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Special Tests in Musculoskeletal Examination

Special Tests in Musculoskeleta…

上传者: jiayi7534 2013-03-13 评分 5 0 127 17 576 暂无简介 简介 举报

简介:本文档为《Special Tests in Musculoskeletal Examinationpdf》,可适用于高等教育领域,主题内容包含GeneralAnatomyGeneraltpindd::AMBIOMECHANICALSYSTEMSTECHNOLOGYAVolumeSetEdi符等。

GeneralAnatomyGeneraltpindd::AMBIOMECHANICALSYSTEMSTECHNOLOGYAVolumeSetEditor:CorneliusTLeondes(UniversityofCalifornia,LosAngeles,USA)ComputationalMethodsISBNISBNCardiovascularSystemsISBNISBNMuscularSkeletalSystemsISBNISBNGeneralAnatomyISBNISBNNEWJERSEY•LONDON•SINGAPORE•BEIJING•SHANGHAI•HONGKONG•TAIPEI•CHENNAIWorldScientificEditorCorneliusTLeondesUniversityofCalifornia,LosAngeles,USAGeneralAnatomyAVolumeSetGeneraltpindd::AMBritishLibraryCataloguinginPublicationDataAcataloguerecordforthisbookisavailablefromtheBritishLibraryForphotocopyingofmaterialinthisvolume,pleasepayacopyingfeethroughtheCopyrightClearanceCenter,Inc,RosewoodDrive,Danvers,MA,USAInthiscasepermissiontophotocopyisnotrequiredfromthepublisherISBN(Set)ISBN(Set)ISBNISBNTypesetbyStallionPressEmail:enquiriesstallionpresscomAllrightsreservedThisbook,orpartsthereof,maynotbereproducedinanyformorbyanymeans,electronicormechanical,includingphotocopying,recordingoranyinformationstorageandretrievalsystemnowknownortobeinvented,withoutwrittenpermissionfromthePublisherCopyrightbyWorldScientificPublishingCoPteLtdPublishedbyWorldScientificPublishingCoPteLtdTohTuckLink,SingaporeUSAoffice:WarrenStreet,Suite,Hackensack,NJUKoffice:SheltonStreet,CoventGarden,LondonWCHHEPrintedinSingaporeBIOMECHANICALSYSTEMSTECHNOLOGYAVolumeSetGeneralAnatomyAugust,:spibvBiomechanicalSysteminxinfmstReadingPREFACEBecauseofrapiddevelopmentsincomputertechnologyandcomputationaltechniques,advancesinawidespectrumoftechnologies,andotheradvancescoupledwithcrossdisciplinarypursuitsbetweentechnologyanditsapplicationstohumanbodyprocesses,thefieldofbiomechanicscontinuestoevolveManyareasofsignificantprogresscanbenotedTheseincludedynamicsofmusculosketalsystems,mechanicsofhardandsofttissues,mechanicsofboneremodeling,mechanicsofimplanttissueinterfaces,cardiovascularandrespiratorybiomechanics,mechanicsofbloodandairflow,flowprosthesisinterfaces,mechanicsofimpact,dynamicsofmanmachineinteraction,andmanymoreThisisthefourthofasetoffourvolumesandittreatstheareaofGeneralAnatomyinbiomechanicsThefourvolumesconstituteanintegratedsetThetitlesforeachofthevolumesare:•BiomechanicalSystemsTechnology:ComputationalMethods•BiomechanicalSystemsTechnology:CardiovascularSystems•BiomechanicalSystemsTechnology:MuscularSkeletalSystems•BiomechanicalSystemsTechnology:GeneralAnatomyCollectivelytheyconstituteanMRW(MajorReferenceWork)AnMRWisacomprehensivetreatmentofasubjectarearequiringmultipleauthorsandanumberofdistinctlytitledandwellintegratedvolumesEachvolumetreatsaspecificbutbroadsubjectareaoffundamentalimportancetobiomechanicalsystemstechnologyEachvolumeisselfcontainedandstandsaloneforthoseinterestedinaspecificvolumeHowever,collectively,thisvolumesetevidentlyconstitutesthefirstcomprehensivemajorreferenceworkdedicatedtothemultidisciplineareaofbiomechanicalsystemstechnologyThereareovercoauthorsfromcountriesofthisnotableMRWThechaptersareclearlywritten,selfcontained,readableandcomprehensivewithhelpfulguidesincludingintroduction,summary,extensivefiguresandexampleswithcomprehensivereferencelistsPerhapsthemostvaluablefeatureofthisworkisthebreadthanddepthofthetopicscoveredbyleadingcontributorsontheinternationalsceneThecontributorsofthisvolumeclearlyrevealtheeffectivenessofthetechniquesavailableandtheessentialrolethattheywillplayinthefutureIhopethatpractitioners,researchworkers,computerscientists,andstudentswillfindthissetofvolumestobeauniqueandsignificantreferencesourceforyearstocomevAugust,:spibvBiomechanicalSysteminxinfmstReadingThispageintentionallyleftblankThispageintentionallyleftblankAugust,:spibvBiomechanicalSysteminxinfmstReadingCONTENTSPrefacevChapterAcousticalSignalsofBiomechanicalSystemsEKaniusasChapterModelingTechniquesforLiverTissuePropertiesandtheirApplicationinSurgicalTreatmentofLiverCancerJMSchwartz,DLaurendeau,MDenninger,DRancourtandCSimoChapterASurveyofBiomechanicalModelingoftheBrainforIntraSurgicalDisplacementEstimationandMedicalSimulationMAAudette,MMiga,JNemes,KChinzeiandTMPetersChapterTechniquesandApplicationsofRobustNonrigidBrainRegistrationOClatz,HDelingette,NArchip,IFTalos,AJGolby,PBlack,RKikinis,FAJolesz,NAyacheandSKWarfieldChapterOpticalImaginginCerebralHemodynamicsandPathophysiology:TechniquesandApplicationsQLuo,SChen,PLiandSZengChapterTheAuditoryBrainstemImplantHTakahashi,MNakaoandKKagaviiAugust,:spibvBiomechanicalSysteminxinfmstReadingviiiContentsChapterSpectralAnalysisTechniquesintheDetectionofCoronaryArteryStenosisEDUbeyliandIGulerChapterTechniquesintheContourDetectionofKidneysandtheirApplicationsMMartinFernandez,LCorderoGrande,EMunozMorenoandCAlberolaLopezCHAPTERACOUSTICALSIGNALSOFBIOMECHANICALSYSTEMSEUGENIJUSKANIUSASInstituteofFundamentalsandTheoryofElectricalEngineering,BioelectricityMagnetismLab,ViennaUniversityofTechnology,GusshausstrasseE,AVienna,AustriakaniusastuwienacatTraditionally,acousticalsignalsofbiomechanicalsystemsshowahighclinicalrelevancewhenauscultatedonthebodyskinTheheartandlungsoundsareappliedtothediagnosisofcardiacandrespiratorydisturbances,respectively,whereasthesnoringsoundshavebeenrecentlyacknowledgedasimportantsymptomsoftheairwayobstructionThischapteraimsatthesimultaneousconsiderationofallthreetypesofbodysoundsfromabiomechanicalpointofviewThatis,therespectivegenerationmechanismsareoutlined,showingthatthevibrationsofdifferenttissuestructuresandairturbulencesmanifestasregionallyconcentratedordistributedsoundsourcesTheresultingacousticalpropertiesandmutualinterrelationsofthebodysoundsarecommentedTheinvestigationofthesoundpropagationdemonstratesaninhomogeneousandfrequencydependantattenuationofsoundswithinthebody,yieldingaspecificspatialandregionaldistributionofthesoundintensityinsidethebodyandonthebodyskin(astheauscultationregion),respectivelyThepresentedissuespertainingtothebiomechanicalgenerationandtransmissionofthebodysoundsnotonlyrevealclinicallyrelevantcorrelationsbetweenthephysiologicalphenomenaunderinvestigationandtheregisteredbiosignals,butalsoofferasolidbasisforbothproperunderstandingofthebiosignalrelevanceandoptimizationoftherecordingtechniquesIntroductionInmanyways,thebodysoundsofhumanbiomechanicalsystemshaveremainedtimelesssinceLaennec,inventorofthestethoscope,aimprovedtheaudibilityofaThestethoscope(greekstetoschestandskopeinexplore)isabasicandwidelyestablishedmedicalinstrument,viewedbymanyastheverysymbolofmedicine,forconductionofthesoundsgeneratedinsidethebodybetweenthebodysurfaceandtheearsTheauscultationofthebodysoundswasemployedmorethancenturiesago,assuggestedinHippocrateswork“deMorbis”:“Ifyoulistenbyapplyingtheeartothechest”Theinventoroftheoriginalstethoscope,RTHLaennec,madeinanepochmakingobservationwithawoodencylinderwhichwasprimarilysoughttoavoidembarrassment“Iwasconsulted,”saysLaennec,“byayoungwomanwhopresentedsomegeneralsymptomsofdiseaseofheartOnaccountoftheageandsexofthepatient,thecommonmodesofexploration(immediateapplicationoftheear)beinginapplicable,Iwasledtorecollectawellknownacousticphenomenon”Later,in,ABianchiintroducedarigiddiaphragmoverthepartofthecylinderthatwasappliedtothechestToday,themodernstethoscopeconsistsofabelltypechestpieceforsoundamplification,arubbertubeforsoundtransmission,andearpiecesforconductingthesoundintoears,EKaniusasheartandlungsoundswiththestethoscopeThesesoundshaveconveyedmeaningfulsignalstotheexaminerlookingforcardiorespiratorydisturbancesRecently,medicalinteresthasalsobeenfocusedonsnoringsounds,therelevanceofwhichhasbeenacknowledged,forinstance,asawarningsignthatnormalbreathingisnottakingplaceduringsleeporevenasthefirstsignofthesleepapneasyndromebObviouslythestethoscopehascontinuedtobethemostrelevantinstrumentfortheauscultation(latinauscultaretheactoflistening)ofthebodysoundssinceitsinventionnearlytwocenturiesagoAmodernversionofthestethoscopeisshowninFig,whichdemonstratesabodysoundssensor,ieachestpieceofthestethoscopecombinedwithamicrophoneThechestpiecediaphragmbeinginclosecontactwiththeskinvibrateswiththeskinwhich,inturn,followsthevibrationsinducedbythemechanicalforcesofthebodysoundsThevibrationsofthediaphragmcreateacousticpressurewavestravelingintothebellandfurthertothemicrophoneThelatteractsasanelectroacousticconvertertoestablishabodysoundssignalsforthesignalprocessingThephysicalpropertiesofthearisingacoustictransmissionpathwithinthebodysoundssensorhavestrongimplicationsonthetransmissioncharacteristicsofthebodysoundsInparticular,theresonantcharacteristicsofthechestpiece(=Helmholtzresonator,)playasignificantroleconcerningthenonlinearfilteringandamplificationcharacteristicsofthebodysoundssensor–,–BodySoundsAnOverviewAbriefoutlineofthebodysoundsisgivenbelow,includingtheirbiomechanicalgenerationmechanismsandacousticalpropertiesInparticular,itwillbeshownthatthevibrationsoftissues,valvesinsidetheheart,blood,wallsofairways,andairturbulencesmanifestasthebodysoundswhichareaccessiblethroughtheauscultationontheskin(Fig)Fromanacousticalpointofview,thebodysoundsarenormallyimpuretonesornoises,andthereforearecomposedofaconglomerationoffrequenciesofmultitudinousintensitiesAsalreadymentioned,thebodysoundsinclude(Fig)Itisworthmentioningthattheintroductionofthestethoscopeforcedphysicianstoacardinalreorientation,forthestethoscopehadalteredthephysician’sperceptionofacousticalbodysoundsandhisrelationtobothdiseaseandpatientDespitetheclearsuperiorityoftheinstrumentinsoundauscultation,itwasacceptedwithsomeantagonismevenbyprominentchestphysiciansTheamusingcriticsincluded“ThestethoscopeislargelyadecorativeinstrumentNevertheless,itoccupiesanimportantplaceintheartofmedicine”orevencomplaintsofphysiciansthat“theyheardtoomuch”bThesleepapneasyndromerepresentsacomplexmedicalproblemcharacterizedbyacessationofeffectiverespirationduringsleepInparticular,thesocalledobstructiveapneasareofgreatinterest,whicharecharacterizedbyanobstructionoftheupperairwaysandobstructivesnoring,ieintermittent,loudandirregularsnoringTheminimumprevalenceoftheapneasisabout,theapneascausingaseveredeteriorationofqualityoflife,excessivedaytimesomnolence,decreasedlifeexpectancy,andnegativeeffectsonotherfamilymembers,August,:spibvBiomechanicalSysteminxinchFAAcousticalSignalsofBiomechanicalSystemsMicrophoneDiaphragmBellAircavitySkinHeartsoundsLungsoundsSnoringsoundss(=sCsRsS)OutputchannelBodysoundssensorFigRecordingoftheheart,lung,andsnoringsoundsbymeansofthebodysoundssensoramicrophoneattachedtoachestpiece(componentofthestethoscope)byaplastictubeThecrosssectionofthechestpieceisshown,whichdepictsthediaphragmandthebellwithitsoutputchannel•cardiaccomponentsC,•respiratorycomponentsR,and•snoringcomponentsSHeartsoundsTheheartsoundsareperhapsthemosttraditionalsounds,asindicatedbythefactthatthestethoscopewasprimarilydevotedtotheauscultationoftheheartsoundsThesesoundsarerelatedtothecontractileactivityofthecardiohemicsystemcandparticularlyyielddirectinformationonmyocardialandvalvulardeteriorationoronhemodynamicabnormalities,Thenormalandabnormalheartsoundsaregeneratedwithintheheart(Fig)andmayincludethefollowingsounds,,–asschematicallydemonstratedinFig:(i)thefirstsound,(ii)thesecondsound,(iii)thethirdsound,(iv)thefourthsound,(v)ejectionsounds,(vi)openingsounds,and(vii)murmurscThecardiohemicsystemrepresentstheheartandbloodtogetherandmaybecomparedtoafluidfilledballoon,which,whenstimulatedatanylocation,vibratesasthewholeandthusemitstheheartsoundsAugust,:spibvBiomechanicalSysteminxinchFAEKaniusasMitralvalveTricuspidvalveAorticvalvePulmonicvalveLeftatriumRightventricleRightatriumLeftventricleVentricularwallInterventricularseptumFigHeartanatomyrelevantforthegenerationoftheheartsoundsPQRSTSystoleDiastoleDiastoletDiastolicmurmursECGsignalstndrdthEjectionsoundsOpeningsoundsSignalsSystolicmurmursSoundsignalsCLowfrequency,highamplitudeHighfrequency,lowamplitudeFigSchematicrepresentationoftheheartsoundsinrelationtoelectrocardiogram(ECG)signalwithindicatedpositionsoftypicalwavesP,Q,R,SandTTheamplitudeandfrequencyofthesoundsarequalitativelyindicated,andthenormalsoundsaredrawninboldThefirstsound:Thissoundisinitiatedattheonsetofventricularsystoleandisrelatedtothecloseoftheatrioventricularvalves,iethemitralandthetricuspidvalveAbrupttensionofthevalves,decelerationoftheblood,andjerkycontractionoftheventricularmusclesyieldvibrationswhichmanifestasthefirstheartsoundItistheloudestandthelongestofalltheheartsoundsandconsistsofaseriesofvibrationsoflowfrequenciesThesounddurationisaboutmsThefrequencyspectraofthefirstheartsoundhasapeakaboutHzwithadBoctavedecreaseinintensity,whereastheintensitydecreaseintherange,HzisaboutdBThesecondsound:ItisgeneratedbytheclosureofthesemilunaraorticandpulmonicvalveswhentheinterventricularpressurebeginstofallAnalogoustotheAcousticalSignalsofBiomechanicalSystemsfirstheartsound,thevibrationsoccurinthearteriesduetodecelerationofbloodtheventriclesandatriaalsovibrateduetotransmissionofvibrationsthroughthebloodandthevalvesThesoundisofshorterdurationofaboutms(<ms)andlowerintensity,andhasamoresnappingqualitythanthefirstheartsound,aswillbedemonstratedlaterThereasonfortheshorterdurationisthatthesemilunarvalvesaremuchtauterthantheatrioventricularvalvesandthustendtoclosemuchmorerapidlyAsaresultoftheshortduration,thesecondsoundiscomposedofhighfrequencyvibrationsContrarytothefirstheartsound,thesecondsounddoesnotshowanyconsistentspectralpeak,butrollsoffmoregraduallyasafunctionoffrequencywithanintensitydecreaseofonlydB(<dB)overtherange,HzThethirdsound:Itoccursinearlydiastole,justafterthesecondheartsound,duringthetimeofrapidventricularfillingwhentheventricularwalltwitchesThevibrationsareofverylowfrequencybecausethewallsarerelaxedThesoundisabnormalifheardinindividualsovertheageofThefourthsound:Thissoundisanabnormaldiastolicsoundwhichoccursatthetimewhentheatriacontractduringthelatediastolicfillingphase,displacingbloodintothedistendedventriclesThefourthheartsoundisheardjustbeforethefirstheartsoundandisalowfrequencysoundEjectionsounds:Theyareproducedbytheopeningofthesemilunaraorticorpulmonicvalves,inparticular,whenoneofthesevalvesisdiseasedThesoundsariseshortlyafterthefirstheartsoundwiththeonsetofventricularejectionTheejectionsoundsarehighfrequencyclickysoundsOpeningsounds:TheyaremostfrequentlytheresultofasuddenpathologicalarrestoftheopeningofthemitralortricuspidvalveThesoundsoccurafterthesecondheartsoundinearlydiastoleandrepresentshorthighfrequencysoundsMurmurs:Thesesounds,bydefinition,aresustainednoisesthatareaudibleduringthetimeperiodsofsystole(=systolicmurmurs)anddiastole(=diastolicmurmurs)Basically,themurmursareabnormalsoundsandareproducedby(a)backwardregurgitationthroughaleakingvalve,(b)forwardflowthroughanarrowedordeformedvalve,(c)highrateofbloodflow(=turbulentflow)throughanormalorabnormalvalve,and(d)vibrationofloosestructureswithintheheartThesystolicanddiastolicmurmursconsistprincipallyofhighfrequencycomponentsintheranged,Hz,occasionallyascendingtoHzdInparticular,thesystolicmurmursofaorticinsufficiencyandthemitraldiastolicmurmursfallintherange,Hz,Theaorticdiastolicmurmursandpericardialrubsoccurathigherfrequenciesintherange,HzThepresystolicmurmurslay,forthemostpart,intherangebelowHz,butmaycontaincomponentsuptoHzEKaniusasInnormalsubjects,onlythe“rstandthesecondheartsoundareaudible(Fig),astheothersoundsarenormallyofverylowintensityConcerningthespectralregionofbothnormalheartsounds,earlystudiesfoundthattheenergycomponentsaboveHzarenegligibleThemainfrequencycomponentswerefoundtofallintheapproximaterange,HzHowever,thesecondheartsoundincludesmorehighfrequencycomponentsthanthe“rstsound,whichcomplieswiththerespectiveoriginofthesounds,asdiscussedaboveFurthermore,thesecondheartsoundisnotcon“nedtoanarrowfrequencybandwidthlackinginconcentratedenergywhichisalsocontrarytothe“rstheartsoundFiguredemonstratesthenormalcardiacsoundsforahealthysubjectduringbreathhold,asregisteredbythebodysoundssensor(Fig)ItconsistsofsC,whichshowscardiacratefCclosetoHzAccordingtothespectrogram,the“rstandthesecondheartsoundaremainlycharacterizedbyshorttermfrequencycomponentsofuptoapproximatelyHz,withweakharmonicsofuptoapproximatelyHzIntheintermediatetimeintervals,thespectrumisrestrictedtoaboutHzItcanbeobse

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