00:01
This is the osteopathic 10-step exam.
00:04
Please always remember and never forget
the osteopathic 10-step exam.
00:08
This is what you need to know. This
is what you need to do.
00:11
And while we broaden it to 10 steps,
you are able to go off of this and focus on
the area of discomfort or area of pain.
00:19
Step #1 is a postural analysis screen,
and this is static—standing still,
do they look comfortable?
Are they symmetrical?
And you can evaluate and palpate
major landmarks, the ASIS
and the shoulders, and see and
make sure they’re even.
00:33
Step #2 is watch them walk. Gait analysis.
00:37
I like having fun and I will often do a
30-second stand here or a duck walk.
00:44
At 55 years of age, people lose
the ability to squat and walk.
00:48
They tend to have lost
the nervous system balance
muscle communication
and they tend to fall off and need
to support themselves more.
00:57
Step #3 is dynamic trunk testing.
It is sidebending
and you can do this while you
have the patient standing.
01:03
Step #4 is a standing flexion test.
01:05
You put your fingers on the PSIS,
the posterior superior iliac spine,
and have them bend over
and you check the motion to make
sure its equal on both sides.
01:15
Step #5 is the Stork test which
we will go over later.
01:18
Step #6 is the seating flexion test
which puts the bone down on the seat
and then you measure again to see
if the posterior superior iliac spine
moves equally or asymmetrically.
01:30
Step #7 is screening of
the upper extremities.
01:33
We tend to forget the arms and legs.
01:35
Don’t forget the arms and legs.
01:37
It’s part of the whole musculoskeletal exam.
01:39
Step #8 is trunk motility
which is rotating and sidebending,
and you do that seated.
01:47
Step #9 is head and neck mobility.
01:50
We check the cervical spine often
but we don’t often check head mobility
and other motions besides just
touching the cervical spine.
02:00
And #10 is the total body screen
palpation and motion testing
where you get the whole body
and make sure you understand
the musculoskeletal system
and the functioning of the whole body.
02:11
You could do arms, Patrick’s FABERE
and other musculoskeletal tests
to check for motion.
02:18
So this is the 10-step exam that you must
always remember and never forget.
02:21
And while you are going to focus
off and go into the area of pain
and the area directed by
the chief complaint,
since osteopathic medicine is
a holistic philosophy,
it’s important to do the whole
musculoskeletal exam
and see where you may need to focus
where the patient may benefit
from care later on.
02:39
The musculoskeletal exam
is a more nuanced exam
than other exams in that you’re doing
multiple things in the same area.
02:48
So when you palpate a muscle,
you’re gonna palpate it with 2 to 3 pounds
of pressure to feel the muscle.
02:54
Then you’re going to try and give
5 to 7 pounds of pressure
to feel the skin drag and to
feel the fascial system.
03:01
And then you go a little bit deeper
to feel the muscle,
to feel the bogginess, to feel
the texture of the muscle.
03:07
So starting with skin drag, when you
put your hand over the muscle,
and you lightly move it, does it move easily
and does it move fluidly?
And does the skin come together
along the Langer lines
so that you can see how the skin bends
and how it folds and how comfortable it is.
03:26
So increased drag when it’s slower
can be caused by moisture,
it can be caused by dryness, and dehydration.
03:34
These are going to change the drag
and we always look for tinting
and turgor of the skin.
03:40
Drag is when you look at tinting
and turgor with motion
and you put them together.
03:46
So a lot of times, this will change acutely
and the skin drag is something that
can change from morning to night
and is not as easily reproducible
at each visit,
but if you notice a problem when
you’re doing the exam,
it helps you understand where you are.
04:02
Faster drag occurs with older people
with dry skin or atrophy,
slower drag in younger people with better
connections and stronger connections.
04:13
And one thing we always
warn students about is
if you’re doing this skin-to-skin
and you get sweat on you or oil on you,
best thing where you don’t want to wash
with just an alcohol based wash.
04:25
You need to wash with soap and water
or you need to consider wearing gloves.
04:29
You don’t want to be doing palpation
with someone who’s sweating or wet
without either gloves or protecting
yourself by washing afterwards.
04:38
That’s the skin drag.
04:40
The other thing I do with most of my
patients is examine the red reflex.
04:44
No, not the red reflex in the eye.
04:46
This is the 32nd red reflex you get
when you go across the big muscle groups,
mostly in the back or the neck
and you rub down 3 times
with about 10 to 12 pounds of pressure,
and you give it about 30 seconds.
In 15 to 30 seconds
you’ll notice a redness come
out in the muscle area
and the superficial skin
and that will give you a good sense
of what the evenness is.
05:10
If you have an area where there’s not good
blood flow or a chronic problem,
you won’t have as red a response.
05:18
So you look at whether there
are compensatory changes,
whether there’s redness here and here,
or if it looks the same on both sides.
05:25
It’s a good test for symmetry
and a good test of how the muscles
are going to exhibit,
and basically, if we’re saying muscles
are an endocrine system
and they release hormones,
this is telling you what the
vascular release is like
and how it’s going to communicate
with the rest of the body.
05:44
So the red reflex is an exam,
I think, is very important to
look for the whiteness,
to look for the redness, and to
look for asymmetry
and to note how long it takes for
the red reflex to come out.
05:56
If it comes out quickly and it comes
out quickly all the time,
that it could be the person’s normal pattern.
06:01
If it’s 15 to 20 seconds, it’s a good lag
time, it’s a good response time,
and it looks healthy, that’s good
but it gives you information and
it’s easy and quick to do.
06:11
Areas of somatic dysfunction that are acute
tend to be redder and come out quicker.
06:16
Issues of somatic dysfunction
that are chronic
and longstanding tend to
have less vasculature,
less blood flow, and they tend to be whiter
and have less of a response.
06:27
So it’s a good, quick differentiator
to see how long the complaint is
and to put some validity to
what the patient is saying
or to question what the patient is saying.
06:37
So these are some easy exam
techniques you can use
when evaluating the musculoskeletal
system in a patient.