Physical examination myths: Assessing range of motion of an acutely injured extremity before imaging

摘要

A 25-year-old man falls from his bicycle and sustains a FOOSH (fall on out-stretched hand) injury to the right upper extremity. An 8-year-old girl falls from the monkey bars (6 feet) and injures her elbow.A 45-year-old man trips while playing soccer and sustains an inversion injury to his ankle.An 80-year-old woman has a syncopal episode and sustains a hyperextension injury to her neck."The important thing is not to stop questioning" -Albert Einstein The introduction of percussion by Auenbrugger in 1761 and the stethoscope by Laennec in 1819 helped 19th-century physicians make anatomical and pathophys-iologic diagnoses. Since then, inspection and palpation-including range of motion (ROM) assessment-was added to the physical examination ritual. It is a universally taught and well-accepted paradigm that ROM assessment should be part of the physical examination of the acutely injured extremity. This medical dogma is engraved in the physical examination armamentarium of most physicians. Classic teaching regarding the essential compo-