Principles in the PT Management of pts inconvenienced by musculoskeletal pathology Flashcards

Question

patient history interview: other risk factors and co-morbitities

Answer 1

- lifestyle (smoking, alcohol, drugs, nutrition, actvity level, social history) - family history - any similar symptoms

Answer 2

- other important/significant thoughts or concerns regarding: - -symptoms - -contextual relevance of condition - -goals, needs or desires - -expectations of PT intervention - patient opinions as to what the problem is

Answer 3

- brief screening procedure - provides information about the bodily systems involved in the pts current condition or health - helps identify possible health problems that require consult or referral to other health care professionals - results may effect further examination and intervention procedures

Answer 4

-determines the necessity and extent of the review

Answer 5

- cardiovascular/pulmonary - integumentary - neuromuscular - musculoskeletal - communication ability

Answer 6

- upper/lower quarter screen - musculoskeletal subset of the system review that emphasizes joints of the body to help determine where the pathology is located - -r/o referral of symptoms from other issues

Answer 7

1. no history of trauma (insidious) 2. suspect referred/radicular symptoms 3. doubt about locatoin of pathologies exists 4. altered sensation 5. unusual pattern or collection of symptoms

Answer 8

- conducted after history and systems review - range from brief to lengthy - generate data most often regarding impairments and functional limitations - order should be prioritized - ask yourself: "should this be compared bilaterally?" - --answer=ALWAYS - start uninvolved/less involved-baseline

Answer 9

- safety - comfort - goals - social needs - cognition - physiological needs - psychological needs - functional needs - financial needs - vocational needs - medical treatment priority

Answer 10

- ROM - Muscle Performance - Joint Integrity and Mobility - Posture, body mechanics and motor function - gait, locomotion and balance - pain - sensory integrity - reflex integrity - athropometric characteristics - special tests - assistive and adaptive device

Answer 11

1. quantity of AROM and PROM 2. Quality - smoothness, movement pattern 3. Symptom provocation - does this reproduce your symtoms

Answer 12

1. type of motion assessed 2. quantity of AROM and PROM 3. quality

Answer 13

- if limited/abnormal, ask yourself why? 1. Active muscle dysfunction? - problem w/muscle "organic weakness" - reflex inhibition due to pain or effusion - tissue reactivity: inflammation, abnormal motor recruitment (guarding or splinting w/antagonists and subsititutions with synergists) 2. passive motion restriction? - blocking ability to go forward, tightness 3. joint stability? - will present w/limited AROM b/c uncomfortable

Answer 14

- if PROM is limited, ask why? - ROM limited b/c instability w/opposing group 1. passive insufficiency? - looking at muscles that cross two joints 2. intrarticular obstruction - loose body - ROM may change each time - vs acl tear with limitation at same spot each time 3. muscle guarding or splinting? - apprehension - pain from tissue reactivity - biomechanical load intolerance

Answer 15

1. strong and painless 2. strong and painful 3. weak and painless 4. weak and painful

Answer 16

1. hard end feel-bone on bone 2. soft end feel-soft tissue approximation 3. firm end feel-shoulder flexion, springy rebound 4. empty end feel- complaint of pain that prevents full endfeel

Answer 17

compression load intolerance->Reactivity - articular cartilage subchondral bone - periosteum - bursa/fat pad - tendon and/or tendon sheath - meniscus or articular disk - neural tissue

Answer 18

- capsule - ligament - tendon or muscle - neural tissue

Answer 19

- if AROm is full and pain free you may often choose not to perform PROM - if AROM

Answer 20

10 rep max, % of 10 rep max

Answer 21

longevity, duration

Answer 22

concentric eccentric isometric

Answer 23

- myotomal, break patient - cyriax classifications - force to pain onset-dynanometer, objective measure

Answer 24

- MMT - isotonic x RM testing - isokinetic testing - functional task testing

Answer 25

dont use strength testing if pain during brake testing

Answer 26

``` testing abilities of contractile unit -innervation (myotome/peripheral nerve) -muscle -myotendinous junction -tendon -tendoperiosteal junction examining gross strength in a static position possible reactivity (pain production) ```

Answer 27

- whether the contraction causes pain and, if it does, the pains intensity and quality - strength of contaction - type of contraction causing problem

Answer 28

- test position is neutral and mid range joint position - joint should be kept still - instruct the patient to hold the test position while resisting the examiner's break or make force - PT gradually increases force until a maximal muscle contraciton is achieved or patient cannot resist the force - hold 3-5 seconds at peak force

Answer 29

Grade 0: strong and painless Grade 1: strong and painful: minor muscle/tendon involvement Grade 2: weak and painful: more severe muscle/tendon lesion Grade 3: weak and painless: complete muscle or tendon rupture or neurological problem. organic weakness

Answer 30

- test position is a neutral joint position - joint kept still - instruct the pt to hold the test position while resisting the break force - PT gradually increase force until onset of pain - -handheld dynamometer - -weights - -time - record force measure bilaterally

Answer 31

- once resisted isometric break testing has confirmed weakness within a nerve root, MMT should be performed to isolate specific muscles innervated by that root - important tool for determining the muscular cause of movement dysfunction

Answer 32

- examination of accessory motions - -component motion and joint play - testing performed by the PT - normally

Answer 33

motion that accompanies active motion, but not under voluntary control (upward rotation of the scapula with clavicular rotation

Answer 34

motion that occurs between the joint surfaces (arthrokinematics-roll, slide distraction, compression)

Answer 35

loosest postion for joint where you can get the most ROM

Answer 36

- pt should be relaxed and fully supported - examiner should be relaxed and should use firm but comfortable grasp - one joint should be examined at a time - the movement should be examined one a time - unaffected side should be tested first - one articular surface is stabilized while the other surface is moved - movements must be normal and not forced - movements should not cause undue discomfort

Answer 37

``` begin palpation procedure with a visual examination -skin and subcutaneous tissue in the affected area -note any: areas of localized edema or effusion ecchymosis or hematoma -abrasions or lacerations -discoloration of skin and nail beds -calluses, blisters, scars -atrophy or hypertrophy -alterations in contour ```

Answer 38

- tissue temp - -increase temp: increase inflammation decrease sympathetic activity - -decrease: decrease vascularity, increase sympathetic activity - moisture and texture - -moist and smooth (inc. symp) - -scaly and dry (dec. symp) - -skin mobility via rolling: adhesions? - tenderness (inflammation, trigger sites, leave to end of exam if known - sensation - muscle status - -increased/decreased tone - -trigger sites - -continuity or defects - swelling - -edema: pitting or non-pitting - -effusion - pulse - bony alignment and relationships - mechanical signs - bilateral comparison

Answer 39

- inform pt as to what is coming - have target and purpose in mind - confidently proceed - use no more pressure than necessary - start superficial then progress to deep - may choose to use the back of the hand to detect temp - tips of the fingers most sensitive and discriminating

Answer 40

grade 1: pt complains of pain grade 2: pt complains of pain and winces grade 3: pt winces and withdraws the joint grade 4: pt will not allow palpation of the joint

Answer 41

- assessment of deep and superficial sensations - proprioception - kinesthesia - touch sensitivity: peripheral sensory - touch discrimination - bilateral comparison

Answer 42

static joint position sense

Answer 43

dynamic, passive awareness of movement

Answer 44

light brush or wisp of cotton - temp - pressure

Answer 45

-2 point and sharp/dull

Answer 46

- used to determine excitability of the nervous system and the integrity of the neuromuscular system - developmental reflexes (pediatrics) - pathological reflexes-not normally present (babinski, clonus, etc) - muscle stretch reflexes/deep tendon reflexes

Answer 47

- pt and muscle must be relaxed - tendon placed on slight stretch - elicit: strike tendon with reflex hammer - repeat 5-6 times to note fading response-bilateral comparison - hyporeflexia: lower motor neuron - hyperreflexia: upper motor neuron - if needed, jendrassik maneuver to enhance DTR - -UE: adduct LE together - -LE: clench UE together

Answer 48

- describes human body characteristics including atrophy and edema - measures: - -height (ruler) - -weight (scales) - -body fat (caliper, electrical impedance) - -girth: flexible ruler, volumetric technique - bilateral comparison or normative comparison

Answer 49

athletic build

Answer 50

round/curvy frame

Answer 51

very skinny, low body fat

Answer 52

- regional tests designed to confirm whether or not a specific condition is present - often many available per condition - often provacative - special tests are used in conjuction with other examination data to formulate a diagnosis - not the be all end all of pt - test validity is often questionable - -skill of examiner - -presence of multiple conditions

Answer 53

- to confirm a tentative diagnosis - to make a differential diagnosis - to differentiate between structures - to understand unusual signs - to unravel difficult signs and symptoms