CA Midterm Review Flashcards
Diagnosis
Term denoting the disease or syndrome a person has or is believed to have
Assessment
A means to fully understand the patients problems, from the patients perspective as well as the clinicians, and the physical basis for the symptoms that have caused the patient to complain
Impairment
Any loss abnormality of psychological, physiological, or anatomical structure or function
WHY ASSESS? List 5 reasons
- Gather information necessary to devise a safe treatment plan
- Gather information necessary to devise an effective treatment plan
- A tool to monitor the progress/effectiveness of treatment
- A means to communicate with other health care professionals
- Required by law
What is in subjective data?
Patients perception of the current symptoms and their health history (what they tell you)
On subsequent visits this section should include how the patient has been doing since the last visit- have their symptoms or level of funtion changed? Compliance with self-care?
What is in objective data?
Practicioners observations, testing and physical findings (palpation, functional/ ROM tests and special orthopaedic tests)
Assessment
The examiners diagnosis or assessment of the condition, what you believe the cause of the complaint to be- an interpertation of the subjective and objective data
Plan
Treatment plan or what the therapist will do to treat the problem- Treatment goals or aims of treatment, techniques used to achieve the effect, what structures were the techniques applied to
Assessment Protocol 10 steps
- Case history
- Observation
- Palpation
- Rule outs
- Functional tests (AF, PR, AR)
- special tests
- Muscle tests
- Neurological tests
- Joint play examination
- Lesion site palpation
Observe and test ______
Bilaterally
Test the ______ side first
unaffected
Do the most ______ test last
painful
What do you do if your patient experiences pain during a particular movement or test?
Have them stop and identify the location and nature of the pain
Be aware of _____ pain
Referred pain- neurological, TRP or visceral
High seated
Hips and knees are at 90 degree flexion
Long seated
Hips at 90 degree flexion, knees extended
Hook lying
Supine, hips at 45 degree flexion, knees at 90 degree flexion
Presenting complaint
why patient is coming to see you, what are their goals/expectations of treatment
General health
Information from health history, Age- many conditions occur within certain age ranges
Occupation
What do they do for a living, any hobbies/sports, key is to identify any repitive motions or prolonged postures that may be contributing factors to the complaint
What kinds of questions would you ask with a previous injury?
Have they had this injury before? how was it treated? have they had an injury to the same joint in the past or to a joint above or below the injury site? Present complaint may be the result of the poor healing or rehad of a previous injury? Did they see anyone for this? How did it help? What didnt you like, what you liked?
What kinds of questions would you ask your patient regarding other therapies?
Are you receiving any other treatment for the current complaint, have you receieved treatment in the past for a similar condition, did the therapy/treatment help? you may want to communicate with any other healthcare practitioners?
Pain
An unpleasent sensation associated with actual or potential tissue damage, mediated by specific nerve fibres to the brain
Inflammatory pain
Pain results from the release of chemical irritants of inflammation, also result of swelling/edema that compresses nociceptors
Mechanical pain
Pain results from the stretch or compression of pain sensitive structures, structures contain nociceptors, when they are stimulated, produce painful sensation
Acute pain
Pain provoked by noxious stimulation produced by injury/disease
Chronic pain
pain that persists beyond the usual course of healing
Chronic pain syndrome
A clinical syndrome in which patients present with high levels of pain that is chronic in duration
Neurogenic pain
Pain as a result of non-inflammatory dysfunction of the peripheral or central nervous system that does not involve nociceptor stimulation or trauma
Referred pain
Pain that is felt at another location of the body that is distant from the tissues that have caused it
Radioculopathy
Pain that is felt in a dermatome, myotome, or sclerotome (involves a spinal nerve or spinal nerve root)
Dermatomal pain
A dermatome is an area of skin supplied by one dorsal nerve root, injury can cause sensory alteration to the skin, or pain (usually burning or electric)
Myotomal pain
a myotome is a group of muscles supplied by one nerve root (finding weakness in the muscles but no pain present)
Sclerotome pain
an area of bone or fascia innervated by a nerve root
Visceral pain
nerve roots can also supply the viscera, pain can be felt in a dermatome as a result of a visceral injury
Trigger point pain
Reffered pain arising from a trigger point, feels the pain at a distance that is entirely remote from the area of the trp
Location
where is the pain and does it travel/radiate anywhere?
As a lesion worsens the area of pain enlarges and moves distally from the original lesion. This concept is referred to as _______. If resolving, the area decreases and becomes localized this is called ______.
peripheralization, cenralization
Local, usually indicates a lesion to a superficial structure such as:
superficial muscles and tendons (ex. hamstrings strain or tendonitis), superficial ligaments (ex MCL), bursa; such as the greater trochanter or olecranon, superficial peiosteum such as at iliac crest contusion
What is diffuse pain? and where can that pain occur?
Pain that is not localized
- deep somatic or neural structure
- Joint subluxation ( joint surface slide and the comeback), dislocation (2 joint surfaces come away from each other)
- severe hematoma
- fractures
- Trp and local cutaneous nerves
What are some questions to consider in regards to the onset of the injury?
was there a mechanism of injury (MOI), how quickly did the pain/ dysfunction begin? (immediate onset- traumatic injury- quicker onset may indicate more serious injury), often occurs with overuse and repetitive strauin injury
Questions to ask in regards to frequency and duration of pain
How frequently and for how long do the symptoms occur? Is the pain constant or intermittent? Is the condition improving or worsening? Are there any patterns (morning or evening pain, pain with activity?)
Ligaments can cause pain when _____
stretched (sprain)
Muscles can cause pain when ______
forcefully contracted and over stretched (tare, muscles shortened)
Morning pain can be caused by?
Adaptive shortening (ex. plantar fasciitis- importance pillow under shin, avoid shortened position)
End of day pain
Suggests inflammation due to overuse (excessive stress on structures through the day), postural strain or Trps due to muscle fatigue
Pain with weight bearing
Pain only on with weight bearing suggests articular joint surfaces or muscular injury ex. meniscuses in the knee
Quality of pain, what structures are associated with sharp?
Skin and fascia, superficial muscle (strain), superficial ligament (MCL or LCL), acute inflammation, periosteum (acute lateral epicondylitis), radicular (nerve roots) pain
What structures are associated with dull ache pain?
Joints, deep muscles, gluteus medius, chronic muscle injuries (chronic hamstring strain), subchondral bone (patellofemoral syndrome, chrondromalcia (early signs of arthritic changes), chronic inflammation, deep or peripheral nerve, trp, referred pain
Tingling or parathesia
nerve injury, circulatory problems
Numbness
can be caused by damage or impingement of a nerve innervating a particular area ex. ulnar border of hand/forearm caused by injury/impingement to ulnar nerve to C8-T1 nerve root
Twinge
twinges with a movement that repeats the mechanism of injury could be caused by injury to a local muscle or ligament
Clicking and or snapping
can be caused by a tendon flipping over a bone, thickened bursa, meniscal tear, or synovial plica (a fold in the synovium of a joint)
Sound of tearing at time of injury
may indicate muscle or ligament tear
Locking or catching
suggests a loose body within the joint
Giving way or instability
commonly caused by severe joint pain damage, esp. to primary stabalizing ligaments (ex. sprain them multiple times, its ability to check movements)
Popping can be caused by
negative pressure within a tendon synovial sheath, a tendon flipping over a boney prominence, or possibly by rupture of ligament or tendon
Rule outs
check the joints immediately above and below the affected area to eliminate them as possible sources of dysfunction, affected side only- rest of the tests are done BL
What tests are always done first?
Active free (they do not differentiate between contractile or inert tissue)
What do you document and observe during AF movement tests
Patients availible ROM, amount of observable restriction, whether movements cause pain- location, intensity and quality, quality of movement, compensatory movements, apprehension about doing the movement,
If you believe your patient has a strain of the semitendinosis then your order of testing would be….
AF, PR, AR
Testing of injury to medial collateral ligament
AF, AR. PR
Passive relaxed movements
amount of joint motion availible when an examiner moves a joint through its anatomical or physiological range without assistance from the patient while the patient is relaxed, test the inert structures, contractile tissues may also cause pain esp. end of range as it is stretched
Hypermobility
which allows a joint to be susceptible to ligamentous sprain, tendonitis, early arthritis, disclocations and subluxations
Hypomobility
can suggest conditions such as muscle strains, nerve compression syndromes, and cartilagious damage due to constant compression forces`
Tissue approximation
movement is stopped by the compression of tissue, normal end feel
bone to bone
when bone touches another bone ex. elbow extension
tissue stretch
hard or firm springy type of movenebt with a slight give, occurs toward the end range of motion, found when the capsule and ligaments are providing resistance to movement
Muscle spasm
sudden dramatic arrest of movement, often accompanied by pain, described as sudden and hard, usually the result of protective reflex designed to splint a joint and prevent further movement/injury, abnormal end feel
capsular
similar to tissue stretch, occurs early in ROM, has a hard and thicker feeling to it, ROM is reduced
springy block
usually indicates an internal derangement within a joint, may be caused by a loose body within a joint, slight rebound may be noted at end of range, abnormal end feel
empty end feel
patient stops the movement due to intensity pain
Active resisted tests are done to determine the status of what ?
contractile unit
What are the four possible findings with AR testing according to cyriax
strong and painless- no lesion, normal
strong and painful- 1st or 2nd degree muscle strain, minor lesion of the musculoteninous unit
weak and painless- interruption of the nerve supply, compression syndromes, complete rupture of a muscle or tendon
weak and painful-partial rupture of a muscle or tendon
what is the oxford manual muscle testing scale
5- normal- overcomes maximal resistance
4- able to overcome some resistance
3-able to overcome gravity but not resistance
2- able to produce movement with gravity eliminated
1-slight contraction, mm tightness but no movement produced
0- no contraction
Special tests
used to confirm rule out injury to specific structures
Muscle testing
length and strength tests for specific muscles (see if a muscle is weak or strong, mm is short or long)
Neurological test
used to confirm neurological involvement, dermatomes, myotomes, deep tendon reflexes
Joint play examination
tests accessory joint motion within a joint
Palpation
finally the lesion should be palpated
What is the term drag used to describe
therapists palpation and the tissue layers resistance to lengthening in response to the force, is integral to the examination of connective tissue such as fascia and skin
What provides info about status of inflammation and circulation
temperature, use palm of hand, 10mm from surface of skin
Tissue hardness descriptors
ropy, stringy, hard can be attributed to chronic inflammation that results in the deposit of collagen in the tissues
Tissue softness
descriptors include distended, spongy, boggy may be attributed to acute inflammatuon and the associated presence of fluid in the tissues, soft tissues have an availible ROM
what is it called when there is soft tissue dysfunction
restrictive barriers (skin, fascia, muscle, ligament, capsule or combination of)
Physiological barrier
ROM of motion availible of normal circumstances, midrange is the range with least amount of resistance
Elastic barrier
felt at the end of range and beyond end feel, this is when the tissue is engaged at the end of passive range
Anatomical barrier
final resistance to normal range, any further motion will cause injury to the tissue (ligament, mm, fascia, bone)
Fasiculations
subconscious mm contusions that do not involve the whole mm; result from the contraction of the muscle cells innervated by a single motor axon (localized)
tremors
Rhythmic movements of a joint that result from involuntary contractions of agonist and antagonist mm groups
Vibration
crepitus is a vibration associated with roughened gliding surfaces of a tendon, tendon sheath, articulating surface, crepitus is often audible in addition to being palpable
