9/9 - Physical Exam and Eval Flashcards
how is exam related to pt hx
exam is an extension of the history
what refines the diagnostic hypotheses
selected tests and measures
what is the extent of the exam dependent on
nature
severity
irritability
stage
stability
… of patient’s sx
what are the goals of physical exam (5)
- determine joints, ms, neural tissues, or other tissues/structures involved
- reproduce pts sx
- look for patterns of movement and restriction comparable w pt hx
- refine, support, or rule out diagnostic hypotheses
- establish objective data baseline to measure functional improvement
what is the goal of an upper quarter scan
clear cervical spine
what are the components of an upper quarter scan
cervical AROM
reflexes
myotome
dermatomes
what cervical AROM is assessed in an upper quarter scan
flexion
extension
side bend
rotation
what reflexes are tested in an upper quarter scan
biceps
brachioradialis
triceps
what are the myotomes assessed in an upper quarter scan
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
how are dermatomes assessed in an upper quarter scan
bilateral light touch
what is the goal of a lower quarter scan
clear lumbar spine
what are the components of a lower quarter scan
lumbar AROM
reflexes
myotomes
dermatomes
how is lumbar AROM assessed in a lower quarter scan
flex
ext
side bend
rotation
what reflexes are assessed in a lower quarter scan
knee jerk
achilles
what are the myotomes assessed in a lower quarter scan
L1-2: hip flexion (iliopsoas)
L3: knee ext (quads)
L4: ankle DF (tib ant)
L5: great toe ext (EHL)
S1-2: ankle PF (gastroc)
how are dermatomes assessed in a lower quarter scan
bilateral light touch
what are the types of posture you could observe
protective
nonprotective structural
nonprotective behavioral
describe a protective posture
correction inc sx
ex: lumbar shift, inc knee flex to dec WB
describe a nonprotective structural posture
deformity that isn’t correctible
- ex: long-standing scoliosis
describe a nonprotective behavioral posture
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
what are possible hypotheses for abnormal posture (5)
joint contracture
limited flexibility
ms weakness
neuro deficit
habitual / repetitive movement pattern
what are hypotheses for LBP with inc lumbar lordosis
hypomobile lumbar spine
weak lower abs
tight hip flexors / low back extensors
what are components to assess when testing active motion
willingness to move
range, quality, & sx provocation
overpressure applied if no sx
what are the two ways to assess passive motion
physiological (osteokinematic)
accessory (arthrokinematic)
osteo vs arthro kinematic
osteo = physiological
- cardinal plane mvement
- flex/ext, IR/ER movements
arthro = accessory
- between joint surfaces
- joint play assessment
what are three ways to measure passive motion
quality - type of resistance
quantity - amount of resistance
end feel
what does pain before resistance in passive motion indicate
acute inflammation
what does pain at the same time as resistance indicate in passive motion
subacute condition
what does pain after resistance in passive motion indicate
chronic with tissue fibrosis
what are the two ways end feel can be categorized
physiological and accessory
what does a 0 for joint mobility mean
no movement
ankylosed
what does a 1 in joint mobility mean
mod - marked hypomobility
what does a 2 for joint mobility mean
slightly hypomobile
what does a 3 in joint mobility mean
normal
what does a 4 in joint mobility mean
slightly hypermobile
what does a 5 for joint mobility mean
mod-marked hypermobility
what does a 6 for joint mobility mean
unstable
what are 3 examples of normal end feels
bone to bone
soft tissue approximation
tissue stretch
what is motor function
ability to learn and demonstrate efficient movement patterns
what are some examples of how you could improve motor function
walking
stair climbing
ther ex
how do you treat a joint with a mobility grade 0
do not mobilize
how do you treat joint with a mobility grade of 1
mobilization
how do you treat a joint with a mobility grade of 3
no treatment is needed
how do you treat a joint with a mobility grade of 4
assess for adjacent hypomobility
exercise
taping
bracing
how do you treat a joint with a mobility grade of 5
assess for adjacent hypomobility
exercise
taping
bracing
how do you treat joint with a mobility grade of 6
bracing
splinting
casting
surgical stabilization
what is an example of a bone to bone end feel
elbow extension
what is an example of a soft tissue approximation end feel
knee flexion
what is an example of a tissue stretch end feel
ankle DF
what is an example of when you would feel an early muscle spasm as a joint’s end feel
protection following injury
what is an example of when you would feel a late muscle spasm as a joint’s end feel
protection from instability / pain
what is an abnormal example of when you would feel tissue stretch as a joint’s end feel
tight muscle (occurs early in range)
what is an example of when you would feel spasticity as a joint’s end feel
upper motor neuron lesion
what is an example of when you would feel hard capsular as a joint’s abnormal end feel
adhesive capsulitis
what is an example of when you would feel soft capsular as a joint’s end feel
synovitis
soft tissue edema
in general is a bone to bone end feel normal or abnormal
abnormal
- elbow ext is the only exception
what is an example of when you would feel bone to bone as a joint’s abnormal end feel
osteophyte formation
what is an example of when you would feel empty (before tissue resistance) as a joint’s end feel
acute injury
what is an example of when you would feel a springy block as a joint’s end feel
meniscal injury
what are measures of muscle performance
strength
endurance
power
how do you measure strength when assessing a muscle’s performance
MMT
HHD
isokinetic testing
how do you measure endurance w assessing a muscle’s performance
functional tests
timed tests
ex: holding a plank
how do you measure power when assessing muscle performance
work / time
ex: jumping activities
what does the quality of a contraction tell you
the significance of tissue damage
what does a strong and painless contraction indicate
normal
what does a strong and painful contraction indicate
minor muscle / tendon lesion
what does a weak and painful contraction indicate
major muscle / tendon lesion
what does a weak and painless contraction indicate
rupture of muscle / tendon
neurological lesion
what is the reflex integrity grading scale
0 = absent
1+ = diminished
2+ = normal
3+ = exaggerated
4+ = exaggerated with clonus
what nerve does testing the biceps reflex integrity assess
C5
what nerve does testing the brachioradialis reflex integrity assess
C6
what nerve does testing the triceps reflex integrity assess
C7
what nerve does testing the quadriceps reflex integrity assess
L4
what nerve does testing the soleus reflex integrity assess
S1
when palpating what is important about your technique
specificity
- what are you palpating
- if non specific could create sx without further info on why
what are soft tissue structures assessed in palpation (5)
muscle
ligament
tendon
bursa
neural elements
what is assessed when palpating a patient
skin
fascia
muscle
joint
what is the process of palpation
uninvolved side is assessed first
perform from superficial to deep
an increase in temperature noted in palpation indicates what
inflammation
what should you document when palpating a patient (7)
temperature
soft tissue swelling
dryness / excessive moisture
tissue texture abnormality
- density and quality
osseous alignment
soft tissue structures
sx response
what are most tests/measures designed to do
r/o or r/i pathoanatomic dx
what are two important qualities of special tests
specific to body region
differentiate between structures
how do special tests relate to diagnostic hypotheses and differential diagnoses
refine, support, or refute diagnostic hypotheses
assist w differential dx
what is a physical therapy diagnosis
label ascribed to a cluster of s/sx
when and when only can a PT diagnosis be made
dx can only be made when all potential causes for sx have been r/o
what does making a PT dx involve
combo of hypothesis testing and pattern recognition
what does the prognosis guide
intensity, duration, and freq of intervention
aids in justifying the intervention
