I promise to continue this today which I am doing now, this is the second part of my previous post:HERE

My last post ended with family and social history (you might want to quickly glance through the previous post for a quick recap).

Dont forget that the focus of our case study is a 46 year old man who had a hip replacement done after a gun shot wound that severly destroyed his left hip.

Let continue 👇
Now

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Observation and Examination
This is basically what is being seen on seeing the man at a particular time, at a particular hour.

On seeing him after surgery on admission, he was met lying in bed with his left leg 🦵 swollen, slightly bent at the knee and elevated on a pillow. There was bandaging and wound dressing at the surgrical site.
His leg was elevated mainly to reduce the swelling going on at his left leg after thr surgery. So what are we seeing here on physical inspection? We have:

• A bandaged leg, at the site where surgery was done
• A swollen leg following the surgey whcih was slightly bent and elevated (note: the leg was slighty bent to preserve the integrity of the joint )
• A reduction in size of the calf and posterior thigh muscles of the left leg compared to the right 🦵
• A change in the integrity of the skin. The skin of the left leg was darker compared to the right.
• His left foot was obviously showing sign of weakness

Now what were the readings of his vitals

His Blood pressure was normal, his heart rate (pulse rate) was still within normal range and his saturation level were good.

His PCV which is basically and in simple term the amount of viable blood (if there is anything like that) was 34% which was quite low so, meaning we still have to be careful about exerting him.

Now we have talked about what we can see on physical inspection, what do we notice on proper examination, getting into the heart of the situation

In this stage everything is examined for both the affected and unaffected side from the Head down to the legs 👇

Head and Neck
There is no abnormality here
The face is symmetrical and there is no head injury

Thorax and abdomen (which is basically is chest and back)

There were some abnormality seen here, although the chest and abdomen moved with respiration, the back have a slight abnormal curvature called scoliosis which in simple term is when the curvature of the spine is more to the right or left, in this case, it could be mild or severe. The curvature was more at the level of his back close to his buttocks and more to the left.

Pelvic and perineum ( basically this refers to the area of his buttocks and genitals)
What was seen here was a urinary catheter ( this basically allows him to urinate since he cant get out of bed, so he urinates and it is drained by a tube into a bag) The urinary catheter is a tube like structure that is inserted in the urethra and allows urine to be drained into a bag which majorly is found at the side of the bed hanged.

Now to his Upper limb which is both hands, what was found on examination. Findings will be broken down into the following to aid your reading and personal observation 👇

Muscle bulk (muscle size), based on comparison, it was:

Normal on the right
Normal on the right also (Normal bilaterally)

Muscle Tone ( In very simple term which I am trying so hard to come up with, this refers to how tense or firm the muscles are). In this case it was:

Normal on the right and the left (normal bilaterally)

Gross Muscle Power (GMP- this basically refers to the strength of the muscle and the amount of force and power it can produce)

For the right hand (upperlimb which is the proper term to use ) GMP was 4 and 4+ for the right.

I understand you are wondering what 4 and 4+, to explain it in details, this is a breakdown in clear terms 👇.

You see when it come to grading the power of
muscles, we have to outcome measures which are commonly use, the

1: Oxford muscle grading
2: Manual muscle testing

For the oxford muscle grading

Now, The oxford muscle grading is the most common method for evaluating the strength of the muscle and the breakdown of how it is used is below 👇

Muscles are graded based on power from 0-5

0 - mean no power ( no movement, flicker, or muscle contraction, the muscle are basically paralyzed)

1- Flicker of power/ flicker of muscle contraction, but it is so weak and not enough to move the joints of the intended body part

2- The muscle power is enough to move the intended body part in full range, but only in the abscence of the influence of gravity. Gravity is usually eliminated when the intended body part is allowed to rest on a surface while trying to perform a movement.

3- In this, the muscle power is enough to move the intended body part against gravity but no active or manual resistance, a resistance which can be provided by a weight or an external pressure which counteract the movement of the moved body part in a particular direction

4- In this, the power in the muscle is enough to move the intended body part against minimal resistance

4+ - In this, the power in the muscle is enough to move the intended body part against moderate resistance or a counteracting pressure to resist movement

5- In this, the power in the muscle is enough to move the intended body part through maximal resistance. In this case, the muscle power is said to be normal as it basically unaffected.

So this where we draw the curtain on today's part of this Case study.

Wish I could continue, but my hands are sore from typing and I am basically dozing 😴 off here, I need some shut eye.

See you tomorrow on part 3 as we continue on examination and assessment.

Stay tuned...

References

https://www.physio-pedia.com/Muscle_Strength_Testing

https://www.prohealthcareproducts.com/blog/manual-muscle-testing-grading-and-procedures

https://www.physio-pedia.com/Total_Hip_Replacement