9/9 - Physical Exam and Eval Flashcards by Jenn Cantilli

how is exam related to pt hx

exam is an extension of the history

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what refines the diagnostic hypotheses

selected tests and measures

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what is the extent of the exam dependent on

nature
severity
irritability
stage
stability

… of patient’s sx

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what are the goals of physical exam (5)

determine joints, ms, neural tissues, or other tissues/structures involved
reproduce pts sx
look for patterns of movement and restriction comparable w pt hx
refine, support, or rule out diagnostic hypotheses
establish objective data baseline to measure functional improvement

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what is the goal of an upper quarter scan

clear cervical spine

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what are the components of an upper quarter scan

cervical AROM
reflexes
myotome
dermatomes

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what cervical AROM is assessed in an upper quarter scan

flexion
extension
side bend
rotation

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what reflexes are tested in an upper quarter scan

biceps
brachioradialis
triceps

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what are the myotomes assessed in an upper quarter scan

C1-2: neck flexion
C3: neck SB
C4: shoulder elevation
C5: shoulder ABD
C6: elbow flex and wrist ext
C7: elbw ext and wrist flex
C8: thumb ext and ulnar dev
T1: hand intrinsics

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how are dermatomes assessed in an upper quarter scan

bilateral light touch

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what is the goal of a lower quarter scan

clear lumbar spine

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what are the components of a lower quarter scan

lumbar AROM
reflexes
myotomes
dermatomes

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how is lumbar AROM assessed in a lower quarter scan

flex
ext
side bend
rotation

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what reflexes are assessed in a lower quarter scan

knee jerk
achilles

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what are the myotomes assessed in a lower quarter scan

L1-2: hip flexion (iliopsoas)
L3: knee ext (quads)
L4: ankle DF (tib ant)
L5: great toe ext (EHL)
S1-2: ankle PF (gastroc)

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how are dermatomes assessed in a lower quarter scan

bilateral light touch

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what are the types of posture you could observe

protective
nonprotective structural
nonprotective behavioral

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describe a protective posture

correction inc sx
ex: lumbar shift, inc knee flex to dec WB

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describe a nonprotective structural posture

deformity that isn’t correctible
- ex: long-standing scoliosis

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describe a nonprotective behavioral posture

pt personality, emotions, or poor body awareness

correctible w/o creating pain, if anything makes the sx better

ex: slumped sitting posture contributing to HAs

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what are possible hypotheses for abnormal posture (5)

joint contracture
limited flexibility
ms weakness
neuro deficit
habitual / repetitive movement pattern

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what are hypotheses for LBP with inc lumbar lordosis

hypomobile lumbar spine
weak lower abs
tight hip flexors / low back extensors

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what are components to assess when testing active motion

willingness to move
range, quality, & sx provocation
overpressure applied if no sx

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what are the two ways to assess passive motion

physiological (osteokinematic)
accessory (arthrokinematic)

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osteo vs arthro kinematic

osteo = physiological - cardinal plane mvement - flex/ext, IR/ER movements arthro = accessory - between joint surfaces - joint play assessment

what are three ways to measure passive motion

quality - type of resistance quantity - amount of resistance end feel

what does pain before resistance in passive motion indicate

acute inflammation

what does pain at the same time as resistance indicate in passive motion

subacute condition

what does pain after resistance in passive motion indicate

chronic with tissue fibrosis

what are the two ways end feel can be categorized

physiological and accessory

what does a 0 for joint mobility mean

no movement ankylosed

what does a 1 in joint mobility mean

mod - marked hypomobility

what does a 2 for joint mobility mean

slightly hypomobile

what does a 3 in joint mobility mean

normal

what does a 4 in joint mobility mean

slightly hypermobile

what does a 5 for joint mobility mean

mod-marked hypermobility

what does a 6 for joint mobility mean

unstable

what are 3 examples of normal end feels

bone to bone soft tissue approximation tissue stretch

what is motor function

ability to learn and demonstrate efficient movement patterns

what are some examples of how you could improve motor function

walking stair climbing ther ex

how do you treat a joint with a mobility grade 0

do not mobilize

how do you treat joint with a mobility grade of 1

mobilization

how do you treat a joint with a mobility grade of 3

no treatment is needed

how do you treat a joint with a mobility grade of 4

assess for adjacent hypomobility exercise taping bracing

how do you treat a joint with a mobility grade of 5

assess for adjacent hypomobility exercise taping bracing

how do you treat joint with a mobility grade of 6

bracing splinting casting surgical stabilization

what is an example of a bone to bone end feel

elbow extension

what is an example of a soft tissue approximation end feel

knee flexion

what is an example of a tissue stretch end feel

ankle DF

what is an example of when you would feel an early muscle spasm as a joint's end feel

protection following injury

what is an example of when you would feel a late muscle spasm as a joint's end feel

protection from instability / pain

what is an abnormal example of when you would feel tissue stretch as a joint's end feel

tight muscle (occurs early in range)

what is an example of when you would feel spasticity as a joint's end feel

upper motor neuron lesion

what is an example of when you would feel hard capsular as a joint's abnormal end feel

adhesive capsulitis

what is an example of when you would feel soft capsular as a joint's end feel

synovitis soft tissue edema

in general is a bone to bone end feel normal or abnormal

abnormal - elbow ext is the only exception

what is an example of when you would feel bone to bone as a joint's abnormal end feel

osteophyte formation

what is an example of when you would feel empty (before tissue resistance) as a joint's end feel

acute injury

what is an example of when you would feel a springy block as a joint's end feel

meniscal injury

what are measures of muscle performance

strength endurance power

how do you measure strength when assessing a muscle's performance

MMT HHD isokinetic testing

how do you measure endurance w assessing a muscle's performance

functional tests timed tests ex: holding a plank

how do you measure power when assessing muscle performance

work / time ex: jumping activities

what does the quality of a contraction tell you

the significance of tissue damage

what does a strong and painless contraction indicate

normal

what does a strong and painful contraction indicate

minor muscle / tendon lesion

what does a weak and painful contraction indicate

major muscle / tendon lesion

what does a weak and painless contraction indicate

rupture of muscle / tendon neurological lesion

what is the reflex integrity grading scale

0 = absent 1+ = diminished 2+ = normal 3+ = exaggerated 4+ = exaggerated with clonus

what nerve does testing the biceps reflex integrity assess

what nerve does testing the brachioradialis reflex integrity assess

what nerve does testing the triceps reflex integrity assess

what nerve does testing the quadriceps reflex integrity assess

what nerve does testing the soleus reflex integrity assess

when palpating what is important about your technique

specificity - what are you palpating - if non specific could create sx without further info on why

what are soft tissue structures assessed in palpation (5)

muscle ligament tendon bursa neural elements

what is assessed when palpating a patient

skin fascia muscle joint

what is the process of palpation

uninvolved side is assessed first perform from superficial to deep

an increase in temperature noted in palpation indicates what

inflammation

what should you document when palpating a patient (7)

temperature soft tissue swelling dryness / excessive moisture tissue texture abnormality - density and quality osseous alignment soft tissue structures sx response

what are most tests/measures designed to do

r/o or r/i pathoanatomic dx

what are two important qualities of special tests

specific to body region differentiate between structures

how do special tests relate to diagnostic hypotheses and differential diagnoses

refine, support, or refute diagnostic hypotheses assist w differential dx

what is a physical therapy diagnosis

label ascribed to a cluster of s/sx

when and when only can a PT diagnosis be made

dx can only be made when all potential causes for sx have been r/o

what does making a PT dx involve

combo of hypothesis testing and pattern recognition

what does the prognosis guide

intensity, duration, and freq of intervention aids in justifying the intervention

9/9 - Physical Exam and Eval Flashcards

(87 cards)