Musculoskeletal Examination & Evaluation Flashcards Preview

exam and Intervention II > Musculoskeletal Examination & Evaluation > Flashcards

Flashcards in Musculoskeletal Examination & Evaluation Deck (154)
Loading flashcards...
1

8 performance expectations for entry to practice

1. screen
2. examine
3. Evaluate
4.Diagnose
5. Prognosticate
6. plan of care
7. intervention
8. outcomes

2

purpose of the examination

to reach to the proper diagnosis

3

How to reach the proper diagnosis through the examination?

systematic and complete

4

Aspects of the Examination? (7)

-patient history
-observation
-ROM/MMT
-Special tests
-Reflexes/Sensations
Accessory motions/ palpation

5

Question to ask for HPI/ Chief Complaint

-What brings pt to PT. pt describe in own words
-mechanism of injury (MOI)
-Pre-injury status
-Assistive devices/equipment

6

Mechanism of Injury

Trauma vs overuse: seek detail description

7

Examples of assistive devices/ equipment

braces, crutches, immobilizers, orthoses, splints

8

Questions to ask for onset

What happened/ mechanism of injury
Was onset insidious
Was onset related to a trauma: macro trauma
Was onset related to repetitive use: Microtrauma
When did onset occur

9

Macrotrauma

Onset related to a trauma

10

Microtrauma

Onset related to repetitive use

11

Questions to ask for Location

Where is the pain
Was initial location of pain different than current location of pain

12

Where is the pain follow up questions?

localized
non-specific/general/diffuse
peripheralization/centralization
referred pain

13

Was initial location of pain different than current location of pain follow up question?

has it moved or spread

14

Duration questions

How long has pain been present
Constant (chemical) vs intermittent (mechanical)
If intermittent, how long does pain last when present

15

What do you want to find out when asking how long pain has been present?

stage of healing: acute/subacute/chronic
-days,weeks, months, years

16

Questions to ask for Character

Patient descriptors
Is pain changing

17

What are patient descriptors

Sharp/ lancinating
burning
dull/aching
deep/boring
aching
throbbing

18

what are aggravating conditions/ activities

-sitting/ standing (flex/ext)
-Walking/running
-lifting/carrying
-Stairs/jumping
-throwing
-ROM/ Resisted motions

19

What are relieving conditions/ activities

Resting (sitting, lying) vs moving
standing vs sitting
ice vs heat
position of comfort

20

What are examples of temporal component

Worse in am when waking
worse as day progresses
worse at beginning of an activity, relieved during activity
worse during the night

21

What can be used to assess Severity

Pain intensity VAS or NPRA

22

VAS

current, past 7 days (best. worst), most severe at any time

23

NPRS

Verbal rating on a 0-10 scale

24

Other questions to ask about patient history

-other symptoms
-previous episode
-previous treatment for condition

25

examples of other symptoms

locking, instability/ giving way, numbness/tingling

26

What information do you want to know about current functional level

-basic home ADLs
-Instrumental (community) ADLs
-Patients goals and expectations

27

Information you want to get from the physician

-sling, brace, immobilizer, orthoses
-WB status
-Post- operative protocol/ precautions

28

Information about environment

home/living environment

29

Information about occupational

job duties

30

information about past medical history

-medical/surgical history
-Systematic diseases
-Allergies
-Pregnancy
-anything else important

31

Do you want to know what medications they are taking?

Yes

32

What test and measures

EMG/NCV
Radiographic imaging: xray, MRI, CT scan

33

Why do you want so much details about patient history ?

-forms working diagnosis
-Differential diagnosis
-Indication of progress or decline
-Goal setting
-Insurance
-can help drive treatment/interventions

34

What systems should be reviewed?

Cardiovascular, integumentary, musculoskeletal, neuromuscular

35

Components of observation

-waiting room assessment
-Visibility
-Dominant eye
-View from ant. post, right and left

36

what are you looking for when assessing the pt in the waiting room?

Posture and gait

37

how do you want to approach posture?

top-down or bottom up

38

What are you looking at for posture

head position
shoulder/ scapula positioning
spine
pelvis
lower extremities

39

When observing head position what are you looking for

forward head, C/S rotation, side bending

40

When observing shoulder/scapula positioning what are you looking for

forward shoulders.
scapula protraction/retraction/elevation/ depression

41

When observing the spine what are you looking for

scoliosis
normal kyphosis/lordosis

42

When observing pelvis position what are you looking for

-level iliac crest/ obvious rotations
-Deviated umbilicus
-Excessive tilt

43

When observing the LE postures what are you looking for

-Hip/knee/ankle joint angles
-Varus/valgus/recurvatum
-rearfoot varus/ valgus
-pes planes, rectus, cavus

44

What are you observing for the integumentary system

color, texture, temperature

45

What are you observing the wound/incision for?

-stage of healing
-Exudate
-Scar: red/vascularized, white/ vascularized

46

what are you observing when there is swelling ?

-edema/effusion
-Masses
-Girth (swelling vs atrophy)

47

what are you examine with AROM

Physiological motion

48

what are the components to physiological motion ?

-cardinal planes of motion

49

what do you want to observe with AROM

-willingness to perform
-quality/ pattern of movement
-pain, where?

50

what are you examining with PROM

Anatomical motion

51

Is AROM or PROM usually greater?

PROM

52

what do you want to look for with PROM

-weakness, active insufficiency
-Pain
-Joint or muscle contractures
-Muscle spasticity
-compare uninvolved side. norm

53

What do you want to asses for in PROM

-Crepitus
-Joint motion/ muscle length
-Pain/pattern of pain to resistance
-End Feel

54

What are you looking at for joint motion for PROM

Excessive, normal, limited

55

What are some causes for Excessive joint motion for PROM

trauma/disease, repetitive exposure (pitcher), genetic predisposition

56

what are some causes for limited joint motion for PROM

Muscle length/spasm, pain, adhesions,

57

Pattern of restriction can be ?

capsular pattern or non capsular pattern

58

Motion restriction in a proportional pattern

capsular pattern (cyriax)

59

what indicates total joint irritation, capsular contraction, arthritis, arthrosis

capsular pattern (cyriax)

60

motion restriction doesn't follow capsular pattern?

non capsular pattern

61

what indicates local restriction, ligamentous adhesions, internal derangement, extra-articular lesion ?

non capsular pattern

62

what is the stage of injury when there is pain before tissue resistance

acute

63

what is the stage of injury when there is pain at tissue resistance

sub acute

64

what is the stage of injury when there is pain with overpressure (if painfree at tissue resistance) tissue resistance

chronic

65

what is the stage of injury when there no pain with overpressure?

No injury

66

Normal End feels for PROM

soft
firm
hard

67

soft end feel

soft tissue approximation

68

Firm end feel

Tissue stretch (muscle or capsule)

69

Hard end feel

bone to bone (elbow)

70

Abnormal end feels

muscle spasm
empty
hard/bony
springy block
capsular

71

Empty end feel

restricted by pain

72

hard bony end feel

occurs early in ROM (ostephyte)

73

Springy block end feel

Typical of meniscal tear

74

Capsular end feel

Occurs with restricted ROM

75

What is a MIDRANGE examination

resisted isometrics

76

Resisted Isometrics asses for

contractile tissue and peripheral n

77

Is resisted Isometric a break test?

NO

78

Strong and painfree

uninvolved contractile tissue or supplying nerve

79

Strong and painful

Mild lesion of contractile tissue, 1st or 2nd degree strain, tendinopathy

80

weak and painfree

Rupture of tendon or neurological involvement

81

Weak and painful

Severe lesion around joint, fracture causes reflex inhibition

82

What does MMT interpret

Muscle STRENTH grade

83

what does resisted isometric interpret

Assessing contractile tissue and peripheral nerve INTEGRITY

84

Examples of examination of task analysis for LE

-sit/stand
-stair ascent/descent
-squat/lift

85

Examples of examination of task analysis for UE

-Lift/ reach
-Grooming/feeding
-Writing/ turning pages
-opening jars

86

Special test are selected by

specific to a joint or structure

87

Special tests are what in nature

provocative

88

What do special test confirms

suspected diagnosis

89

Special test assists with what?

differential diagnosis

90

Grade 1 sprain for ligamentous testing

increased pain, no increased joint laxity, end feel softer than unaffected side

91

Grade 2 sprain for ligamentous testing

increased pain, increased joint laxity, end feel softer than unaffected side

92

Grade 3 sprain for ligamentous testing

no pain/ minimal pain, increased joint laxity, hard or soft end feel

93

What are findings for deep tendon reflexes

hyporeflexia (LMNL, aging)
Areflexia (LMNL)
Hyperreflexia (UMNL)

94

what must be relaxed to perform DTR

patient

95

what must be on stretch to perform DTR

tendon

96

grading of 0 for DTR

Absent

97

grading of 1 for DTR

diminished

98

grading of 2 for DTR

Normal

99

grading of 3 for DTR

Increased/ exaggerated

100

grading of 4 for DTR

clonus

101

When screening for sensation what do you do

Light touch, side-to-side difference, dermatomal distribution

102

What do you look for when examining sensation

pain, pressure, temp

103

accessory motions

movement between joint surface

104

Osteokinematic motion

cardinal planes of motion

105

Normal accessory movement is necessary for what?

full pain free ROM

106

Accessory motion is also referred as?

joint play

107

When looking at accessory motions, how must one assess the joint?

resting, open, loose packed position

108

When performing accessory motion what do you have to do to the segments?

stabilize one and mobilize the other

109

during traction/distraction the movement is in what direction from the concave joint surface

perpendicular and away

110

movement for traction/distraction is through what

up to and slightly through tissue resistance

111

During glide movement is what to the concave joint surface

parallel

112

movement for glide is through what

up to and slightly through tissue resistance

113

What are you examine for accessory motions?

mobility and pain

114

what is mobility for accessory motions

based on how much excursion is present from the beginning position to tissue resistance

115

How is mobility measured for accessory motions

7 grades

116

Grade 0 for accessory motions

fused

117

Grade 1 for accessory motions

considerably hypo mobile

118

Grade2 for accessory motions

slightly hypo mobile

119

Grade 3 for accessory motions

normal

120

Grade 4 for accessory motions

slightly hyper mobile

121

Grade 5 for accessory motions

considerably hyper mobile

122

Grade 6 for accessory motions

unstable

123

interpretation of hypomobility, no pain

chronic joint contracture/adhesion

124

interpretation of hypomobility, pain

acute joint contracture/ adhesion. muscle guarding

125

interpretation of normal excursion, pain

minor sprain

126

interpretation of normal excursion, no pain

normal

127

interpretation of hypermobility, no pain

chronic joint laxity or partial ligament tear, acute/chronic complete ligament tear

128

interpretation of hypermobility, pain

acute joint laxity or partial ligament tear

129

pain with distraction means what?

joint capsule

130

Pain with compression means what ?

joint surface , shortening the capsule

131

why do you palpate ?

alignment, tissue tension/texture/thickness, warmth, tenderness, pulses

132

Palpation grading of 1

compliant of pain

133

Palpation grading of 2

compliant of pain & winces

134

Palpation grading of 3

Winces & withdraws

135

Palpation grading of 4

No palpation allowed

136

Why do we exam diagnostic imaging?

confirm vs establish diagnosis

137

Radiography

Bone integrity, cartilage thickness (joint space)

138

Arthography? CT Arthrography

Peripheral joints

139

MRI

Joint pathology, spinal/ neural structures

140

CT scan

disc/ facet, complex fractures

141

Diagnostic US

Soft tissue injuries/ masses

142

what four things do you want for goals

structure (ABCDE), measurable, meaningful/functional, timely

143

what does A mean for goals

Actor: who will accomplish the goal

144

what does B mean for goals

Behavior: the action, task, or function that the individual will be able to perform

145

what does C mean for goals

Circumstances: The context, circumstances, and support needed to perform the behavior

146

what does D mean for goals

Degree: a quantitative specification of performance

147

what does E mean for goals

Expected time: the time period within which the goal will be achieved

148

Short term goals are

time frame within therapy episode of care

149

Long term goals are expected to met what?

as a result of PT interventions

150

Each STG should have what?

appropriate intervention

151

Plan of care should include?

Frequency and duration
patient input
STG and its interventions
direct intervention
patient education
discharge planning

152

Patient input should be based on what?

their expectations and previous experience with PT

153

Direct interventions include?

TE
Neuromuscular re-education
manual techniques
functional training
physical agents

154

Patient education includes?

HEP
posture/ergonomics/body mechanics
activity modification