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Neuromusculoskeletal Systems III - #34540


Foot & Ankle

Hip

Shoulder

Orthopedic Tests

Elbow

Hand / Wrist

Knee


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Don Eggebrecht, DC F.A.C.O.
4.5
75.0
30.0

45.0 (+ 4 Gross Lab hours)

Students will study the diagnosis and care of common conditions affecting the upper and lower extremities.
Please select from the list on the right.

The Institution-wide learning goals define the common ground that unites the programs within the university. They are purposefully broad so that the various colleges and schools can continue to develop their unique identities through varying ways in which the goals are met.

  1. Effective Communication
    Graduates will demonstrate effective verbal, non-verbal, and written communication skills in a wide variety of contexts, including collaborative activities.
  2. Self Directed and Lifelong Learning
    Graduates will be aware of the limits of one’s personal knowledge and experience and have an intellectual interest in scholarly and creative endeavors. Graduates will actively set appropriate learning goals, pursue them, and apply the knowledge gained.
  3. Ethical Reasoning
    Graduates will demonstrate a willingness to recognize the values of others while maintaining one’s own integrity, and act ethically and professionally in all endeavors.
  4. Individuals, Communities and Cultures
    Graduates will demonstrate awareness and sensitivity to the cultural and health practices of individuals and communities. Graduates will be able to identify appropriate health related resources.
  5. Service to the Community
    Graduates will understand and value the benefits of service to the community.
  6. Influence of Mind, Body and Spirit on Health
    Graduates will recognize the inter-relationship of the mind, body and spirit and the influence of extrinsic factors on an individual’s health.
  7. Critical Thought and Knowledge Acquisition
    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
  8. Competence in one's Discipline
    Graduates will demonstrate competence of appropriate depth and scope for one's discipline.

Course Objectives
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A. COGNITIVE SKILLS
  1. Understand and describe the pathophysiological changes of stress to connective tissue.
  2. Understand and describe the normal biomechanics of the shoulder, elbow, and and wrist, hip, knee, ankle and foot.
  3. Understand and describe the interrelationship of a motion segment within the closed kinetic chain to the function and structure of all weight bearing motion segments.
  4. Describe the pathophysiology and/or pathobiomechanics, epidemiology, manifestations and natural history of the most common upper and lower extremity conditions.
  5. Develop a treatment protocol for the most common conditions affecting the upper and lower extremities, correlating the goals of various treatment procedures with the pathophysiological and/or pathobiomechanical changes.
  6. Determine normal and abnormal function of the upper and lower extremity demonstrated through examination findings.

    B. AFFECTIVE SKILLS

    1. Proper gowning (clothing) of patients to respect and maintain their comfort zones in the performance of various diagnostic and treatment procedures. This includes the ability to communicate with the patient the proper gowning procedures and why the gowning procedures is necessary.
    2. Appropriate touch of patients to respect and maintain their comfort zones in the performance of various diagnostic and treatment procedures. This includes the ability to communicate with the patient what procedure is about to be performed, why it is necessary to perform it, and how it will be performed.
    3. Respect and appreciation of the patient's pain and or tenderness tolerance when performing diagnostic and or treatment procedures.
    4. Respect and appreciate the patient's comfort zones demonstrated through verbal and non verbal communications.

    C. PSYCHOMOTOR SKILLS

    1. Perform a postural analysis on all weight bearing joints, differentiating normal from abnormal findings.
    2. Demonstrate static palpatory skills in palpating the upper and lower extremities consisting of static alignment, palpatory tenderness, temperature, tone, and texture.
    3. Demonstrate motion assessment skills in examining the upper and lower extremities consisting of active, passive, and accessory motions of end feel and joint play.
    4. Perform various orthopedic and neurological tests for the upper and lower extremities.
    5. Perform various adjusting/manipulative/mobilization procedures for the upper and lower extremities.
Materials
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A. Required Text(s):
  1. Differential Diagnosis for the Chiropractor; by Souza
  2. Physical Examination of the Spine and Extremities; by Hoppenfeld
  3. Illustrated Essentials in Orthopedic Physical Assessment; by Evans
  4. Class notes/handouts
  5. CD-Rom - QuickTime required
  6. Website - Real Player required

B. Recommended Text(s):
  1. Chiropractic Technique; by Bergmann, Peterson, Lawrence
  2. Cailliet books on the extremities
  3. Kapandji Volume I

C. Required Materials for Lab:
1. shorts and gowns 
Assignments
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A. Reading class handout material
B. Lecture and lab materials
Attendance
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Students with health related conditions which contraindicate participation in any class activity, must notify the instructor during the first week of class or immediately following the onset of the conditions. Students who believe they have incurred an injury or exacerbated a preexisting condition while in class, should report to the instructor immediately.
Grading Criteria
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  1. See weekly calendar
  2. Make up examinations are given with an excused absence. The usual fee will be charged, as outlined in the student handbook, or as advised by the instructor if there are extenuating circumstances being allowed.

Guaranteed grades are as follows:

A = 92-100%
B = 83-91%
C = 74-82%
D = 65-73%
F = <65%
Laboratory Privacy Policy
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  • Gross anatomy labs containing cadaver specimens will be locked at all times.
  • Access to labs and cadavers is strictly limited to students registered for approved courses at NWHSU.
  • No photography is allowed in the anatomy labs.
  • Cell phones are strictly prohibited.
  • Access to labs and cadavers is limited to post high school age people only.

All persons involved in the study, or with knowledge of the study, will keep CONFIDENTIAL all aspects of the study. All students will be counseled on appropriate respect for the cadavers and only involved students and faculty are allowed to use and view the cadavers. Any violation of these regulations will be punishable by immediate suspension and/or criminal prosecution.
Course Competencies
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-

COGNITIVE DOMAIN


  • Students will be able to describe the basic distortion pattern from the occiput to the foot, based upon understanding the biomechanics of the closed kinetic chain, and how the integrity of one joint is dependent on all the other joints within the closed kinetic chain.
  • Students will be able to describe the stabilizing and restricting structures of the shoulder, elbow, wrist and hand, hip, knee, ankle, and foot and how each will affect the biomechanics.
  • Students will be able to describe the various phases of the gait cycle.
  • Students will understand the normal components of motion of the shoulder, elbow, wrist and hand, ankle, knee, and hip.
  • Students will understand the normal biomechanics of the shoulder, elbow, hand and wrist, foot, ankle, knee, and hip.
  • Students will understand how abnormal biomechanics of the shoulder, elbow, hand and wrist, foot, ankle, knee, and hip will cause stress to connective tissue and result in various NMS conditions. How these various conditions will affect gait resulting in abnormal biomechanics.
  • Students will understand the origin of pain, and be able to differentiate the origin based upon location, quality, depth, reproducibility, and type of pain.
  • Students will understand the pathophysiology of stress to connective tissue.
  • Students will understand the clinical significance of abnormal end feel of passive joint motion.
  • Students will understand the clinical significance of shoulder, elbow, hand and wrist, foot, ankle, knee and hip orthopedic tests.
  • Student will be able to list the red flag signs of a pronated foot.


Conditions:
Students will be able to make case management decisions regarding common upper and lower extremity conditions based on their understanding of the following information regarding each of the following conditions. (See key on the following page for description of codes.)


Clinical Condition
Etiology & Epidem
Patho-phy
Natural
History
Exam
& DX
Rx/Mgmt
Adhesive Capsulitis 3 3 3 2,3 1,2,4,6,
Rotator cuff tear 3 3 3 1,2,3,4,6 1,2,4,5,6
T.O.S. 3 3 3 1,2,3,4,6 1,2,4,5
Bursitis 3 3 3 1,2,3,6 2,4
strain/sprain 2 2 2 1,2,3,4,6 1,2,4,7
clavicle fracture 3 3 3 1,2,3,4,6 6
shoulder separation 3 3 3 1,2,3,4,6 2,4,5,6
shoulder separation 3 3 3 1,2,3,4,6 2,4,5,6
supraspinatis tendinitis 3 3 3 1,2,3,4,6 1,2,4,5,6
subacrominal bursitis 3 3 3 1,2,3,4,6 1,2,4,5,6
shoulder dislocation 3 3 3 1,2,3,4,6 2,4,5
tenosynovitis of the long head of the biceps 2 2 2 1,2,3 2
biceps rupture 2 2 2 1,2,3 6
biceps tendon dislocation 2 2 2 1,2,3 2
calcific tendinitis 2 2 2 1,2,3,6 2,6
tennis elbow 3 3 3 1,2,3,4,6 1,2,4,5,6,7
lateral epicondylitis 3 3 3 1,2,3,4,6 1,2,4,5,6,7
medial epicondylitis 3 3 3 1,2,3 1,2,4,5,6,7
peripheral nerve entrapments 3 3 3 1,2,3,4,6 1,2,4,5,6,7
myositis ossificans 2 1 1 1,2,3,6 2,6
olecranon bursitis 2 1 1 1,2,3,6 2,6
osteochordritis dissecans of the capitellum 2 2 2 1,2,3,6 2,6
osteochondrosis of the radial head 2 2 1 2,3,6 6
carpal tunnel 3 3 3 1,2,3,4,6 1,2,4,5,6
ganglion 2 2 2 1,2,3 6,7
subluxations/ dislocations 3 3 2 1,2,3,4,6 1,2,4,5
Fracture of the Hook of the Hamate 3 3 2 1,2,3,6 6
Preiser's Disease 2 2 2 1,2,3,6 5
Trigger Finger 2 2 2 1,2,3 6
Heberding's nodes 2 2 2 2,3,6 2,4
Haygarth's nodes 2 2 2 2,3,6 2,4
Kienbock's Disease 2 2 2 1,2,3,4,6 5
Bouchard's nodes 2 2 2 2,3,6 2,4
Mallet finger 2 2 2 1,2,3 2,4
Dupuytren's 2 2 2 1,2,3 1,4,6
Ankle & Foot Conditions
Achilles tendinitis
2
3
3
1,2,3,4
1,2,4,6,7
Anterior shin splints
3
3
3
1,2,3,4
1,2,4,6,7
Anterior compartment syndrome
3
3
3
1,2,3,4
1,2,4,6,7
Bunions
3
3
3
1,2,3,4
1,2,4,6,7
Calcaneal spur
3
3
3
1,2,3,4,6
1,2,3,4,6,7
Calluses
3
3
3
1,2,3,4
1,2,4,6,7
Corns
3
3
3
1,2,3,4
1,2,4,6,7
Eversion sprains
3
3
3
1,2,3,4,6
1,2,4,6,7
Hallux rigidis
3
3
3
1,2,3,4,6
1,2,4,6,7
Hallux valgus
3
3
3
1,2,3,4,6
1,2,4,6,7
High ankle sprains
3
3
3
1,2,3,4
1,2,4,6,7
Ingrown toenails
3
3
3
1,2,3,4
1,2,4,6,7
Interdigital neuroma
3
3
3
1,2,3,4
1,2,4,6,7
Inversion sprains
3
3
3
1,2,3,4,6
1,2,4,6,7
Jammed ankle mortise joint
3
3
3
1,2,3,4,6
1,2,4,6,7
Metatarsalgia
3
3
3
1,2,3,4
1,2,4,6,7
Morton's neuroma
3
3
3
1,2,3,4
1,2,4,6,7
Peroneus longus & brevis strain
2
3
3
1,2,3,4
1,2,4,6,7
Plantar fasciitis
3
3
3
1,2,3,4
1,2,4,6,7
Posterior shin splints
2
3
3
1,2,3,4,6
1,2,4,6,7
Pronated foot
3
3
3
1,2,3,4,6
1,2,4,6,7
Retrocalcaneal bursitis
2
3
3
1,2,3,4
1,2,4,6,7
Sesamoiditis
3
3
3
1,2,3,4,6
1,2,4,6,7
Knee Conditions
ACL sprain
2
3
3
1,2,3,4,6
1,2,4,6,7
Baker's cyst
2
3
3
1,2,3,4
1,2,4,6,7
Chondromalacia patella
3
3
3
1,2,3,4,6
1,2,4,6,7
Coronary ligament sprain
3
3
3
1,2,3,4
1,2,4,6,7
Genu varus
2
1
2
1,2,3,4
1,2,3,4,6,7
Genu Valgus
2
1
2
1,2,3,4
1,2,3,4,6,7
Infrapatellar bursitis
3
3
3
2,3,4
1,2,4,7
Jumper's knee
3
3
3
1,2,3,4
1,2,4,7
Larson Johanson disease
0
0
0
1,2,3,4,6
0
LCL sprain
3
3
3
1,2,3,4
1,2,4,7
MCL sprain
3
3
3
1,2,3,4
1,2,4,6,7
Myositis ossificans
3
3
3
1,2,3,4,6
1,2,3,4,6,7
Osgood Schlatter's disease
3
3
3
1,2,3,4,6
1,2,4,6,7
Patella mistracking
3
3
3
1,2,3,4,6
1,2,4,7
PCL sprain
3
3
2
1,2,3,4
1,2,4,6,7
Quadriceps strain
3
3
3
1,2,3,4
1,2,4,7
Subluxation of the head of the fibula
3
3
3
1,2,3,4
1,2,7
Suprapatellar bursitis
3
3
3
1,2,3,4
1,2,4,7
Torn meniscus
3
3
3
1,2,3,4,6
1,2,4,6,7
Unhappy Triad of O'Donahue
3
3
3
1,2,3,4,6
1,2,4,6,7
Hip Conditions
Avascular necrosis
2
2
3
1,2,3,4,6
1,2,4,6,7
Bone avulsions
3
3
3
1,2,3,4,6
1,2,4,6,7
Coxa vera
1
1
2
1,2,3,4,6
1,4,7
Coxa valgus
1
1
2
1,2,3,4,6
1,4,7
Coxa plana
2
2
2
1,2,3,4,6
1,4,6,7
Excessive anteversion
3
3
3
1,2,3,4,6
1,4,6,7
Greater trochanteric bursitis
3
3
3
1,2,3,4
1,2,4,7
Groin strains
3
3
3
1,2,3,4
1,2,4,7
Hip dislocation
2
3
3
1,2,3,4,6
1,2,4,6,7
Hip pointer
2
3
3
1,2,3,4
1,2,4,7
Hip arthritis
3
3
3
1,2,3,4,6
1,2,4,6,7
Iliac apophysitis
2
3
3
1,2,3,4,6
1,2,4,7
Iliopectineal bursitis
3
3
3
1,2,3,4
1,2,4,7
Ischiogluteal bursitis
3
3
3
1,2,3,4
1,2,4,7
Leg length inequality
3
3
3
1,2,3,4,6
1,4,7
Osteitis pubis
3
3
3
1,2,3,4,6
1,4,7
Piriformis syndrome
3
3
3
1,2,3,4
1,2,4,7
Retroversion
3
3
3
1,2,3,4
1,4,6,7
Slipped femoral capital epiphysis
2
2
3
1,2,3,4,6
1,4,6,7
Transient synovitis of the hip
3
3
3
1,2,3,4,6
1,2,4,7

The following codes refer to the depth of coverage for Etiology and Epidemiology, Pathophysiology, and Natural History and Course:
0 No coverage or content
1 Introduction, without test items
2 Moderate class discussion and/or handouts material, with test items
3 Extensive discussion and/or handout material, with test items

For Exam and Diagnosis, the following numbers indicate which aspects of exam and diagnosis of each condition are taught in this course:

1
 Presenting SX: Presenting symptoms related to condition are discussed.
2
 History findings: Relevant personal and family history are discussed.
3
 Exam findings: General physical exam findings are discussed.
4
 Chiro. Findings Posture, subluxation, muscle tone, and length, trigger pts.
5
 Lab findings: Blood, urine, CSF...
6
 Imaging findings: Normal, CT, CAT, MRI...
7
 Special test findings: eg. sweat test for cystic fibrosis, spirometry for asthma.

For Treatment/management, the following numbers indicate which aspects of treatment and management of each condition are taught in this course:

1
 Chiropractic: Adjustments, soft tissue techniques.
2
 PT: Physical therapy modalities of all types.
3
 Nutrition/Suppl: Diet and supplement recommendations
4
 Exercise: Stretching, strengthening, aerobic exercise recommendations
5
 Lifestyle Mgmt: Stress reduction, smoking cessation, allergen avoidance....
6
 Medical: Drugs, antibiotics, surgical procedures, radiotherapy...
7
 Other Acupressure/puncture, massage, homeopathic or herbal Rx...
8
 Guidelines: If published, do you refer to them regarding this condition?


PSYCHOMOTOR DOMAIN


  • The student will be able to perform an upper and lower extremity posture analysis.
  • The student will be able to locate upper and lower extremity osseous and soft tissue structures.
  • The student will be able to evaluate range of motion of the shoulder, elbow, wrist and hand,ankle, knee, and hip (active, passive, and end feel)
  • The students will be able to perform orthopedic tests.
  • The students will be able to test for joint play accessory motions.
  • Students will be able to assess the necessity for an adjustment based upon observation, palpatory tenderness, static alignment and/or loss of motion.
  • Students will be able to perform upper and lower extremity adjustments.
  • Students will be able to perform proprioceptive-neuro-facilitation procedures.
  • Students will be able to screen for excessive anteversion and retroversion using passive hip internal and external rotation.
  • Students will be able to screen for coxa valgus and coxa vera using passive hip adduction and abduction.


AFFECTIVE DOMAIN


  • Students will be able to instruct a patient as to proper gowning (clothing) of patients, demonstrating respect and maintaining the patient's comfort zones in the performance of various diagnostic and treatment procedures. This includes the ability to communicate with the patient the proper gowning procedures and why the gowning procedures is necessary.
  • Students will be able to demonstrate an appropriate touch of patients to respect and maintain their comfort zones in the performance of various diagnostic and treatment procedures. This includes the ability to communicate with the patient what procedure is about to be performed, why it is necessary to perform it, and how it will be performed.
  • Students will be able to demonstrate respect and appreciation of the patient's pain and or tenderness tolerance when performing diagnostic and or treatment procedures.
  • Students will be able to demonstrate respect and appreciate the patient's comfort zones when using verbal and non verbal communications.
  • Students will demonstrate integrity, sensitivity, respect, courtesy, compassion and professionalism at all times, both in lecture and labs, and will be able to apply the history, physical examination and treatment techniques learned in this course to any patient while demonstrating those same qualities.
Weekly Calendar of Learning Objectives
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Click here to download the calendar (pdf).
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
Maintained by Northwestern College of Chiropractic
Last updated: 5 July, 2006
 

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