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5 Ortho > L2 Elements of Exam and Eval > Flashcards

L2 Elements of Exam and Eval Flashcards

1
Q

Primary reasoning errors during patient encounters

A
  1. failing to generate a key hypothesis
  2. retaining a hypothesis in the face of conflicting reasoning
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2
Q

Three necessary elements of reflection

A
  1. active engagement in intellectual processess
  2. exploration of problems or experiences
  3. subsequent changed perspective or new insights
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3
Q

Skills needed for reflection

A

self-awareness
description
critical analysis
synthesis
evaluation

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4
Q

Shared Decision Making

A
  1. results in improved outcomes compared to not implementing SDM
  2. considers patients’ individual circumstances, values, and preferences

Motivational interviewing and decision aids can help you

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5
Q

Total musculoskeletal assessment

A

patient history
observation
movement exam
palpation
joint play movements
reflexes, cutaneous distribution
special tests
diagnostic imaging

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6
Q

Observation

A

not palpation
starts the moment you come into visual contact with patient and continues during the session

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7
Q

Overt pain behaviors to observe

A

guarding
bracing
rubbing
grimacing
sighing

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8
Q

Structural deformity

A

present even at rest (fracture)

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9
Q

Functional deformity

A

result of a particular posture and disappears when posture is changed (scoliosis due to short leg)

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10
Q

Dynamic deformity

A

caused by muscle action
valgus moment at knee

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11
Q

Why should you be interested in detecting asymmetries of limbs/muscle/bones?

A

Can be a fracture, tumor, complete tear
Or can be normal asymmetry, sprain/strain, inflammation

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12
Q

Movement Exam

A

confirms or refutes the working diagnosis/hypothesis, which was formulated during the history and observation

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13
Q

Red Flags during examination

A

severe unremitting pain
severe spasm
psychological overlay

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14
Q

12 principles of exam (1-6)

A
  1. unless bilateral movement is required, the normal side is tested first
  2. the pt does active movements before examiner does passive movements
  3. any movements that are painful are done last
  4. if active ROM is not full, overpressure is applied only with extreme care to prevent the exacerbation of symptoms
  5. during active movements, if ROM is full, overpressure may be carefully applied to determine the end feel of the joint
  6. each active, passive, or resisted isometric movement may be repeated several times or sustained
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15
Q

12 principles of exam (7-12)

A
  1. resisted isometric movements are done with the joint in a neutral or resting position so that stress on the inert tissues is minimal
  2. for passive ROM or ligamentous tests, it is not only the degree of opening, but also the quality of the opening
  3. when examiner is testing ligaments, appropriate stress is applied and repeated
  4. myotomes, each contraction is held for a min of 5 seconds to see if weakness becomes evident
  5. examiner warns the patient that symptoms might be exacerbated
  6. examiner does not hesitate to refer out if needed
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16
Q

Exam of specific joints

A
  1. pompjrsd
  2. adjacent joints to clear
  3. looking for pt subjective and objective findings
  4. include scan of spine
  5. acute injury preclude complete exam
  6. exam is extensive enough to allow pattern to emerge
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17
Q

Spinal scanning

A

scanning is a quick check of the portion of the spine that relates to the limb in question

purpose is to rule out symptoms which may be referred from one part of the body to another

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18
Q

When to use the spinal scanning exam

A
  1. no history of trauma
  2. radicular signs
  3. trauma with radicular signs
  4. altered sensation in limb
  5. patient presents with abnormal patterns
  6. suspected psychogenic pain
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19
Q

Movement Exam

A

Goal is to differentiate between muscle, tendon, ligament, nerve, bone

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20
Q

Contractile tissue

A

effected by contraction or stretch.
Muscle or tendon
tested by AROM and resistance

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21
Q

Non-contractile tissue

A

effected by loading, compression/pinching
ligament, capsule, cartilage, blood vessels, bursae, skin
tested by PROM and special tests

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22
Q

Nervous Tissue

A

effected by stretching, compression, pinching

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23
Q

Bone Testing

A

bone is impacted by direct pressure, compressive load, torsion

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24
Q

Active motion looks at

A

available range, control, power, willingness to move

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25
Observations to do during active movement
when and where S/S occurs whether movement increases intensity reaction of patient amount of restriction pattern of movement quality of movement willingness to move
26
Classic presentations/patters of contractile tissues
1. no pain, movement is strong 2. pain, and movement is relatively strong 3. pain, and movement is weak 4. no pain, movement is weak
27
no pain and movement is strong
normal, even if muscle hurts to the touch
28
Pain and movement is relatively strong
local lesion of muscle and/or tendon, 1 or 3nd degree strain
29
Pain and movement is weak
2nd degree or greater strain, and/or a significant lesion around joint like a fracture
30
no pain and movement is weak
severe 3rd degree strain/rupture, neurological involvement
31
Passive motion
used to find the anatomical barrier to further motion vs AROM which determines the physiological barrier to further motion
32
Examiner observations during passive movement
when and where symptoms begin if intensity and quality increases with movement pattern of limitation end feel ROM available
33
End-feel
barrier to further motion at the end of passive ROM each joint has unique structure that will provide a stopping point to mobility
34
Abnormal end feel
early muscle spasm late mucle spasm spasticity hard capsular soft capsular bone to bone empty (bursitis) springy block (meniscus)
35
Inert Tissue Presentations of Pain
1. ROm is full and there is no pain 2. Pain and limitation of movement in every direction 3. Pain and limitation or excessive movement in some directions but not others 4. limited movement that is pain free
36
ROM is full and there is no pain
no lesion in the direction of PROM
37
Pain and limitation of movement in every direction
entire joint is affected, indicating arthritis or capsulitis
38
Pain and limitation or excessive movement in some directions but not in others
ligament sprain or local capsular adhesion, non capsular pattern, internal derangement
39
Limited movement that is pain free
moderate OA, bone to bone
40
Capsular Patterns
pattern of limitation is the feature that indicates the presence of a capsular pattern in the joint not well researched hence variations based on observations
41
Resisted Isometrics
for inert tissues make sure to test in the position that is causing issues
42
Contractile tissue lesions
AROM and PROM are usually painful in the opposite direction painful in opposite directions as they create opposing types of stress to the same tissue
43
Inert Tissue Lesions
AROM and PROM are usually painful in the same direction pain occurs as the limitation of motion occurs
44
S/S of Upper motor lesions
spasticity hypertonicity hyperreflexia positive pathological reflexes absent or reduced superficial reflexes extensor plantar response
45
S/S of Lower motor neuron lesions
flaccid paralysis loss of reflexes muscle wasting and atrophy lost of synergistic action of muscles fibrosis, contractures, adhesions joint weakness, instability decreased ROM and stiffness growth affected
46
S/S of myopathy
difficulty lifting difficulty walking myotnia cramps pain progressive weakness
47
Palpation
determine tissue at fault before using palpation practice makes perfect relax and support area
48
Assess during palpation
1. tissue tension and tone 2. tissue texture 3. abnormalities 4. tenderness 5. temperature 6. pulse, tremors 7. pathological state of tissues 8. dryness or excessive moisture 9. sensation
49
edema that comes on soon after injury
blood
50
edema that comes on after 8 to 24 hours
synovial
51
edema that is boggy, spongy feeling
synovial
52
edema that is harder, tense feeling with warmth
blood
53
edema that is a leathery thickening
chronic
54
edema that is soft and fluctuating
acute
55
edema that is thick and slow-moving
pitting edema
56
Joint play movement
small ROM that can be obtained only passively by the examiner accessory movement required for nomal, pain free joint mobility joints shoudl be tested in loose pack position
57
Facet loose pack
midway between flexion and extension
58
Hip loose pack
flexion, abduction, Er
59
GH loose pack
abduction, horizontal adduction
60
Knee loose pack
slight flexion
61
Close packed position
no accessory movement is posisble
62
Rules for joint play testing
pt should be relaxed and fully supported one joint at a time unaffected side first movements aren't forced and don't cause discomfort
63
Reflex grading
0--absent 2--normla 4--hyperflexia
64
Sensory testing is used to
1. determine extent of sensory loss, whether loss is caused by nerve root lesions, peripheral nerve lesions, compressive tunnel syndromes 2. determine the degree of functional impairment 3. determine nerve recovery after injury
65
Purposes of special tests
confirm tentative diagnosis make a differential diagnosis differentiate between structures
66
Caution w/special tests
osteoporosis, instability, severe pain, bone disease, apprehensions, major neuro
67
Clearing the CS
perform AROM perform over pressure for lateral flexion, flexion, rotation, extension
68
If normal range of motion and overpressure is unremarkable
the clearance exam is negative
69
If reproduction of shoulder symptoms occurs
perform the CS scan exam
70
If a new pain/symptom is produced in CS or shoulder
perform the CS scan exam
71
CS Scan Exam
used to rule out referral of symptoms from CS to the shoulder AROM PROM Over pressure RROM UE myotomes Reflexes Dermatomes Compression and Distraction Neurodynamics test
72
RROM for CS
Flexion Extension Lateral Flexion Rotation
73
Myotomes for CS
Neck flexion (C1/2) Lateral flexion (C3) Shoulder elevation (C4) Shoulder abduction (C5) Elbow flexion (C6) Wrist extension (C6) Elbow extension (C7) Wrist flexion (C7) Thumb extension (C8) Finger abduction (T1)
74
Cervical compression test
examiner exerts downward pressure on subjects head Positive: increased pain or altered sensation indicates pressure on a nerve root
75
Spurlings Test
Patients neck is in slight extension, laterally flexed. Apply downward axial compression Positive: pain radiates down the neck High spin and snout
76
Cervical Distraction test
pull patients head at mastoid process positive: patients symptoms are reduced with distraction

5 Ortho (14 decks)

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