Approach To Pt With Joint Pain Flashcards
History of pain
OLDCAAARTS
Point to the pain
Anything that might have occurred to cause the pain
Mechanism of injury
Direction of force
What did joint do
What did it feel like at the time
Any sounds or sensations
Sprain
Ligaments stretch causing tearing
Tearing causes bruising
Greater the tearing of the ligament, the greater the blood loss and subsequent bruising
May fee or hear a “pop”
Strain
Muscle is stretched
“Grabbing sensation”
Assessing strain or sprain
Any immediate swelling or bruising?
Could you still use the joint (walking/standing)?
How does it feel now?
Symptoms
What the patient feels
Pain
Stiffness
Signs
What can be observed, measured, and described Warmth Redness Swelling Pain
Injury
Definitive onset
General mono-articular
Generally unilateral
Non-injury
Insidious or gradual Associated with constitutional symptoms Mono-articular or polyarticular Unilateral or bilateral Single or multiple joints Migratory Change with activity Extra-articular signs: not on joint, but around joint
Mono articular
1 joint
Poly articular
Multiple joints
Migratory
Moves from one joint to another
Extra-articular
Bones, muscles, tendons, bursa, skin
Myalgia
Muscle pain
Arthralgia
Joint pain
Effusion
Fluid escaped from blood vessels or lymphatics into the tissues or a cavity
Tendinitis
Inflammation of the tendon
Bursitis
Inflammation of the bursa
Tenosynovitis
Inflammation of the tendon sheath
Genu varus
Bowed legs
Genu valgus
Knock kneed
Subluxation
Residual contact between two articular surfaces
Dislocation
Complete lack of contact between two articular surfaces
Sensitivity
The proportion of patient with the diagnosis that also have the physical sign (true positive)
Rules things out
SnOUT: a sensitive test it’s a negative result rules a disease OUT
Specificity
The portion of the patient without the diagnosis who lacks the physical sign (true negative)
Rules things in
SpIN: a specific test with a positive result rules IN a disease
Likelihood ratio (LR)
Values between 0 and infinity
LR>1 increase the probability of a disease
The greater the value of the LR, the more likely the diagnosis or disease
LR<1 decrease the probability of disease
The closer to 0, the probability of the disease or diagnosis decreases
LR=1 do not change the probability of the disease
What should you always do when assessing a joint
Do it BILATERALLY Observe Palpation Range of motion Neuro Vascular Diagnostic testing
Muscle strength testing
0-no visible or palpable contraction
1-visible or palpable contraction with no motion
2-full ROM with no gravity
3-full ROM against gravity
4-full ROM against gravity, with moderate resistance
5-muscle contracts normally against full resistance
Reflexes
4+-very brisk, hyperactive it’s clonus 9rhythmic oscillations between flexion and extension)
3+-brisker than average, possibly but not necessarily indicative of disease
2+-average; normal
1+-somewhat diminished; low normal
0-no response
Triceps reflex
C7
Biceps reflex
C5,6
Brachioradialis reflex
C5,6
Patellar reflex
L2-L4
Achilles reflex
S1
Capillary refill
Compress digit between index and thumb to cause blanching; release pressure and note time to regain color
Normal time-2 sec or less
Tests digital perfusion (e.g. arterial occlusion, hypovolemic shock, hypothermia)
Pulses
0/4 absent
1/4-palpable, but thready and weak; easily obliterated
2/4 normal, easily identified; not easily obliterated
3/4 increased pulse; moderate pressure for obliteration
4/4 full, bounding, cannot obliterate
Edema
Pressing firmly for 5 seconds over the dorsum of foot, anterior tibia, or behind medial malleolus
0-absent
1+: barely detectable, slight pitting (2mm); disappears rapidly
2+ slight indentation (4 mm); 10-15 seconds
3+ deeper indentation (6 mm); over 1 minute
4+ very marked indentation (8 mm); 2-5 minutes
C2 Dermatomes
Ears
C3 dermatome
Front of neck
C4 dermatome
Across clavicles and over shoulders
C5 dermatome
Superior lateral arm
C6 dermatome
Lateral arm-forearm and thumb
C7 dermatome
Middle 1 finger plus lateral half of first finger and medial half of 3rd finger
C8 dermatome
Pinky finger
T4 dermatome
Nipples
T10 dermatome
Umbilicus
L1 dermatome
Inguinal region
L2 dermatome
Very top of thigh by femoral triangle
L3 dermatome
From lateral superior thigh crossing diagonally to medial inside of knee
L4 dermatome
Lateral middle thigh crossing over knee and down to medial leg
L5 dermatome
Lateral superior leg crossing over to big toe
Anterior ankle and foot
S1 dermatome
Lateral thigh and leg and little toe (posterior side)
S2 dermatome
Posterior side
Medial thigh and leg
T1 dermatome
Posterior medial side of arm and forearm
