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Semester 2 > Clinical Assessment (palpation) > Flashcards

Clinical Assessment (palpation) Flashcards

1
Q

palpation is

A

skillful art of assessing the quality @ structural characteristics of the human body.

Anatomical palpation
Sensory palpation

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2
Q

4 Ts of palpation

A

temperature
texture
tone

tenderness

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3
Q

what can temperature indicate

A

increased circulation

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4
Q

what are some causes of increased temperature

A

increased circulation – INFLAMMATION as a result of IMMUNE response

by Fever – (IMMUNE response)

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5
Q

texture

A

E.g.
ropey, bumping (E.g. TRIGGER POINTS)
spongey, hard (can refer to tonicity)

“stuck together” texture of scar tissue & restricted fascia

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6
Q

tone?

A

how does muscle respond to stretch?

Does it lengthen easily or not?

does the muscle resist pressure

E.g.
Hypertone
Hypotone

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7
Q

tenderness

A

guest/patient’s sensitivity to touch/pressure

some have higher tolerance

pain? soreness? tenderness?

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8
Q

E.g. of informed consent for palpation

A

Case scenario: soreness in right lower back

“Based on the information you provided in this interview, I would like to do an assessment called Palpation. This is where I would palpate, meaning touch, your lower back. I like to compare the unaffected side and the affected. I would be feeling the tone, the temperature of your skin, texture, and the tenderness of your lower back.”

Pain scale
Do you have any questions?
Do I have your consent

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9
Q

palpation assessment – things to note

A

compare bilaterally

start on unaffected side

use flat hand firmly on unaffected tissue

feel for 4 Ts

Compare to affected side

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10
Q

patient position during palpation assessment

A

seated/supine/prone – depends on area palpated

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11
Q

remember to ____

A

always get feedback from patient – ask if there is pain/tension/discomfort/pressure, etc.

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12
Q

remember to also ____ at the end

A

document your clinical findings

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13
Q

MOVEMENT

A

A-ROM
P-ROM (& POP-ROM)
R-ROM

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14
Q

note the relationship between range of motion – and contractile vs. Non-contractile tissue

A

AROM is assessing contractile & non-contractile tissue

PROM is assessing non-contractile tissue

RROM is assessing contractile tissue only

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15
Q

definition of RANGE OF MOTION

A

end-to-end distance of a specific joint movement which is structurally possible

“The term Range of Motion refers to the degree of motion that is present in a joint.”

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16
Q

Note 5th type of ROM (Not covered in this course)

A

AA-ROM

active assisted range of motion

17
Q

AROM

A

active contraction of muscle crossing the joint

unaffected then affected

18
Q

what is the therapist looking for during AROM assessment?

A

is action/movement correct?

can patient complete full ROM?

is there visible compensation w/ other muscles? (???)

FACIAL EXPRESSION OF GUEST

quality of movement? smooth? consistent? gradual? choppy? etc.

19
Q

Very important note about ROM assessments. Always pay attention to patient’s _____.

A

facial expressions

20
Q

other things to watch for during AROM assessment

A

When and where during each of the movements the onset of pain occurs

Whether the movement increases the intensity and quality of the pain

The reaction of the patient to pain

The amount of observable restriction and its nature

The pattern of movement

The rhythm and quality of movement

The movement of associated joints

The willingness of the patient to move the part

21
Q

AROM vs PROM – which produces more movement?

A

PROM

22
Q

what is the primary limiting factor of P-ROM (& POP-ROM) ?

A

PROM & POPROM are primarily limited by PAIN

23
Q

what to observe during PROM assessment?

A

when/where does pain begin?

does movement increase intensity?

pattern of movement limitation?

ROM available?

END FEEL?
(NOTE THAT POPROM IS ESP EFFECTIVE FOR ASSESSING END FEEL)

24
Q

note hypo/hypermobility during PROM assessment

A

PROM can be performed if there is hypo/hyper-mobility

avoid overstretching hypermobility

avoid trying to push past limited ROM w/ hypomobility

25
Q

different types of END feels for passive ROM

A

Normal ROM – typical tissue approximation

Boggy – soft/swollen, w/ edema (?)

leathery – feeling of “stretching leather belt”

firm – hard/dense tissue, w/ poor movement

bony – bone on bone feeling

26
Q

normal vs abnormal/pathological JOINT END FEELS

A

bone to bone = elbow extension

soft tissue approximation = knee flexion

tissue stretch = ankle dorsiflexion, finger extension, shoulder LR

27
Q

abnormal/pathological JOINT END FEELS

A

early muscle spasm (protective spasm following injury)

late muscle spasm (spasm via instability/pain)

“Mushy” tissue stretch (tissue stretch)

spasticity (upper motor neuron lesion)

hard capsular (frozen shoulder)

soft capsular (synovitis)

bone to bone (osteophyte)

empty (PAIN. E.g. acute subacromial bursitis)

springy block (meniscus tear)

28
Q

POPROM

A

only if painless PROM

29
Q

RROM assessment uses

A

isometric contraction

30
Q

RROM 2 protocols

A

protocol 1 = Magee (test @ neutral position)

protocol 2 = Kendall (test @ mid-range)

31
Q

RROM purpose

A

to test the general strength of all the muscles that cross the joint in general

(ALSO TESTING FOR PAIN)

(in contrast to MMT which tests a specific muscle)

(or MYOTOME TESTING – which tests CNS)

(or MUSCLE SETTING – which is for the purpose of realigning the fibres of a muscle or muscle group)

32
Q

observations during RROM

A

quality of RROM

patient weak or strong?

compensating muscles detected?

PAIN?

can the patient complete RROM (or give in?)
–> if give in, consider myotome testing (???)

And again – MONITOR FACIAL EXPRESSION

33
Q

AAROM (?)

A

rehabilitation for MVA, sports trauma, falls, etc.

patient requires assistance regaining full ROM

34
Q

A VERY IMPORTANT NOTE ABOUT EXPLAINING THE PROCEDURE

A

MAKE SURE TO EXPLAIN THE PROCEDURE OF AROM, PROM, RROM to the patient, so they understand what the procedure consists of (and purpose?)

35
Q

another important thing the patient should be reminded of

(PAIN FREE RANGE)

A

ALL MOVEMENT SHOULD BE DONE IN PAIN-FREE ZONE

Instruct patient/guest to not move to/past the point of pain

36
Q

something else to be observant of

(BASELINE OF MEASUREMENTS)

A

note starting on unaffected side

Not JUST for preparing nervous system on affected side

But also – OBSERVE movement of unaffected side, and COMPARE the movement on the affected side to the movement on the unaffected side

37
Q

Be sure to reference charts demonstrating NORMAL ROM in order to know when a particular ROM is not within normal limits

A

.

38
Q

on charting (star diagram) what notation is used for different types of ROM?

A

AROM with squiggly line

PROM with straight line

Semester 2 (14 decks)

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