5 - MSK Assessment Principles and Concepts Flashcards
What is the purpose of an MSK Assessment?
To understand the pt’s problems and design a Rx plan.
What is the difference between a sign and a symptom?
Symptom - what the patient tells you, what they complain of
Sign - something the therapist observes or feels upon palpation
What is the number one rule of an initial assessment?
Always give the impression that the pt’s problem is the most important thing that you have to deal with and nothing else matters
What are things to include in your subjective assessment history taking?
Personal factors: age, occupation (type of work, hours working, etc), language, gender, activity history, culture, psychological factors, hand dominance
Environmental/Social Factors: living arrangements, family/friend support, culture, work/school, team/coach/trainer environment
What to include when looking at the history of their present illness?
When did it start
How long have you been dealing with it
What was the MOI if there was one
Slow building or traumatic
What things do you want to know about your patients pain?
Site Does it radiate Nature Periodic or constant Duration Intensity Quality
What is referred pain?
When symptoms have left their origin where the patient first felt pain
What causes referred pain?
Convergence of sensory input from separate parts of the body onto the same dorsal horn neuron
Secondary pain resulting from a myofascial trigger point
Secondary hyperalgesia from inflammation
What is the most common of example of referred pain?
When people have a heart attack (mainly males) feel pain in their left arm
What is the acronym for remember what to ask about a patients pain?
SOCRATES
Site, Onset, Characteristic, Radiation, Alleviation, Timing, Exacerbation, Severity
What are the three types of pain?
Mechanical, Chemical and Thermal
What does ADL stand for
Activities of Daily Living
If a patient has pain in the morning what can that indicate?
Ligamentous pain or inflammatory disease (ex. rheumatoid arthritis, allow chemicals to build up over night)
If a patient has stiffness in the morning what can that be indicative of?
Degenerative joint disease, loss of lubrication while sleeping, could also be inflammatory if stiffness lasts more than 1 hour.
What are some questions you may ask a patient who complains of pain at night?
Does the pain wake the patient up?
Does the pain keep them from sleeping
Is there anything that relieves the symptoms?
What are the two causes of night pain?
Chemical and Mechanical
What are the chemical signs of night pain?
When movement and position can’t have an effect on the pain
Comes on around the same time each night
Patient will often “walk the floor”
Could possibly be cancer
What would make you think it is a mechanically caused night pain?
When it improves with change in position and movement
What medications would be a yellow flag to a therapist?
Anti-coagulants (warfarin and cumafin)
What are the red flag questions?
5D’s (dizziness, double vision, difficulty articulating words, difficulty swallowing, drop attacks)
Plus any alterations in energy level?
Pain constantly from the time you wake up till the time you go to bed
Night sweats?
Unexplained weight loss?
What three things help you determine a patients level of irritability?
Vigour, Duration and Intensity
What is vigour?
the activity needed to reproduce the pt’s symptoms
True or false: vigour is inversely proportional with irritability
True, the more vigour needed the less irritable the pt is
True or false: the duration of the patients symptoms are inversely proportional with their irritability
False, the duration of symptoms is proportional to their irritability ( the longer lasting the symptoms the more irritable)
True or false: the intensity of the patients symptoms is proportional with their irritability
True, the more intense the more irritable
A client has a ____ level of irritability if they are not easily provoked and symptoms return to baseline once the source has been removed
Low/mild
A client has a _____ level of irritability if their symptoms are proportionate to the source and the symptoms gradually return to baseline
Moderate
A client has a _____ level of irritability if their symptoms are easily provoked and remain elevated for a while
High/severe
What is considered the “looking phase” of the initial assessment?
Postural scan
What are you looking for when you complete a gait assessment?
Balance, Stride Length, Coordination, Limp, Rhythm, Assistive Devices, Distribution of Weight
What are the principles of examination?
Test the unaffected side first
AROM - PROM - resisted isometric (should be done in resting and on stretch)
Apply over pressure to test the end feel
What is active range of motion used to determine?
patients willingness to move and the available joint ROM (quality and quantity)
What are passive physiological movements?
Movements that occur normally at the joint performed voluntarily by the client and passively
What are osteokinematics?
rotary movements of the bony level in space during physiological joint motion
What are arthrokinematics?
Movements that occur during osteokinematics. When one segment is relatively stable and the other segment moves on the stable base
What are passive accessory movements?
Movements that are not under voluntary control. They are necessary to human movement and function
What is another term for passive accessory movements?
Joint play movements
Resisted ROM tests _______ structures by active tension
Contractile
When doing resisted testing if it is relatively strong but they are in some pain what does this mean?
There is a mild strain of contractile structure
When doing resisted testing if it is weak and painful what does this mean?
There is a moderate to severe strain of contractile structures
When doing resisted testing if it is weak and painless what does this mean?
There is a complete tear or rupture of the contractile structures
What is hyporeflexia?
A reduced deep tendon reflex
What is areflexia?
A loss or absence of deep tendon reflex
What is hyperreflexia?
An increased deep tendon reflex
What can you gather from palpation?
Pulses, local temperature, swelling
