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MSK 1 > 9/9 - Physical Exam and Eval > Flashcards

9/9 - Physical Exam and Eval Flashcards

1
Q

how is exam related to pt hx

A

exam is an extension of the history

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2
Q

what refines the diagnostic hypotheses

A

selected tests and measures

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3
Q

what is the extent of the exam dependent on

A

nature
severity
irritability
stage
stability

… of patient’s sx

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4
Q

what are the goals of physical exam (5)

A
  1. determine joints, ms, neural tissues, or other tissues/structures involved
  2. reproduce pts sx
  3. look for patterns of movement and restriction comparable w pt hx
  4. refine, support, or rule out diagnostic hypotheses
  5. establish objective data baseline to measure functional improvement
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5
Q

what is the goal of an upper quarter scan

A

clear cervical spine

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6
Q

what are the components of an upper quarter scan

A

cervical AROM
reflexes
myotome
dermatomes

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7
Q

what cervical AROM is assessed in an upper quarter scan

A

flexion
extension
side bend
rotation

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8
Q

what reflexes are tested in an upper quarter scan

A

biceps
brachioradialis
triceps

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9
Q

what are the myotomes assessed in an upper quarter scan

A

C1-2: neck flexion
C3: neck SB
C4: shoulder elevation
C5: shoulder ABD
C6: elbow flex and wrist ext
C7: elbw ext and wrist flex
C8: thumb ext and ulnar dev
T1: hand intrinsics

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10
Q

how are dermatomes assessed in an upper quarter scan

A

bilateral light touch

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11
Q

what is the goal of a lower quarter scan

A

clear lumbar spine

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12
Q

what are the components of a lower quarter scan

A

lumbar AROM
reflexes
myotomes
dermatomes

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13
Q

how is lumbar AROM assessed in a lower quarter scan

A

flex
ext
side bend
rotation

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14
Q

what reflexes are assessed in a lower quarter scan

A

knee jerk
achilles

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15
Q

what are the myotomes assessed in a lower quarter scan

A

L1-2: hip flexion (iliopsoas)
L3: knee ext (quads)
L4: ankle DF (tib ant)
L5: great toe ext (EHL)
S1-2: ankle PF (gastroc)

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16
Q

how are dermatomes assessed in a lower quarter scan

A

bilateral light touch

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17
Q

what are the types of posture you could observe

A

protective
nonprotective structural
nonprotective behavioral

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18
Q

describe a protective posture

A

correction inc sx
ex: lumbar shift, inc knee flex to dec WB

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19
Q

describe a nonprotective structural posture

A

deformity that isn’t correctible
- ex: long-standing scoliosis

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20
Q

describe a nonprotective behavioral posture

A

pt personality, emotions, or poor body awareness

correctible w/o creating pain, if anything makes the sx better

ex: slumped sitting posture contributing to HAs

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21
Q

what are possible hypotheses for abnormal posture (5)

A

joint contracture
limited flexibility
ms weakness
neuro deficit
habitual / repetitive movement pattern

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22
Q

what are hypotheses for LBP with inc lumbar lordosis

A

hypomobile lumbar spine
weak lower abs
tight hip flexors / low back extensors

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23
Q

what are components to assess when testing active motion

A

willingness to move
range, quality, & sx provocation
overpressure applied if no sx

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24
Q

what are the two ways to assess passive motion

A

physiological (osteokinematic)
accessory (arthrokinematic)

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25
Q

osteo vs arthro kinematic

A

osteo = physiological
- cardinal plane mvement
- flex/ext, IR/ER movements

arthro = accessory
- between joint surfaces
- joint play assessment

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26
Q

what are three ways to measure passive motion

A

quality - type of resistance
quantity - amount of resistance
end feel

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27
Q

what does pain before resistance in passive motion indicate

A

acute inflammation

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28
Q

what does pain at the same time as resistance indicate in passive motion

A

subacute condition

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29
Q

what does pain after resistance in passive motion indicate

A

chronic with tissue fibrosis

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30
Q

what are the two ways end feel can be categorized

A

physiological and accessory

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31
Q

what does a 0 for joint mobility mean

A

no movement
ankylosed

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32
Q

what does a 1 in joint mobility mean

A

mod - marked hypomobility

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33
Q

what does a 2 for joint mobility mean

A

slightly hypomobile

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34
Q

what does a 3 in joint mobility mean

A

normal

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35
Q

what does a 4 in joint mobility mean

A

slightly hypermobile

36
Q

what does a 5 for joint mobility mean

A

mod-marked hypermobility

37
Q

what does a 6 for joint mobility mean

A

unstable

38
Q

what are 3 examples of normal end feels

A

bone to bone
soft tissue approximation
tissue stretch

39
Q

what is motor function

A

ability to learn and demonstrate efficient movement patterns

40
Q

what are some examples of how you could improve motor function

A

walking
stair climbing
ther ex

41
Q

how do you treat a joint with a mobility grade 0

A

do not mobilize

42
Q

how do you treat joint with a mobility grade of 1

A

mobilization

43
Q

how do you treat a joint with a mobility grade of 3

A

no treatment is needed

44
Q

how do you treat a joint with a mobility grade of 4

A

assess for adjacent hypomobility
exercise
taping
bracing

45
Q

how do you treat a joint with a mobility grade of 5

A

assess for adjacent hypomobility
exercise
taping
bracing

46
Q

how do you treat joint with a mobility grade of 6

A

bracing
splinting
casting
surgical stabilization

47
Q

what is an example of a bone to bone end feel

A

elbow extension

48
Q

what is an example of a soft tissue approximation end feel

A

knee flexion

49
Q

what is an example of a tissue stretch end feel

A

ankle DF

50
Q

what is an example of when you would feel an early muscle spasm as a joint’s end feel

A

protection following injury

51
Q

what is an example of when you would feel a late muscle spasm as a joint’s end feel

A

protection from instability / pain

52
Q

what is an abnormal example of when you would feel tissue stretch as a joint’s end feel

A

tight muscle (occurs early in range)

53
Q

what is an example of when you would feel spasticity as a joint’s end feel

A

upper motor neuron lesion

54
Q

what is an example of when you would feel hard capsular as a joint’s abnormal end feel

A

adhesive capsulitis

55
Q

what is an example of when you would feel soft capsular as a joint’s end feel

A

synovitis
soft tissue edema

56
Q

in general is a bone to bone end feel normal or abnormal

A

abnormal
- elbow ext is the only exception

57
Q

what is an example of when you would feel bone to bone as a joint’s abnormal end feel

A

osteophyte formation

58
Q

what is an example of when you would feel empty (before tissue resistance) as a joint’s end feel

A

acute injury

59
Q

what is an example of when you would feel a springy block as a joint’s end feel

A

meniscal injury

60
Q

what are measures of muscle performance

A

strength
endurance
power

61
Q

how do you measure strength when assessing a muscle’s performance

A

MMT
HHD
isokinetic testing

62
Q

how do you measure endurance w assessing a muscle’s performance

A

functional tests
timed tests

ex: holding a plank

63
Q

how do you measure power when assessing muscle performance

A

work / time

ex: jumping activities

64
Q

what does the quality of a contraction tell you

A

the significance of tissue damage

65
Q

what does a strong and painless contraction indicate

A

normal

66
Q

what does a strong and painful contraction indicate

A

minor muscle / tendon lesion

67
Q

what does a weak and painful contraction indicate

A

major muscle / tendon lesion

68
Q

what does a weak and painless contraction indicate

A

rupture of muscle / tendon
neurological lesion

69
Q

what is the reflex integrity grading scale

A

0 = absent
1+ = diminished
2+ = normal
3+ = exaggerated
4+ = exaggerated with clonus

70
Q

what nerve does testing the biceps reflex integrity assess

A

C5

71
Q

what nerve does testing the brachioradialis reflex integrity assess

A

C6

72
Q

what nerve does testing the triceps reflex integrity assess

A

C7

73
Q

what nerve does testing the quadriceps reflex integrity assess

A

L4

74
Q

what nerve does testing the soleus reflex integrity assess

A

S1

75
Q

when palpating what is important about your technique

A

specificity
- what are you palpating
- if non specific could create sx without further info on why

76
Q

what are soft tissue structures assessed in palpation (5)

A

muscle
ligament
tendon
bursa
neural elements

77
Q

what is assessed when palpating a patient

A

skin
fascia
muscle
joint

78
Q

what is the process of palpation

A

uninvolved side is assessed first
perform from superficial to deep

79
Q

an increase in temperature noted in palpation indicates what

A

inflammation

80
Q

what should you document when palpating a patient (7)

A

temperature
soft tissue swelling
dryness / excessive moisture
tissue texture abnormality
- density and quality
osseous alignment
soft tissue structures
sx response

81
Q

what are most tests/measures designed to do

A

r/o or r/i pathoanatomic dx

82
Q

what are two important qualities of special tests

A

specific to body region
differentiate between structures

83
Q

how do special tests relate to diagnostic hypotheses and differential diagnoses

A

refine, support, or refute diagnostic hypotheses

assist w differential dx

84
Q

what is a physical therapy diagnosis

A

label ascribed to a cluster of s/sx

85
Q

when and when only can a PT diagnosis be made

A

dx can only be made when all potential causes for sx have been r/o

86
Q

what does making a PT dx involve

A

combo of hypothesis testing and pattern recognition

87
Q

what does the prognosis guide

A

intensity, duration, and freq of intervention

aids in justifying the intervention

MSK 1 (31 decks)

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