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MSK Upper Quadrant > (1) UQ Scanning and Clinical Decision Making > Flashcards

(1) UQ Scanning and Clinical Decision Making Flashcards

1
Q

Regional Interdependence Definition

A

Idea that seemingly unrelated impairments (in an area outside of the one being assessed) may be associated with pt’s primary complaint / mediated by central mechanisms

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2
Q

When is a good time to consider Regional Interdependence?

A

Pt’s presentation is unclear

Response to treatment is less than favorable

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3
Q

Biomedical Model

A

Diagnosis is required to prescribe treatment

More applicable to infectious diseases than MSK disorders

Vague descriptors used in absence of clear diagnosis (knee pain, disc herniation)

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4
Q

Regional Interdependence (Impairment) Model

A

Physical (MSK) Impairments: Pain, ROM

Neurophysiologic Impairments: Impact of pain on function

Biopsychosocial Impairments: Impact of depression, fear avoidant behaviors, pt expectations on outcomes

Somatovisceral Impairments: Impact of referred or radicular pain

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5
Q

Impairments Associated w/ Chronic Neck Pain (Ghamkhar Research)

A

Decreased:
*Neck muscle strength

*Scapulothoracic muscle (traps, rhomboids) strength

*Hip muscle strength

*Trunk flexor/extensor strength

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6
Q

Lateral elbow pain is associated with impairments in what other areas of the body?

A

Cervical

Shoulder

Wrist/hand

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7
Q

LB pain is associated with impairments in what other areas of the body?

A

Hip

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8
Q

PFPS is associated with impairments in what other areas of the body?

A

LB/hip

Foot/ankle

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9
Q

Thoracic HVLAT treatment is proven to improve what in addition to the t-spine area?

A

Decrease c-spine pain

Increase lower trap strength

Improve outcomes in pts with RC tendinopathy and adhesive capsulitis

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10
Q

When treating the different areas of the spine, what serves as the most proximal point? What are the implications of this?

A

Center of body mass

T-spine more proximal than c-spine (c-spine is already more mobile than t-spine) - treat t-spine first!

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11
Q

How do we decide when or when not to scan?

A

No obvious MOI/history related to S&S

Proximal cause for distal symptoms

Non-mechanical “sounding” symptoms (serious, non-MSK conditions)

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12
Q

Components of UQ Scanning Exam

A

Observation/pt history

Cervical AROM (OP as appropriate)

UE ROM (shoulder, elbow, wrist, hand)

Myotomes (C5-T1)

Dermatomes (C4-T1)

Cervical compression/distraction

NPT (ULTT 1)

Common UQ DTRs

Pathologic reflexes

Palpation (pulses, glands, lymph nodes)

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13
Q

What can we observe for when looking at a pt’s eyes?

A

Ptosis (compare dilation of pupils)

Bulging eyes (could be related to a thyroid problem)

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14
Q

If a pt responds “Yes” to the presence of a symptom related to a red flag, what else should you consider?

A

Is the complaint new/different/unusual for the pt

Is there an explanation for it that would minimize concern

Has pt mentioned this to a physician (if so, has it worsened since then)

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15
Q

Review of Systems vs. Systems Review

A

Review of Systems (ROS): Collects info about each system to determine what warrants physical examining

Systems Review: Hands-on component of exam

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16
Q

When does fatigue become a concern during a general health screen?

A

When it interferes with one’s ability to carry out daily activities at home, work, school, social setting

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17
Q

Malaise Definition

A

Uneasiness, feeling that “something isn’t right”

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18
Q

Fever, chill, sweats can all be indicative of what? When is a fever considered “significant?”

A

infection, cancer, inflammatory disorders

> or = 99.5 degrees for 2 weeks+

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19
Q

What parameters make weight loss/gain significant? What could this be indicative of?

A

Unexplained loss/gain of 5-10% of BW

depression, cancer, GI disease

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20
Q

What could n/v be attributed to outside of GI problems?

A

Metabolic, CV, liver dysfunction

Pregnancy

Medications

Increased intracranial pressure, HA, hemorrhage

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21
Q

Dizziness + lightheadedness can be attributed to what?

A

Neurologic, CV dysfunction

DM, anxiety, psychosis

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22
Q

Paresthesia, numbness, weakness can be attributed to what?

A

Renal, endocrine disorders

Adverse drug reactions

Progressive neurologic loss

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23
Q

A change in mentation/cognitive ability can be a result of what?

A

Delirium, dementia

Head injury

Adverse drug reactions

Infection

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24
Q

Red vs. Yellow vs. Blue Flags

A

Red - potentially life-threatening

Yellow - psychological factors that may impact pt outcomes

Blue - socioeconomic factors (e.g., occupation) that may impact pt outcomes

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25
Yellow Flags (Examples)
Negative coping skills Anxiety / depression Kinesiophobia Dizziness Abnormal sensory patterns Progressive weakness Fainting Circulatory / skin changes
26
Blue Flags (Examples)
SES Social determinants of health
27
Is it abnormal to observe side-to-side differences in a pt's UE ROM?
Not always! Differences inevitable in dominant vs. non-dominant side
28
C5 Myotome
Shoulder abd Deltoid Axillary N.
29
C6 Myotome
Elbow flex (biceps brachii, musculocutaneous n.) Wrist ext (ECRL, ECRB, ECU, radial n.)
30
C7 Myotome
Elbow ext (triceps brachii, radial n.) Wrist flex (FCR, FCU, median n. for radialis + ulnar n. for ulnaris)
31
C8 Myotome
Finger flex FDS, FDP, lumbricals Median N. (superficialis), Median + Ulnar N. (profundus, lumbricals)
32
T1 Myotome
Finger abd Dorsal interossei Ulnar N.
33
Label UE Dermatomes (C4-T1) and corresponding peripheral nerves.
34
What does pain reproduced with cervical compression suggest?
Disc herniation Vertebral end plate/body fx Acute arthritis/jt inflammation Nerve root irritation (if radicular symptoms produced)
35
What does pain reproduced with cervical distraction suggest?
Spinal ligament tear Tear/inflammation of AF Muscle spasm Large disc herniation Dural irritability (if non-radicular arm pain produced)
36
In the event of a pt experiencing pain w/ cervical distraction, what are we MOST concerned about?
Spinal cord This could indicate cervical instability which may be life-threatening
37
Radicular vs. Non-Radicular Arm Pain
Radicular: Symptoms "shoot" below the elbow Non-Radicular: Symptoms stay above the elbow
38
What are the indications of a POSITIVE ULTT?
Differences between limbs in elbow ROM Reproduction of concordant neurologic symptoms in UE w/ movement of distant component Different symptoms between two extremities
39
NINDS Grading Scale
DTRs 0 - absent 1 - slight (hyporeflexia) 2 - normal 3 - brisk (still considered norm) 4 - enhanced (hyperreflexia including clonus if present)
40
A positive Hoffman's/Babinski/Lhermitte Reflex are all indicative of what?
UMN lesion Lhermitte specifically demyelination on SC
41
The Lhermitte Phenomenon is most commonly seen in individuals with ___.
MS Cervical Myelopathy Cervical Radiculopathy Neck trauma
42
What would prompt you to perform a Cranial Nerve exam?
Concussion (head trauma) MVA Observable symptoms (eyes, facial droop, slurred speech)
43
Cranial Nerves Major Functions
I (Olfactory): Smell II (Optic): Vision III (Oculomotor): Eyelid and eyeball movement IV (Trochlear): Innervates superior oblique / turns eye down and laterally V (Trigeminal): Chewing / face and mouth touch and pain VI (Abducens): Turns eye laterally VII (Facial): Controls most facial expressions / secretion of tears and saliva / taste VIII (Vestibulocochlear): Hearing / equilibrium sensation IX (Glossopharyngeal): Taste / senses carotid BP X (Vagus): Senses aortic BP / slows HR / stimulates digestive organs / taste XI (Spinal Accessory): Controls traps and SCM / controls swallowing movements XII (Hypoglossal): Controls tongue movements
44
UMNs vs. LMNs Location / Structures
UMN: CNS - cortex / brainstem / corticospinal tracts / SC LMN: CN nuclei + nerves / anterior horn cell / spinal roots / peripheral nerve
45
UMNs vs. LMNs Pathology Examples
UMN: Stroke, TBI, SCI LMN: Peripheral nerve neuropathy / radiculopathy / polio / Guillan Barré
46
UMNs vs. LMNs Tone
UMN: Increased - hypertonia / velocity-dependent LMN: Decreased or absent - hypotonia / flaccidity / nonvelocity-dependent
47
UMNs vs. LMNs Reflexes
UMN: Increased - hyperreflexia / clonus / exagerrated cutaneous and autonomic reflexes / positive Babinski LMN: Decreased or absent - hyporeflexia / cutaneous reflexes decreased or absent
48
UMNs vs. LMNs Involuntary Movements
UMN: Muscle spasms: flexor or extensor LMN: Fasciculations w/ denervation
49
UMNs vs. LMNs Voluntary Movements
UMN: Impaired or absent - dysynergic patterns, mass synergies LMN: Weak or absent (if nerve integrity interrupted)
50
UMNs vs. LMNs Strength
UMN: Weakness / paralysis ipsilateral (stroke) or bilateral (SCI), contra if above decussation in the medulla, ipsi if below CST distribution; never focal LMN: Ipsi weakness / paralysis in limited distribution - segmental / focal / root pattern
51
UMNs vs. LMNs Muscle Appearance
UMN: Disuse atrophy - variable, widespread distribution, especially for antigravity muscles LMN: Neurogenic atrophy
52
What would indicate to you to assess a patient's pulses?
Temperature changes Discoloration of the skin
53
If you recognize a patient's pulse is reduced, what would be the next step?
Check each pulse point in a proximal to distal pattern for comparison
54
What are we assessing in the taking of a patient's pulse?
HR, potency Scale: 0 - absent 1 - markedly reduced 2 - slightly reduced 3 - normal 4 - bounding pulse
55
Thyroid Gland Palpation
Distal and lateral to laryngeal prominence Looking for asymmetries, pain, tenderness, lump or nodule Only assess based on symptoms (pain / tenderness/ hx of thyroid issues) and visible asymmetries
56
Deep Cervical Lymph Node Palpation
Only palpate when indicated based on symptoms (recent sickness / infection) and visible asymmetries
57
Pattern Recognition vs. Diagnostic Reasoning
Pattern Recognition: Forward reasoning / used by expert clinicians Diagnostic Reasoning: Formation of dx based on physical disabilities and impairments while considering tissue pathology, pain mechanisms, other contributors / used by novice PTs
58
Tendon Healing Timelines
Tendinopathy: General tendon problem / 3-7 weeks Tendinosis: Chronic degeneration of a tendon / 2-6 months Laceration: Cut in a tendon / 5 weeks - 6 months Insertional: Injury to area where tendon attaches to bone / 3 months - up to 2 years
59
Muscle Healing Timelines
Exercise-Induced: 0-3 days Grade I Strain: Small number of fibers stretched or slightly torn / 0-14 days Grade II Strain: Significant number of fibers torn / 4 days - 3 months Grade III Strain: Complete rupture of muscle fibers / 3 weeks - 6 months
60
Ligament Healing Timelines
Grade I: Mild sprain, over-stretching but no tear / 0-3 days Grade II: Partial tear / 3 weeks - 6 months Grade III: Complete tear / 5 weeks - 1 year Graft: Healthy tissue replacing torn ligament / 2 months - 2 years
61
Bone / Articular Cartilage Healing Timelines
Bone Fracture: 5 weeks - 3 months Articular Cartilage Repair: 2 months - 2 years

MSK Upper Quadrant (8 decks)

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