10-14c Musculoskeletal Differential Diagnosis Lab

Question 1

What is step one for Ddifferential diagnosis?

Answer 1

Take a history and subjective exam from this patient

Question 2

What is step two for a differential diagnosis?

Answer 2

Consider the information gained in step 1.

What do you consider the most relevant information? Why?

What do you consider the least important information? Why?

If you had to guess (hypothesize) what the problem is right now, what do you think?

Question 3

What is the third step?

Answer 3

Work through a basic physical examination of this patient focusing on the knee and record your findings.

Question 4

What is step 4?

Answer 4

Discuss the significant findings (both positive and negative) from the physical exam.

What would be the “medical” (tissue-based, pathoanatomic) diagnosis ?

What are the key impairments amenable to PT intervention?

Question 5

What are some good history questions?

Answer 5

what brings you in today
how did you hurt it
have you been to a doc
swelling? bruising?
ice?
medication?
pain worse or better
describe pain
rate pain
occupation/
numbness or tingling?
anything you stopped doing that you want to get back to?
using AD?
previous Rx?
anyone home with you?
above and below?
stairs/railing?
describe pain

Question 6

What are the steps after history?

Answer 6

AROM
PROM
palpate
special tests
assess gait
assess balance
intervention

Question 7

what are signs you need imaging?

Answer 7

Ottowa Knee Rule
Age >55 years
Isolated patellar tenderness without other bone tenderness
Tenderness of the fibular head
Inability to flex the knee to 90°
Inability to bear weight immediately after injury and in the emergency department (4 steps) regardless of limping

Question 8

What indicates a bone problem?

Answer 8

specific tenderness over bony prominence

difficulty weight bearing

Question 9

What indicates a contractile problem?

Answer 9

m. or tendon
isometric test midrange positive

strong and painful or weak and painless

Question 10

what are possible non-contractile problems?

Answer 10

ligament, cartilage
cartilage: locking, catching, giving way, joint line tenderness

ligament: tenderness to palpation of ligament, immediate onset of swelling, joint laxity, positive special test

Question 11

What are some interventions you can do?

Answer 11

ankle pumps, POLICE, hip ROM, slides, NWB strengthening

functional training
balance and proprioception

bracing