10-14a Musculoskeletal Examination Flashcards
What is the musculoskeletal differential diagnosis in the medical world?
Medical world “Pathoanatomic Dx,” Anatomically based Pathology based
What tissue is affected?
Pathology drives Rx
What is the musculoskeletal differential diagnosis in the PT world?
“Movement Dx”
Impairment based (What is/are the primary impairment(s)? What is causing them?)
Impairment drives Rx
Based on the assumption that impairments relate to limitations in functional activity and participation
What is the differential diagnosis for pathoanatomy in the medical world?
Fractured radius - Rotator Cuff tear - Lateral ankle sprain - Knee Osteoarthritis - Achilles tendinitis
What is the differential diagnosis for impairments in the PT world?
Wrist joint stiffness – Shoulder weakness – Joint instability – Knee pain and effusion – Heel pain and tightness
decreased endurance
generalized weakness
How does PT incorporate the pathoanatomy of the medical world to the impairments in the PT world?
pathoanatomy often directs general treatment approach and informs prognosis
Impairments usually dictates what we actually do with a patient
What is important for PTs to note about Dx/pathology?
just because pts have the same pathology, it doesn’t mean they have the same impairments (widely variable presentations)
Are impairments highly related to activity?
Building evidence that there is not a 1 to 1 correlation
Correlation can even be below .5
Constantly check assumptions when treating impairments to influence the things the patients care about (care more about participation)
What are the steps for analyzing the movement sys. and functional movement task
1. Observe a Functional Movement Task (Qualitative) Control Amount Speed Symmetry Symptoms
- Develop Hypotheses about the Dysfunction
- Incorporate Specific Tests and Measures concerning:
i. Motion
ii. Energy
iii. Force
iv. Motor control - Come to a Movement Diagnosis
- Intervention
- Qualitative Observation Targets/revisit
What is the cyriax approach to examination?
orthopedic medicine (practiced non-surgical orthopedic care) Dx by selective tension: 1. ID the tissue with the "lesion" (inflammation, injury, tissue tear) 2. Repro c/c sx by applying tension (ID injured tissue = medical Dx)
What did Maitland look for?
Reproduction of the patient’s chief complaint with a movement, position, or test (usually pain)
What did cyriax say the two types of tissues are in the musculoskeletal sys?
Contractile (m., tendon, tenoperiosteal junction (outer covering around bone where tendon inserts)
Intert (not capable of producing movement): capsule, ligament, menisci, bone, bursa, cartilage
What is the cyriax approach targeting?
“Selective tissue tension”
Based on the notion that the “lesion” can be localized by selective applying tensile stress to various tissues in a systematic way
Goal is to diagnose the location of the symptomatic “lesion”
Can be applied to virtually all musculoskeletal regions…works better at some than others (extremities vs spine)
What is the cyriax approach progression?
AROM > PROM > Isometric resistance
What does AROM assess?
Ability and willingness to move
Quality of motion (CASSS/look for compensation)
Range, pain, painful arc (midway through ROM it hurts: something is getting stressed or pinched)
What does PROM assess?
sequence of pain / limitation
capsular / non-capsular pattern
end-feel
