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Yami

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3分钟骨骼肌肉和周围神经检查

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3分钟骨骼肌肉和周围神经检查

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国内有关骨骼肌肉和周围神经检查法图书中,收录检查法最全面面、最直观的图书,书后附有“临床速查索引”帮助读者快速选择检查手法,也是本书的一大特色。


Content Description

体格检查是临床医生的基本功,但由于诊断时间紧迫(尤其在门诊),对于新手而言,要在短时间内完成必要的检查,实属不易。如果检查操作不正确,必将影响诊断。特别是某些比较少用的检查方法,更令人感觉生疏,这些都是对临床医师的挑战和考验。针对骨骼、肌肉和周围神经的体格检查,本书作者收集了重要数据、图表和方法,经过精心编排,使林林总总的检查项目井然有序,令人耳目一新。
比如,遇到主诉“肩部疼痛“的患者,医生需要快速整理思路:
· 引起肩痛的原因有哪些?疼痛真的是从肩部发出的吗?肩部有哪些重要的结构?
··哪些体格检查有助于将部疾病与其他疾病鉴别开?
只需要3分钟内,《3分钟骨骼肌肉和周围神经检查》帮助读者选择恰当的检查方法、掌握检查要点和手法。
特别地,书后附有“临床速查索引“,帮助读者快速完成临床评估

Author Description

引进美国DEMO医学出版公司。

Catalogue

第1章 关节检查
简介 (Introduction)
肩部检查 (Shoulder Exam)
简介(Introduction)
颈椎和肩部的活动范围(Range of Motion of the Cervical)
肩部触诊(Palpation of the Shoulder)
颈椎棘突检查(Cervical Spinous Process Exam)
Spurling 检查(Spurling’s Test)
垂臂检查(Drop Arm Test)
阻抗式外旋检查(Resisted External Rotation)
阻抗式内旋检查(Resisted Internal Rotation)
Patte 检查(Patte’s Test)
空罐检查(Empty Can Tset)
背后举起检查(Lift-off Test)
Hawkins 检查(Hawkins’ Test)
Neer 检查(Neer’ Test)
研磨操作手法(Scouring Maneuver)
上臂交叉/ 内收/Apley 绕颈检查(Crossed Arm/Adductoin/Apley’s Scarf Test)
Yergason 检查(Yergason’s Test)
改良Yergason 检查(Modified Yergason’s Test)
Speed 检查(Speed’s Test)
主动压迫检查 (O’Brien 检查)[Active Compression(O’Brien’s)Test]
恐惧检查(Apprehension Test)
复位检查(Relocation Test)
惊奇检查 ( 向前放松检查)[Surprise(Anterior Release)Test]
Adson 操作手法(Adson’s Maneuver)
Allen 检查(Allen’s Test)
肋锁检查(Costoclavicular Test)
Roos 检查(Roos’s Test)
Wright 超外展检查(Wright’s Hyperabduction Test)
肘部检查 (Elbow Exam)
简介(Introduction)
肘部的活动范围(Range of Motion of the Elbow)
肘部触诊(Palpation of the Elbow)
Cozen 检查(Cozen’s Test)
腕关节屈曲检查肱骨内上髁炎(Wrist Flexion for Medial Epicondylitis)
肘部尺神经Tinel 征(Tinel’s Sign of Ulnar at Elbow)
尺侧副韧带松弛(Medial Ligamentous Laxity)
桡侧副韧带松弛(Lateral Ligamentous Laxity)
腕部/手部/手指检查(Wrist/Hand/Digit Exam)
简介(Introduction)
腕部和手指的活动范围(Range of Motion of the Wrist and Digits)
拇指动作 (Thumb Motion)
腕部/ 手部/ 手指触诊(Wrist/Hand/Digit Palpation)
腕部正中神经Tinel 征(Tinel’s Sign of Median nerve at Wrist)
改良Phalen 检查(Modified Phalen’s Test)
反向Phalen 检查(Reverse Phalen’s Test)
腕部压迫检查(Carpal Compression Test)
蛤壳检查 ( 腕部伸肌) [Clamshell (Wrist Extensors)]
反向蛤壳检查 ( 腕部屈肌)[Reverse Clamshell (Wrist Flexors)]
手部内部肌肉紧张检查 (Bunnel-Littler 检查)[Tight Hand Intrinsics Test (Bunnel-Littler’s Test)]
改良Finkelstein 检查(Modified Finkelstein’s Test)
Froment 征(Froment’s Sign)
拇指轴向研磨检查(Thumb Axial Grind Test)
腰骶部和髋部检查(Lumbosacral Spine and Hip Exam)
简介(Introduction)
髋部和下背部的活动范围(Range of Motion of Hip and Low Back)
胸椎- 腰椎- 骶椎屈曲(T-L-S Spine Flexion)
胸椎- 腰椎- 骶椎伸展和旋转(T-L-S Spine Extension and Rotation)
胸椎- 腰椎- 骶椎侧向弯曲(T-L-S Spine Lateral Bending)
髋关节内旋(Hip Internal Rotation)
髋关节外旋(Hip External Rotation)
髋关节屈曲(Hip Flexion)
髋关节伸展(Hip Extension)
下背部和髋部触诊(Palpation of the Low Back and Hip)
腰椎棘突检查(Lumbar Spinous Process Exam)
腰椎小面关节碾磨检查(Lumbar Facet Gring Test)
Yeoman 检查(Yeoman’s Test)
Gaenslen 检查(Gaenslen’s Test)
Ober 检查(Ober’s Test)
Noble 压迫检查(Noble’s Compression Test)
直腿抬举检查(Straight Leg Raise Test)
Ely 检查(Ely’s Test)
松垮检查(Slump Test)
股神经牵张检查(Femoral Nerve Stretch Test)
下肢不等长(Leg Length Discrepancy)
股骨前倾(Femoral Anteversion)
Hoover 征(Hoover’s Sign)
Herbison背部3分钟检查法(The Herbison 3-Minute Back Exam)
1 胸部旋转(Thoracic Rotation)
2 Thomas 检查(Thomas’s Test)
3 改良Gaenslen 检查(Modified Gaenslen’s Test)
4 改良Ely 检查(Modified Ely’s Test)
5 改良股神经牵张检查(Modified Femoral Nerve Stretch Test)
6 改良Ober 检查(Modified Ober’s Test)
7 髋部活动范围检查(Hip Range of Motion Test)
8 直腿抬举检查(Straight Leg Raise Test)
9 FABERE/Patrick 检查(FABERE/Patrick’s Test)
膝部检查 (Knee Exam)
简介(Introduction)
膝部的活动范围(Range of motion of the Knee)
膝部触诊(Palpation of the Knee)
髌骨上方压迫检查(Suprapatellar Compression Test)
髌骨轻推滑动检查(Patellar Ballotment)
向前拖曳检查(Anterior Drawer Test)
轴向移动检查(Pivot Shift Test)
向后拖曳检查(Posterior Drawer Test)
Lachman 检查(Lachman’s Test)
McMurray 检查(McMurray’s Test)
外侧稳定度检查(Test for Lateral Stability)
关节线压痛检查(Joint Line Tenderness Test)
内侧稳定度检查(Test for Medial Stability)
Apley 碾磨检查(Apley’s Grinding Test)
Apley 牵引检查(Apley’s Distraction Test)
腓骨头处腓神经的Tinel 征(Tinel’s Sign of Peroneal Nerve at Fibular Head)
踝部检查 (Foot and Ankle Exam)
简介(Introduction)
踝部的活动范围(Range of Motion of the Ankle)
踝部触诊(Palpation of the Ankle)
跟腱触诊(Achilles Tendon Palpation)
紧握挤压检查 (Thompson 检查)[Squeeze Test(Thompson’s Test)]
踝部向前拖拽检查(Ankle Anterior Drawer)
外旋检查(External Rotation Test)
距骨倾斜检查(Talar Tilt Test)
足底筋膜炎检查(Plantar Fasciitis Test)
跗管检查 ( 踝部胫神经的Tinel 征)[Tarsal Tunnel Test (Tinel’s Sign of nerve at Ankle)]

第2章 肌肉检查
简介 (Introduction)
肌力分级(Grading Muscle Strength)
上肢(Upper Extremities)
上斜方肌(Upper Trapezius)
中斜方肌(Middle Trapezius)
下斜方肌(Lower Trapezius)
中三角肌(Middle Deltoid)
胸大肌(Pectoralis Major)
菱形肌(Rhomboids)
前锯肌(Serratus Anterior)
肩胛下肌(Subscapularis)
肩部外旋肌(Shoulder External Rotators)
肱二头肌(Biceps Brachii)
肱三头肌(Triceps)
旋前圆肌(Pronator Teres)
桡侧腕屈肌(Flexor Carpi Radialis)
尺侧腕屈肌(Flexor Carpi Ulnaris)
桡侧腕长伸肌和桡侧腕短伸肌(Extensor Carpi Radialis Longus and Brevis)
指浅屈肌(Flexor Digitorum Superficialis)
指深屈肌(Flexor Digitorum Superficialis)
示指伸肌(Extensor Indicis)
拇长屈肌(Flexor Pollicis Longus)
拇长伸肌和拇短伸肌(Extensor Pollicis Longus and Brevis)
拇短展肌(Abductor Pollicis Brevis)
拇收肌(Adductor Pollicis)
第一骨间背侧肌(First Dorsal Interosseous)
小指展肌(Abductor Digiti Minimi)
骨间掌侧肌(Palmar Interossei)
掌长肌(Palmaris Longus)
下肢(Lower Extremities)
髂腰肌(iliopsoas)
髋部内收肌(Hip Adductors)
髋部外展肌(Hip Adbuctors)
髋部内旋肌(Hip Internal Rotators)
股四头肌(Quadriceps)
腿后群肌(Hamstrings)
胫骨前肌(Tibialis Anterior)
胫骨后肌(Tibialis Posterior)
腓骨长肌和腓骨短肌(Peroneus Longus and Brvis)
长屈肌(Flexor Hallucis Longus)
长伸肌(Extensor Hallucis Longus)
腓肠肌和比目鱼肌(Gastrocnemius and Soleus)

第3章 反射检查
简介 (Introduction)
深腱/ 肌肉牵张反射的分级(Grading Deep Tendon/Muscle Stretch Reflexes)
记录反射的常用方法(Conventional Method of Documenting Reflexes)
上肢反射 (Upper Extremity Reflexes)
肱二头肌反射 (C5) (Biceps Reflex)
肱桡肌反射 (C6) (Brachioradialis Reflex)
桡侧腕伸肌反射 (C6)(Extensor Caepi Radialis Reflex)
旋前圆肌反射 (C6) (Pronator Teres Reflex)
肱三头肌反射 (C7) (Triceps Reflex)
手屈肌反射 (C8/T1) (Finger Flexors Reflex)
下肢反射 (Lower Extremity Reflexes)
内收肌反射 (L3) (Adductor Reflex)
髌反射(L4)(Patellar Reflex)
内侧腿后肌群反射 (L5) (Medial Hamstring Reflex)
踝阵挛反射 (S1)
外侧腿后肌群反射 (S1) (Lateral Hamstring Reflex)
其他
Babinski 征(Babinski’s Sign)
Chaddock 征(Chaddock’s Sign)
Oppenheim 征(Oppenheim’s Sign)
Hoffman 征(Hoffman’s Sign)
Wartenberg 征(Wartenberg’s Sign)
颌反射(Jaw Jerk)
掌颏反射(Palmomental)
眉心反射(Glabellar Reflex)
鼻口部反射(Snout Reflex)
Jendrassik 操作法(Jendrassik’s Maneuver)

第4章 周围神经检查
简介 (Introductoin)
外周神经和脊神经根 ( 正面分布) [Peripheral Nerves and Spinal Roots (Anterior Distribution)
外周神和脊神经根 ( 背面分布) [Peripheral Nerves and Spinal Roots (Posterior Distribution)]
上肢 (Upper Extremities)
臂从神经(Brachial Plexus)
肌皮神经(Musculocutaneous Nerve)
正中神经(Median Nerve)
桡神经和腋神经(Radial and Axillary Nerves)
尺神经(Ulnar Nerve)
神经根皮节分区检查的临床标志(Clinical Landmarks for Root-level Dermatomal Examination)
下肢 (Lower Extremities)
腰从、骶丛神经(Lumbosacral Plexus)
股神经(Femoral Nerve)
闭孔神经(Obturator Nerve)
腓神经[Peroneal (Fibular) Nerve]
胫神经(Tibial Nerve)
神经根皮节分区检查的临床标志(Clinical Landmarks for Root-level Dermatomal Examination)
其他 (Miscellaneous)
轻触检查(Light Touch Sensatoin)
针刺检查(Pinprick Sensation)
振动检查(Vibratory Sensation)
体位觉(Propriception)

第5章 步态和姿势
简介 (Introduction)
姿势评估(Posture Evaluation)
步态周期(Gait Cycle)
常见的步态异常(Common Abnormalities of Gait)
Trendelenburg 氏步态(Trendelenburg Gait)
腿长不等(Leg Length Discrepancy)
止痛 ( 剧痛) 步态 [Antalgic (Painful) Gait]
共济失调步态(Ataxic Gait)
神经病变性步态(Neuropathic Gait)
足部拍击地面(Foot Stap)
跨越步态(Steppage Gait)
膝关节反屈(Knee Recurvatum)
臀大肌跛行(Gluteus Maximus Lurch)
痉挛型偏瘫步态(Spastic Hemiplegic Gait)
痉挛型双侧麻痹步态(Spastic Diplegic Gait)
肌营养不良步态(Dystrophic Gait)
回转步态(Circumduction Gait)
帕金森病步态(Parkinsonian Gait)
步态周期图解(Gait Cycle Diagram)

第6章 脊髓损伤检查
简介 (Introduction)
美国脊椎损伤学会(American Spinal Injury Association)
脊髓综合征(Spinal Cord Syndrome)
感觉检查(Sensory Examination)
运动检查(Motor Examination)
功能损伤评分(Impairment Scale)
分类步骤(Steps in Clasification)
标准分类表(Standard Classification Form)

第7章 参考表格和资料
简介 (Introduction)
神经学和肌肉骨骼学参考资料(Neurologic and Musculoskeletal Resources)
解剖平面和说明(Anatomic Planes and Descriptors)
肌力分级(Grading Muscle Strength)
评估痉挛的改良Ashworth 评分系统(Modified AshworthScale for Grading Spasticity)
深部肌腱/ 肌肉牵张反射分级(Grading Deep Tendon/Muscle Stretch Reflexes)
记录反射的传统方法(Conventional Method ofDocumenting Reflexes)
上运动神经元与下运动神经元病况之比较(Upper MotorNeuron Versus Lower Motor Neuron Findings)
典型上肢神经根病变(Classic Upper ExtremityRadiculopathies)
典型下肢神经根病变(Classic Lower ExtremityRadiculopathies)
疼痛类型(Types of Pain)
不自主动作的定义(Definitions of Involuntary MotorMovements)
常见卒中综合征(Common Stroke Syndrome)
美国风湿病学院1990 年纤维肌痛症分类标准(AmericanCollege of Rheumatology 1990 Criteria for theClassification of Fibromyalgia)
非器质性下背痛的Waddell 征(Waddell’s Sign ofNonorganic Low Back Pain)
对称性肌肉无力的诊断(Diagnosis of Symmetric Muscle Weakness)
疼痛的视觉类比评分量表(Visual Analog Scale of Pain)
Wong-Baker FACES 小儿疼痛评估表(Wong-Baker’sFACES Pain Rating Scale)

第8章 肌肉骨骼图谱
简介 (Introduction)
上肢 (Upper Extremities)
下肢 (Lower Extremities)

第9章 肌肉简表
简介 (Introduction)
上肢(Upper Extremities)
肌肉动作、解剖位置和神经支配——肩部与上臂
(Muscle Action, Location and Innervation——Shoulder and Arm)
肌肉动作、解剖位置和神经支配——前臂(MuscleAction,Location and Innervation——Forearm)
肌肉动作、解剖位置和神经支配——手部(MuscleAction,Location and Innervation——Hand)
下肢 (Lower Extremities)
肌肉动作、解剖位置和神经支配——腹部、髋部、骨盆
(Muscle Action,Location and Innervation——Abdomen, Hip, Pelvis)
肌肉动作、解剖位置和神经支配——大腿和小腿
(Muscle Action,Location and Innervation——Thigh and Leg)
肌肉动作、解剖位置和神经支配——足部(MuscleAction,Location and Innervation——Foot)

笔记
Book Abstract

许许多多的医师们、医学生们和治疗师们,都曾经在接受训练的过程中,有过类似的经历:患者正在检查室的门后等待接受检查,其病历上的主诉为“肩部疼痛”。此时每个人由于自己的不同经验或不同思路,可能在脑海中一下子就塞满了许多问题,努力思考着有关如何开始着手处置这位患者,这些问题例如:引起肩痛的原因有哪些?疼痛真的是从肩部引发的吗?肩部有哪些重要的结构?哪些身体检查有助于鉴别肩部疾病与其他疾病的差异?患者正等待着您,您在不久前也许还很清楚如何判定肱二头肌肌腱炎 (bicipital tendonitis) 或肩周病变 (rotator cuff pathology) 的检查步骤,但突然间却觉得这些检查步骤变得令人捉摸不透,无从下手。这种情形在个人融会贯通各项检查步骤,并形成整套独特步骤之前,的确很难理出头绪。
受训者通常并没有个人的办公室,医疗专业人员也往往没有个人图书馆供他们即刻查阅,至少在他们评估患者之前,无法供他们马上查询。正因为这个原因,他们的白大衣口袋内经常塞满了各种纸张、笔记本和掌上电脑 (PDA)。一直到时过境迁,功夫学成时,他们才会逐渐减少依赖这些援助,但仍有许多执业20年以上的医师,继续将重要的图表和图解张贴在办公室的墙壁上,可见我们的确需要能够快速便利地取得有关患者的信息。有鉴于此,本书作者决定将这许许多多的临床宝贵知识,浓缩成一本可以放在口袋内的小书,以便于翻阅。作者们精心编排书籍内容,针对评估患者时出现的相关问题,提供可在3分钟内查得的解答——正如前文所提的肩部疼痛的个案一样,终究患者仍正在等着您呢。作者在此诚心期盼,在您的受训和执业过程中,当您寻求患者的最佳处置方法时,您会认为本书对您提供最有用的协助。
Allan Miller
Kimberly Dicuccio Hecker
Brain A. Davis

Introduction

译者序
《3分钟骨骼肌肉和周边神经检查》是一本骨骼、肌肉、神经检查的实用性参考书,体格检查是临床医学诊断疾病的基本功,在诊疗过程中经常进行这项检查,才能从患者的体征中得到更加明确的依据,或成为安排进一步检查的线索。虽然临床中实施体格检查的机会很多,但由于时间紧迫(尤其是门诊),对于新手而言,要在短时间内完成必要的检查,实属不易。如果检查操作不正确,还将影响诊断,这种情况,即使是具有临床经验的老手,也会遇到。而某些较少用到的检查项目,更令人感到生疏,这些都是对临床医师的挑战和考验。
针对骨骼、肌肉和神经的物理学检查,本书作者详尽地收集了重要数据、图表和方法,经过精心安排,使林林总总的检查项目井然有序,让人耳目一新。我在本书翻译过程中学到了许多宝贵的知识,备感欣慰,特向读者朋友推荐本书。本书可以在很短时间内,让你掌握这些检查的要点和手法。当然,具备基本的人体解剖学知识和临床诊断思维,才有可能合理地选择检查方法。除了阅读本书,还要用心复习有关的临床知识,反复练习,才能做到熟能生巧,正确运用本书的知识去诊治疾病。
有机会翻译本书,使我获益匪浅。付梓之际,我要感谢父母、兄长和师长的指导,女儿雅婷的帮助以及出版社的支持。本书虽经多次校阅,但百密必有一疏,错误在所难免,祈请医界贤达先进和广大读者不吝指教。
杨荣森
于台大医学院骨科
2010年9月12日

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