COMPARE AND CONTRAST MR. A TO MR. B
I found this week’s video of Bates’ Guide to Physical Examination of the Musculoskeletal System very informative. It provided valuable insights into the comprehensive assessment of the musculoskeletal system. It teaches a systematic and thorough examination that can be used to evaluate various aspects of the musculoskeletal system, including joints, muscles, and bones. As emerging nurse practitioners, it is important to be proficient at the various techniques such as inspection, palpation, range of motion assessment. I particularly enjoyed learning about the special tests that can be used to identify abnormalities, injuries, or disorders.
The patient in this week’s video seemed to be having trouble with his right shoulder. I noticed that he winced during the drop arm test and was unable abduct his arm beyond approximately 90 degrees laterally. According to a research article I found, this is also called the painful arch test. The purpose of the painful arch test is to assess “pain on abduction, with extended elbow, in the scapular plane” (Garving et al., 2017). Pain that is elicited between 60 degrees and 120 degrees during abduction “indicates pathology in the subacromial space” (Garving et al., 2017). These types of tests are very helpful, not only in diagnosing injury, but also in ruling out certain injuries. Garving reports that when using tests like the painful arch test “the diagnostic sensitivity of physical examination is 90%” (2017). In doing so, we can more accurately order confirmative diagnostic tests and avoid excessive and unnecessary testing for the patient.
MR. B
“What did you learn from watching this week’s assigned videos from Bates Visual Guide to Physical Examination?”
After studying the chapter on the musculoskeletal system in Bates’ Visual Guide to Physical Examination and watching the Bates videos, I feel confident in my ability to perform musculoskeletal examinations in clinical settings. These materials serve both pedagogical and applied purposes, providing invaluable insights into the systematic evaluation of the musculoskeletal system.
The video demonstrations of different examination techniques in Bates’ Visual Guide were made for a visually engaging learning experience. Upper and lower limbs, the spine, and the joints were examined, as well as their range of motion and responsiveness to special tests (Bickley, 2020). In this course, I learned how important it is to perform a complete physical examination of the musculoskeletal system to detect any anomalies, injuries, or pathological conditions.
On the other hand, Macleod’s OSCE Guide also provided a methodical strategy developed for the unique context of OSCEs. It outlined the steps to take and emphasized the value of a thorough examination. Using this tool was essential for improving performance on musculoskeletal assessments in clinical settings under time constraints (Innovate, 2018).
Both the book and Bates video emphasized the need for thorough examinations, precise documentation, and clear patient communication when evaluating patients’ musculoskeletal systems. These manuals clearly demonstrated the incorporation of theoretical knowledge with practical skills, guaranteeing a thorough and patient-centered examination process (Bickley, 2020).
Bates’ Visual Guide to the Musculoskeletal System and Macleod’s Objective Structured Clinical Examination Guide provide a comprehensive view of musculoskeletal examinations. To assess and diagnose musculoskeletal conditions competently and with confidence in clinical practice, healthcare professionals and medical students will find these resources invaluable.
“What are some potential diagnoses related to musculoskeletal conditions if this week’s exam findings were abnormal? “
Depending on the nature of the abnormalities found, a musculoskeletal examination can lead to a wide variety of diagnoses. Some potential diagnoses related to musculoskeletal conditions that may be considered if abnormal findings are detected during this week’s exams include fractures. Fractures may be present if there are abnormalities in bone alignment, tenderness, or deformities. Fractures of various types could be considered, including stress, compound, and greenstick fractures (Almoallim et al., 2021). Arthritis is another abnormal finding that may be present.
Osteoarthritis, rheumatoid arthritis, and gout are just some of the arthritic conditions that can cause joint stiffness, swelling, and reduced range of motion. Conditions like Achilles tendonitis, rotator cuff tendonitis, and tennis elbow can cause tenderness, pain with movement, and inflammation near a joint or tendon (Murray et al., 2022). Muscle strains, which can cause mild to severe symptoms like weakness, pain, and reduced strength, are common. Ligament injuries, such as those to the anterior cruciate ligament (ACL) or the ankle ligaments, can cause instability, joint laxity, and pain with specific movements (Almoallim et al., 2021). Carpal tunnel syndrome is a common nerve compression condition that can cause numbness, tingling, and weakness in the hands. Herniated discs and other spinal problems can cause limited mobility, radiating pain, and other neurological symptoms (Murray et al., 2021). Reduced bone density may indicate osteoporosis if bone fractures occur with little to no external force. Infections of the musculoskeletal system, such as osteomyelitis or septic arthritis, can cause swelling, redness, warmth, and fever (Almoallim et al., 2021).
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