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NCE > Chapter 6 Clinical Assessment and Diagnosis > Flashcards

Chapter 6 Clinical Assessment and Diagnosis Flashcards

1
Q

What is the HOPS format?

A

History – subjective evaluation coming from patient
c/c, MOI, symptoms, medical history

Observation, Palpation and Special Tests
Objective evaluation
Observation – signs of pathology

Palpation – assess surface anatomy

Special tests – ROM, specific pathology testing

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2
Q

What is the SOAP note format?

A

Subjective – history or follow-up with patient
Objective – observation, physical exam, special testing, palpation, joint play
Assessment – clinical/working diagnosis
- Suspected site on injury, involved structures, severity of damage
- Establish long-term and short-term goals
Plan – how will goals be achieved using modalities, exercises, manual therapy, etc.
- Immediate treatment given to individual
- Referral needed?
- Frequency/duration of treatments, modalities, exercises
- Patient education
- Criteria for discharge
- Evaluation standards

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3
Q

What is the primary complaint?

A

reason patient is seeking assistance
Nature, location, onset, sounds

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4
Q

What is the MOI?

A

mechanism of injury
most important info gained, helps identify injured structures

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5
Q

What is somatic pain?

A

arises from skin, ligaments, muscles, bones and joints
- Most common
- Deep (diffuse or nagging, intense pressure, stabbing, damage to bone/internal joint structures/muscles) and superficial (epidermis or dermis, sharp, prickly, brief)

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6
Q

What is visceral pain?

A

disease or injury to an organ in the thoracic or abdominal cavity (compression, tension, distention)
- Deep, nagging, pressing – nausea and vomiting
- Referred pain – perceived by brain as somatic pain

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7
Q

What is localized pain?

A

limited bony or soft-tissue structures involved, in one spot

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8
Q

What is diffuse pain?

A

entire joint may indicate inflammation of the joint capsule or injury to several structures

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9
Q

What is radiating pain?

A

traveling along a nerve

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10
Q

What is disability resulting from injury?

A

Limitations due to pain, weakness, disability
sport/PA, activities of daily living

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11
Q

What is related medical history?

A

other problems that affect current injury, chronic medical problems, medication, etc…

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12
Q

What other group of questions should you ask?

A

Sports specific questions
General (age, gender/sex, occupation, lifestyle)

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13
Q

What are components of observation?

A

General posture obs, symmetry, gait and functional movements
Inspection of injury site - joint effusion (swelling inside the joint), ecchymosis (superficial discoloration), keloids (scars). Bilateral comparison

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14
Q

What is active ROM?

A

voluntary movement through muscle contraction
Pain? Limitations? Type of pain?
Measurements start from anatomical position

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15
Q

What is passive ROM?

A

body part is moved by the clinician
Helps distinguish pain coming from contractile tissue vs non-contractile or inert tissue
Overpressure to determine end-feel
- Soft-tissue approximation – contact between soft tissues
- Muscular/capsular/ligamentous stretch
- Bone to bone – contact between two bones

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16
Q

What are abnormal end feels?

A
  • Soft – occurs sooner or later in ROM than usual or in a joint that normally has a soft or hard end feel 🡪 soft-tissue edema, synovitis, ligamentous stretch or tear
  • Firm – occurs sooner or later in ROM than usual or in a joint that normally has a soft or hard end feel 🡪 increased muscular tone, capsular/muscular/ligamentous shortening
  • Hard – occurs sooner or later in the ROM than usual or in a joint that has a soft or firm end feel, bony block is felt 🡪 chondromalacia, osteoarthritis, fracture, myositis ossificans
  • Empty – no end feel because end of ROM not reached due to pain, no resistance except muscle spasm 🡪 acute joint inflammation, bursitis, fracture, psychogenic in origin
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17
Q

What are accessory movements?

A

Within the joint accompanied by traditional ROM but is involuntary, joint play in resting position

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18
Q

What is RROM/MMT used for?

A

to assess muscular strength/weakness

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19
Q

What is goniometry used for?

A

Measure AROM and PROM objectively

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20
Q

What are special tests used for?

A

Detect injury or pathologies

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21
Q

What is the loose packed position of the glenohumeral joint?

A

55 degrees abduction, 30 degree horizontal adduction

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22
Q

What is the loose packed position of the elbow joint?

A

70 degrees elbow flexion, 10 degrees forearm supination

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23
Q

What is the loose packed position of the radiohumeral joint?

A

full extension, full forearm supination

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24
Q

What is the loose packed position of the proximal radioulnar joint?

A

70 degrees elbow flexion, 35 degrees supination

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25
What is the loose packed position of the distal radioulnar joint?
10 degrees forearm supination
26
What is the loose packed position of the wrist?
neutral with slight ulnar deviation
27
What is the loose packed position of the carpometacarpal joint?
midway between abd/add and flexion/extension
28
What is the loose packed position of the metacarpophalangeal/interphalangeal joints?
slight flexion
29
What is the loose packed position of the hip joint?
30 degrees flexion, 30 degrees abduction, slight lateral rotation
30
What is the loose packed position of the knee joint?
25 degrees flexion
31
What is the loose packed position of the ankle joint?
10 degrees PF, midway between max inv/ev
32
What is the loose packed position of the subtalar joint?
midway between max inv/ev
33
What is the loose packed position of the tarsometatarsal joint?
midway between extreme ROM
34
What is the loose packed position of the metatarsophalangeal joint?
neutral
35
What is the loose packed position of the interphalangeal joint?
slight flexion
36
What is the closed packed position of the glenohumeral?
abduction and lateral rotation
37
What is the closed packed position of the elbow joint?
extension
38
What is the closed packed position of the radiohumeral joint?
elbow flexed 90 degrees, 5 degrees forearm supination
39
What is the closed packed position of the proximal radioulnar joint?
5 degree forearm supination
40
What is the closed packed position of the distal radioulnar joint?
5 degrees forearm supination
41
What is the closed packed position of the wrist joint?
extension with radial deviation
42
What is the closed packed position of the metacarpophalangeal joint?
full extension (fingers), full opposition (thumb)
43
What is the closed packed position of the interphalangeal joint?
full extension
44
What is the closed packed position of the hip joint?
full extension, medial rotation and abduction
45
What is the closed packed position of the knee joint?
extension and tibial external rotation
46
What is the closed packed position of the ankle joint?
maximum DF
47
What is the closed packed position of the subtalar joint?
full supination
48
What is the closed packed position of the midtarsal joint?
full supination
49
What is the closed packed position of the tarsometatarsal joint?
full supination
50
What is the closed packed position of the metatarsophalangeal joint?
full extension
51
What is the closed packed position of the interphalangeal joint?
full extension
52
What is the grading system for MMT?
5 (Normal) – Complete ROM against gravity with maximal overload 4 (Good) – Complete ROM against gravity with moderate overload 3+ (Fair +) – complete ROM against gravity with minimal overload 3 (Fair) – Complete ROM against gravity with no overload 3- (Fair - ) – Some but not complete ROM against gravity 2+ (Poor +) – Initiates motion against gravity 2 (Poor) – Complete ROM with some assistance and gravity eliminated 2 – (Poor -) – Initiates motion if gravity is eliminated 1 (Trace) – evidence of slight muscular contraction, no joint motion 0 (Zero) – No muscle contraction palpated
53
What is the normal joint ROM and End Feels for the ankle?
Dorsiflexion (tissue stretch, 20°) Plantarflexion (tissue stretch, 50°) Inversion/Supination (tissue stretch, 45-60°) Eversion/Pronation (tissue stretch, 15-30°)
54
What is the normal joint ROM and End Feels for the knee?
Flexion (tissue approximation, 135°) Extension (tissue stretch, 15°) Tibial internal rotation (tissue stretch, 20-30°) Tibial external rotation (tissue stretch, 30-40 °)
55
What is the normal joint ROM and End Feels for the hip?
Flexion (tissue approximation or tissue stretch, 0-120°) Extension (tissue stretch, 0-30°) Abduction (tissue stretch, 0-40°) Adduction (tissue approximation or tissue stretch, 0-30°) Internal rotation (tissue stretch, 0-40°) External rotation (tissue stretch, 0-50°)
56
What is the normal joint ROM and End Feels for the shoulder?
Flexion (tissue stretch, 160-180°) Extension (tissue stretch, 50-60°) Abduction (bone on bone/tissue stretch, 170-180°) Adduction (tissue approximation, 50-75°) Internal rotation (tissue stretch, 60-100°) External rotation (tissue stretch, 80-90°) @ 0° & 90° Horizontal abduction (tissue stretch, 130°) Horizontal adduction (tissue stretch/tissue approximation, 130°)
57
What is the normal joint ROM and End Feels for the elbow?
Flexion (tissue approximation, 140-150°) Extension (bone on bone, 0-10°) Pronation (tissue stretch, 80-90°) Supination (tissue stretch, 90°)
58
What is the normal joint ROM and End Feels for the wrist?
Flexion (tissue stretch, 80°) Extension (tissue stretch, 70°) Radial Deviation (bone to bone, 20°) Ulnar Deviation (bone to bone, 30°)
59
What is the normal joint ROM and End Feels for the cervical spine?
Flexion (tissue stretch, 0-80°) Extension (tissue stretch, 0-70°) Lateral flexion (tissue stretch, 0-45°) Rotation (tissue stretch, 0-80°)
60
What is the normal joint ROM and End Feels for the thoracic and lumbar spine?
Flexion (tissue stretch, 0-60°) Extension (tissue stretch, 0-35°) Lateral flexion (tissue stretch, 0-20°) Rotation (tissue stretch, 0-50°)
61
What are the C1-T1 dermatomes?
C1: top of head C2: forehead C3: cheeks C4: anterior/lateral neck C5: top of shoulder C6: posterior thumb C7: posterior hand C8: posterior pinky T1: medial arm
62
What are the T2-T12 dermatomes?
T2: second rib, down medial arm to elbow T3: third rib T4: above nipple area T5: nipple area, closer to the sternum T6: under nipple area T7: below T8: below T9: below T10: towards belly button T11: below belly button T12: inguinal area
63
What are the L1- S2 dermatomes?
L1-L2:inguinal line/superior thigh L3: distal thigh L4: anterior leg/top of foot L5: big tow S1: posterior lower leg S2: posterior knee
64
What are the C2 - T1 myotomes?
C2: cervical spine flexion C3: cervical spine side flexion C4: shoulder shrug C5: shoulder abduction C6: elbow flexion or wrist extension C7: elbow extension or wrist flexion C8: thumb extension T1: finger abduction/adduction
65
What are the L1-S2 myotomes?
L1/L2: hip flexion L3: knee extension L4: dorsiflexion L5: big toe extension S1: plantarflexion S2: knee flexion
66
What is the superficial reflex for the upper abdominals?
umbilicus moves up and toward area being stroked - T7-T9
67
What is the superficial reflex of the lower abdominal?
umbilicus moves down and toward area being stroked - T11-L1
68
What is the superficial reflex of the cremasteric?
scrotum elevates - T12, L1
69
What is the superficial reflex of the plantar foot?
flexion of toes - S1-S2
70
What is the gluteal superficial reflex?
skin tenses in the gluteal area L4-L5, S1-S3
71
What is the anal superficial reflex?
anal sphincter muscles contract - S2-S4
72
Name some of the pathological reflexes?
Babinski Chaddock Oppenheim Gordon Brudzinski Hoffman
73
What is the babinski reflex?
stroke lateral aspect of sole of foot – extension or big toe or fanning of four small toes (normal in newborns)
74
What is the Chaddock reflex?
stroke lateral side of foot beneath lateral malleolus – extension or big toe or fanning of four small toes
75
What is the Oppenheim reflex?
stroke anteromedial tibial surface – extension or big toe or fanning of four small toes
76
What is the gordon reflex?
squeeze calf muscle firmly – extension or big toe or fanning of four small toes
77
What is the brudzinski reflex?
passive flexion of one lower limb – extension or big toe or fanning of four small toes in opposite limb
78
What is the hoffman reflex?
flicking of terminal phalanx of index, middle, or ring finger – reflex flexion of distal phalanx of thumb and of distal phalanx of index or middle finger
79
What are the different components of palpation?
Temperature - Increased temperature = inflammation/infection - Decreased temperature = reduction in circulation Swelling Point tenderness - Indicate inflammation over a tendon/bursa/joint capsule Crepitus - Bone = fracture – tuning fork, compression, distraction Deformity Muscle spasm Cutaneous sensation - Nerve involvement Pulse - Rule out major artery damage
80
What are the characteristics of radiography?
Most common imaging, x-ray Provides an image of certain body structures and can rule out fractures, infections and neoplasms A minute amount of radiation passes through the body to expose sensitive film placed on the other side - Bone – restrict rays passing through - Lungs/air-filled structures – pass through - Soft tissue – varying degree of penetration Contraindicated: thyroid gland, pregnant abdomen, reproductive organs Myelogram – opaque dye introduced into the spinal canal through lumbar puncture Arthrogram – opaque dye, air or both into a joint space
81
What are the characteristics of Computed Tomography?
A form of radiography that produces a three-dimensional, cross-sectional picture of a body part Reveal abnormalities in bone, fat and soft tissue – excellent at detecting tendinous and ligamentous injuries Use a beam of light across a slice or layer of the body Computer calculates the absorption of the light beams at thousands of different points – converted to two-dimensional image
82
What are the characteristics of Magnetic Resonance Imaging?
Excellent tool for visualizing the CNS, spine and musculoskeletal and cardiovascular systems Ability to provide soft-tissue differentiation, used to demonstrate space-occupying lesions in the brain and joint damage MRI tube that produces the magnetic field – causes body’s hydrogen nuclei to align with the magnetic axis, tissues are then bombarded by radio waves which causes the nuclei to resonate as they absorb the energy Energy from the radio waves ceases – nuclei return to their state of equilibrium by releasing energy that is detected by the MRI unit
83
What are the characteristics of radionuclide scintigraphy (bone scan)?
Used to detect stress fractures of the long bones and vertebrae, degenerative diseases, infections and tumours of the bone Radionucleotide material is injected into a vein and is slowly absorbed by areas of the bone undergoing remodeling – after several hours, patient is placed under a recording device that scans radioactive signals and records the images on film Area subject to stress – fractures 🡪 show as areas of greatest uptake and appear darker on film
84
What are the characteristics of ultrasonic imaging?
Uses sound waves to view the various internal organs and certain soft-tissue structures such as tendons A piezoelectric crystal is used to convert electrical pulses into vibrations that penetrate bony structures – the sound waves are reflected away from the tissues and create a two-dimensional image of the subcutaneous structures
85
What are the characteristics of electromyography?
Detect muscular conditions A thin electrode needle that is inserted into the muscle to determine the level of muscular contraction following an electrical stimulation Motor unit potentials can be observed on an oscilloscope screen or recorded on an electromyogram Detect denervated muscles, nerve root compression injuries, muscle diseases
86
What are the do's of documentation?
Use correct medical terminology – convey precise structure, location, pathology, condition, process under examination Use only standardized and accepted medical abbreviations Use correct punctuation Be as accurate as possible Use anatomical/medical terms and abbreviations, important to record pertinent information Write with an instrument that cannot be erased or removed

NCE (16 decks)

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