the straight leg raising test(直腿抬高试验). The patient is asked to lie supine（仰卧位） while the examiner flexes the extended leg to the trunk（躯干） at the hip. The presence of pain is a positive test.,The patient is asked to plantarflex (跖屈) and dorsiflex（背屈） the foot. This stretches the sciatic n
20、erve even more. If sciatica is present, this test reproduces(复制重现) pain in the leg. The test is illustrated in Figure 20-40,Part 4 髋关节症状Hip SymptomsP625 第二段,Limp gait,Hip Symptoms,The main symptoms of hip disease are pain, stiffness（僵硬）, deformity （畸形）, and a limp(跛行). Hip pain may be localized to t
21、he groin（腹股沟） or may radiate（放射） down the medial aspect of the thigh. Stiffness may be related to periods of immobility（固定的时间段）.,An early symptom of hip disease is difficulty putting on shoes. This requires external rotation（外旋） of the hip, which is the first motion to be lost with degenerative（退变性的
22、） disease of the hip. This is followed by loss of abduction（外展） and adduction（内收）; hip flexion（屈曲） is the last movement lost.,Vocabulary,stiffness（僵硬）deformity（畸形）limp(跛行)groin（腹股沟）radiate（放射）,vocabulary,periods of immobility（固定的时间段）external rotation（外旋）degenerative（退变性的）abduction（外展）adduction（内收）fl
23、exion（屈曲）,单词复习,stiffnessdeformitylimpgroinradiate,单词复习,periods of immobilityexternal rotationdegenerativeabductionadductionflexion,Hip Symptoms Part 4 详解,The main symptoms of hip disease are pain, stiffness（僵硬）, deformity （畸形）, and a limp(跛行). Hip pain may be localized to the groin（腹股沟） or may radia
24、te（放射） down the medial aspect of the thigh. Stiffness may be related to periods of immobility（固定的时间段）.,An early symptom of hip disease is difficulty putting on shoes. This requires external rotation（外旋） of the hip, which is the first motion to be lost with degenerative（退变性的） disease of the hip. This
25、 is followed by loss of abduction（外展） and adduction（内收）; hip flexion（屈曲） is the last movement lost.,Part 5Hip Examination,Hip Examination,The examination of the hip is performed with the patient standing and lying on the back. Inspection（望诊） of the hips and gait（步态） has already been described. The T
26、rendelenburg test indicates（提示，预示） a disorder（混乱，失调） between the pelvis（骨盆） and the femur（股骨）. The patient is asked to stand on the “good” leg, as illustrated in Figure 20-42A.,The examiner should note that the pelvis on the opposite side elevates（提高，提升）, demonstrating （展示，演示，说明）that the gluteus med
27、ius(臀中肌) is working efficiently（有效地）. When the patient is asked to stand on the “bad” leg, as shown in Figure 20-42B, the pelvis on the opposite side falls. This is termed a positive Trendelenburg test.,Ask the patient to lie on his or her back. The hip is acutely（强烈地，剧烈地，极度地） flexed on the abdomen（
28、腹部） to flatten the lumbar（腰椎的） spine（脊柱）. Flexion（屈曲） of the opposite thigh suggests a flexion deformity（屈曲畸形） of that hip. Figure 20-43 illustrates the technique.,Leg length measurements are useful in evaluating hip disorders（混乱，失调，疾患）. The distance between the anterosuperior iliac spine（髂前上棘） and
29、the tip of the medial（内侧的） malleolus(踝) is measured on each side and compared. A difference in leg length may be caused by hip joint disorders.,As indicated, loss of rotation（旋转） of the hip is an early finding in hip disease. To test this movement, ask the patient to lie on his or her back. Flex the
30、 hip and knee to 90 and rotate the ankle inward（向内） for external rotation（外旋）, as illustrated in Figure 20-44A, and outward（向外） for internal rotation（内旋）, as shown in Figure 20-44B. Restriction（限制） of this motion is a sensitive sign of degenerative（退变的） hip disease.,vocabulary,inspection（望诊）gait（步态）
31、indicates（提示，预示）disorder（混乱，失调）pelvis（骨盆）femur（股骨）,elevates（提高，提升）demonstrate （展示，演示，说明）gluteus medius(臀中肌)gluteus （臀肌） medius（中间的）efficiently（有效地）,acutely（强烈地，剧烈地，极度地）abdomen（腹部）lumbar（腰椎的） spine（脊柱）flexion（屈曲）flexion deformity（屈曲畸形）,disorders（混乱，失调，疾患）anterosuperior iliac spine（髂前上棘）anterosuperior
32、(前上的)iliac（髂骨的）spine（棘，脊柱）medial（内侧的） malleolus(踝),rotation（旋转）inward（向内）external rotation（外旋）outward（向外）internal rotation（内旋）restriction（限制）degenerative（退变的）,单词复习,inspectiongaitindicatesdisorderpelvisfemur,单词复习,elevatesdemonstrategluteus mediusgluteusmediusefficiently,单词复习,acutelyabdomenlumbarspine
33、flexionflexion deformity,单词复习,disordersanterosuperior iliac spineanterosuperioriliacspinemedial malleolus,单词复习,rotationinwardexternal rotationoutwardinternal rotationrestrictiondegenerative,Hip Examination Part 5 详解,The examination of the hip is performed with the patient standing and lying on the b
34、ack. Inspection（望诊） of the hips and gait（步态） has already been described. The Trendelenburg test indicates（提示，预示） a disorder（混乱，失调） between the pelvis（骨盆） and the femur（股骨）. The patient is asked to stand on the “good” leg, as illustrated in Figure 20-42A.,The examiner should note that the pelvis on t
35、he opposite side elevates（提高，提升）, demonstrating （展示，演示，说明）that the gluteus medius(臀中肌) is working efficiently（有效地）. When the patient is asked to stand on the “bad” leg, as shown in Figure 20-42B, the pelvis on the opposite side falls. This is termed a positive Trendelenburg test.,Ask the patient to
36、lie on his or her back. The hip is acutely（强烈地，剧烈地，极度地） flexed on the abdomen（腹部） to flatten the lumbar（腰椎的） spine（脊柱）. Flexion（屈曲） of the opposite thigh suggests a flexion deformity（屈曲畸形） of that hip. Figure 20-43 illustrates the technique.,Leg length measurements are useful in evaluating hip disor
37、ders（混乱，失调，疾患）. The distance between the anterosuperior iliac spine（髂前上棘） and the tip of the medial（内侧的） malleolus(踝) is measured on each side and compared. A difference in leg length may be caused by hip joint disorders.,As indicated, loss of rotation（旋转） of the hip is an early finding in hip disea
38、se. To test this movement, ask the patient to lie on his or her back. Flex the hip and knee to 90 and rotate the ankle inward（向内） for external rotation（外旋）, as illustrated in Figure 20-44A, and outward（向外） for internal rotation（内旋）, as shown in Figure 20-44B. Restriction（限制） of this motion is a sensitive sign of degenerative（退变的） hip disease.,
