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Clinical Assessment Flashcards

1
Q

What are the 6 steps of the evaluative phase?

A
  1. Conduct subjective evaluation
  2. Generate preliminary clinical hypothesis
  3. Conduct objective examination
  4. Confirm the clinical hypothesis
  5. Summarize pertinent clinical findings
  6. Determine appropriateness for treatment
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2
Q

What are the 10 steps of the assessment protocol?

A
  1. Case history
  2. Observation
  3. Palpation - temperature
  4. Rule outs
  5. Functional tests (ROM tests AF, PR, AR)
  6. Special tests
  7. Muscle tests
  8. Neurological tests
  9. Joint play examination
  10. Lesion site palpation
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3
Q

What are the 8 points to keep in mind for general guidelines of clinical assessment?

A
  1. Observe and test bilaterally (all observations and functional/ROM testing)
  2. Test the unaffected side first
  3. Do the most painful tests last
  4. If your client experience pain, stop and have them identify location and nature of pain
  5. Take thorough case history
  6. Always support the limb in a secure and neutral position
  7. Rule out the proximal and distal joints
  8. Be aware of referred pain (neuro, trp, visceral)
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4
Q

What’s radiculopathy?

A
  • aka radicular or nerve root pain
  • Involves a spinal nerve or spinal nerve root
  • Pain that is felt in a dermatome, myotome or sclerotome
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5
Q

What’s Sclerotomal pain?

A

pain in an area of bone or fascia innervated by a nerve root

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6
Q

What’s visceral pain?

A
  • Nerve roots also supply the viscera
  • Pain can be felt in a dermatome as a result of visceral injury
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7
Q

What’s the primary use of overpressure?

A

Overpressure is used primarily to clarify the end feel or end range

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8
Q

Cyriax defines seven end feels for passive relaxed testing:

A
  1. Tissue approximation
    • normal
  2. Bone to bone
    • can be normal or abnormal – abnormal if it occurs before normal end range
  3. Tissue stretch
    • most common type of normal end feel
  4. Muscle spasm:
    • sudden dramatic arrest of movement, often accompanied by pain (usually protective)
    • often seen in acute or severe injuries
    • abnormal end feel
  5. Capsular:
    • very similar to tissue stretch early in ROM
    • Tends to have thicker feeling to it
    • Some divide into ‘hard’ or ‘soft’
    • Abnormal end feel
  6. Springy block
    • Usually indicates internal derangement within a joint (maybe a loose body)
    • A slight rebound may be noted at end of range
    • Abnormal end feel
  7. Empty end feel
    • Client stops movement due to pain before end of range is felt
    • Abnormal end feel
  • A common end feel not listed above is muscular, often described as rubbery (ex. Tension felt in hamstrings during straight leg raise)
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9
Q

Cyriax notes four possible findings with resisted testing:

A
  1. Strong and painless
    • No problems
    • Normal
  2. Strong and painful
    • 1st or 2nd degree muscle strain
    • A minor lesion of the musculotendinous unit
  3. Weak and painless
    • Interruption of nerve supply, compression syndromes, etc
    • Complete rupture of m or tendons
  4. Weak and painful
    • Partial rupture of a m or tendon
    • Painful inhitbition caused by pathology such as neoplasm, fracture or acute inflamm of tissue
  • Pain with repetitive movements may indicate problem with vascular supply to region
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10
Q

What’s Turgidity/turgor?

A

(when palpating) is the fluid pressure or tension

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11
Q

Where do I position myself when conducting postural assessment, lateral view?

A

External accoustic meatus

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12
Q

What are the 9 steps in performing a postural assessment?

A
  1. Ask client ot remove shoes and as much clothing as reasonable
  2. Get into good position to assess
  3. Position client behind plumb line or posture grid (if using one)
  4. Get client to assume relaxed/normal posture
  5. Perform visual inspection
    • Identify the position of landmarks
    • Note symmetry of contours and mm bulk
    • Compare bilaterally
  6. Confirm or refute visual analysis with palpation when necessary
  7. Document findings
  8. Note findings that indicate further assessment
  9. Reposition for next view
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13
Q

What’s the normal carrying angle of elbows?

A

5-15 degrees

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14
Q

What’s the normal foot angle?

A

10 degrees of ext. rotation

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15
Q

What’s planus foot? Cavus foot?

A

Flat feet; high arch

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16
Q

In lateral view, what structures should be in line with each other?

A
  • Ear lobe
  • Bodies of cervical vertebrae
  • Acromion process
  • Lumbar vertebrae
  • High point of iliac crest
  • Hip joint
  • Anterior knee joint
  • Anterior ankle joint
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17
Q

What’s the term for blood pooling outside blood vessel wall and not at the point of injury?

A

ecchymosis (bruising will track laterally if limb not elevated)

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18
Q

What’s normal inversion and eversion range of the subtalar joint?

A

5 degrees either way

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19
Q

What’s the end feel of inversion and eversion?

A

bony or tissue stretch

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20
Q

What might cause pain or limitation of range for inversion?

A
  • injury to the lateral structures being stretched
  • injury to the ATFL, calcaneofibular lig., joint capsule, peroneals, extensor digitorum mm or tendons
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21
Q

What might cause pain or limitation of range for eversion?

A
  • injury to medial structures being stretched
  • injury to deltoid ligament, tibialis anterior/posterior mm or tendons
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22
Q

What’s normal dorsiflexion and plantar flexion for the talocrural joint?

A

20 degrees dorsi; 50 degrees plantar

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23
Q

What’s the normal end feel for dorsiflexion and plantar flexion?

A

dorsiflexion - tissue stretch; plantar flexion - either bony or tissue stretch

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24
Q

What do the three talar tilts test?

A
  • ATFL
  • calcaneofibular ligament
  • deltiod ligament
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25
Q

How is the anterior drawer test conducted, what’s tested, and what’s a positive sign?

A
  • high seated or long seated with towel under the popliteal region
  • grasp calcaneus while stabilizing above ankle joint, distract the ankle slightly and draw foot anteriorly
  • primarily tests ATFL
  • positive sign is pain or excessive ROM
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26
Q

How is the wedge test conducted, what’s tested, and what’s a positive sign?

A
  • Tests integrity of inferior tibiofibular ligaments
  • Patient supine, foot in neutral, tap once on heel with base of my hand
  • Positive is pain in region of the ligs
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27
Q

How is Thompson test conducted, what’s tested, and what’s a positive sign?

A
  • tests for achilles tendon rupture
  • Prone, squeeze calf m
  • Positive is absence of plantar flexion
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28
Q

How is Homan’s sign test conducted, what’s tested, and what’s a positive sign??

A
  • tests for deep vein thrombosis
  • Consider doing this test if client reports any of the following s/s:
    • pain deep in calf or popliteal fossa
    • onset of pain after period of immobilization
    • constant aching, which worsens with activity such as walking or climbing stairs
    • pain appears after walking a certain distance then grows until they rest, at which point it dissapates
    • NB: this pain is not conclusive, but may reinforce suspicions
  • Prone, knee bent to 90 degrees, dorsiflex and slowly extend knee
  • positive is excruciating pain
  • squeeze calf after extending knee (provided client is not already experiencing pain)
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29
Q

How is the sqeeze test conducted, what’s tested, and what’s a positive sign?

A
  • tests for presence of a neuroma (tumor or new growth of nerve cells) between 3rd and 4th (and occasionally the 2nd and 3rd) MT heads; condition is commonly called Morton’s Neuroma
  • encircle both hands around MT heds and squeeze
  • positive is sharp pain between 3rd and 4th (or 2nd and 3rd) MTs
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30
Q

What are signs that Soleus, Quadriceps, or Gastrocnemius might be weak (just by visual queues)?

A
  • weak soleus usually results in knee flexion in standing position
  • hyperextension of knee might be soleus compensating for weak quads in standing position
  • weak gatrocs might result in knee hyperextension in standing position
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31
Q

What position should leg be in to test gastrocnemius and soleus?

A
  • extended for gastrocs
  • flexed for soleus (good idea to have pt in prone for this one so I can use my body weight, since soleus is so strong)
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32
Q

How are everters tested?

A

resist pt eversion

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33
Q

How are inverters tested?

A
  • Tib Ant: resist dorsiflexion and inversion (prime action is dorsiflexion)
  • Tib Post: resist plantar flexion and inversion (prime action is plantar flexion)

Remember there are also EDL and B, EHL and B, FDL and B, FHL and B

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34
Q

How is the deep tendon reflex (S1) tested?

A
  • High seated, leg dangling, put achilles tendon on slight stretch by passively dorsiflexing slightly
  • tap achilles tendon with flat end of reflex hammer
  • repeat 10 times
  • tests proprioception
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35
Q

When can site be palpated (except temperature)?

A

after rule outs, functional tests, special tests, mm tests, and neuro tests

36
Q

What’s the aka for Morton’s neuroma?

A

interdigital neuritis

37
Q

What’s the aka for bunion?

A

hallux valgus

38
Q

Do the menisci have a neural or vascular supply?

A

aneural; avascular except peripheral 1/3rd (so any pain in the area will be coronary ligs, not menisci themselves)

39
Q

What’s loose packed position for the knee?

A

around 25-30 degees of flexion

40
Q

What does recurvatum mean?

A

hyperextension

41
Q

Might I consider doing a joint effusion test before knee testing?

A

maybe: this can show whether subsequent testing causes, increases or decreases swelling

42
Q

When conducting hip ruleouts prior to knee testing, what needs to be tested?

A

just hip flexion (followed by overpressure) and internal rotation of hip (followed by overpressure)

43
Q

How is the superior tibiofibular joint ruled out prior to knee testing?

A
  • hook lying or high seated
  • passively glide superior tibiofibular joint anterior and posterior
  • if client has movement in ankle, the therapist can palpate superior tibiofibular joint for movement (sup/post with dorsiflexion, ant/inf with plantar flexion)

If neurological s/s were present, it would be wise to rule out lumbar spine

44
Q

At what point during testing should joint effusion tests be conducted?

A

before and after functional tests

45
Q

How is the brush/stroke/wipe test conducted, what’s tested, what’s positive, and what’s it testing for?

A
  • tests for minimal swelling (shows as little as a teaspoon of swelling if present)
  • stroke 2-3 times along medial aspect of patella from inferior to superior to sup-med (this pushing exudate proximally) follow up immediately with other hand and continue around lat patella to below joint line
  • any swelling will appear just medial and inf to patella
  • quickly moving swelling prob indicates synovial fluid, slower moving, probably blood and should be referred to GP
46
Q

How is the fluctuation test conducted, what’s tested, what’s positive, and what’s it testing for?

A
  • tests for moderate to significant swelling
  • place web space of one of my hands above patella and web space of other hand below, then alternately push down
  • note if synovial fluid is fluctuating from hand to hand
47
Q

How is the patellar tap test conducted, what’s tested, what’s positive, and what’s it testing for?

A
  • tests for moderate to gross swelling
  • apply pressure to the patella, pushihng it posteriorly
  • positive sign is noted when patella is felt to pass through swelling and then tap the fem condyles
48
Q

What’s the approximate normal range of knee flexion?

A

135 degrees

49
Q

What mm might cause limitation of range with knee flexion?

A
  • hamstrings
  • pes anserine
  • gastrocs
50
Q

What degree of overextension would be considered hyperextension?

A

negative 10-15 degrees

51
Q

what’s normal range of tibial rotation when doing knee tests?

A

10 degrees of rotation

52
Q

What’s the end feel for knee flexion?

A

tissue approximation

53
Q

What are the primary nerve roots supplying mm of knee flexion and internal/external rotation?

A

L5, S1/2

54
Q

What are the primary nerve roots supplying knee extension?

A

L2, 3, 4

55
Q

How is valgus stress tests conducted, what does it test, and what’s a positive?

A
  • knee is tested in resting position (25-30 degrees flexion) and full extension
  • apply valgus force just above knee while other hand applies counter-force to lower leg
  • knee extended, the posteromedial capsule and medial collateral lig are tested
  • knee slightly flexed, primarily anterior superficial fibres of medial collateral lig are tested (these fibres are tautest at 30 degrees and are commonly injured first)
  • Positive is increased joint opening and/or pain compared to unaffected leg
56
Q

How is varus stress tests conducted, what does it test, and what’s a positive?

A
  • knee extended lateral collateral lig, posterolateral capsule, and occasionally biceps femoris
  • knee slightly flexed, tests primarily lateral collateral lig and occasionally IT band
  • tested in resting position and full extension
  • apply varus stress just above knee and counter-force at distal leg sup to med malleolus
  • note any increased joint opening and/or pain compared with unaffected leg
57
Q

How is Apley’s distraction test conducted, what does it test, and what’s a positive sign?

A
  • prone, leg flexed to 90 degrees, grab just proximal to malleoli, distract joint (pull up) while internally and externally rotating
  • positive is pain in either ligament (doesn’t differentiate btwn ligs)
58
Q

How is the anterior drawer test conducted, what does it test, and what’s a positive sign?

A
  • tests integrity of ACL
  • first
    • do a sag sign: supine, lift leg and knee to 90/90 degrees, hold distal leg, check if tibia has sagged (damaged PCL might give false positive)
    • check hamstrings to see if they’re in spasm (might be false negative)
  • sit on patient’s foot, grasp around posterior aspect of proximal tibia, draw it forward in relation to femur
  • positive is pain and/or increased movement in comparison to unaffected leg
59
Q

How is the posterior drawer test conducted, what does it test, and what’s a positive sign?

A
  • tests integrity of PCL
  • sit on patient foot, push anterior aspect of proximal tibia, move it backward in relation to femur
  • positive is pain and/or increased movement in comparison to unaffected leg
60
Q

How is Lachman’s test conducted, what does it test, and what’s a positive sign?

A
  • tests integrity of ACL
  • can test for damage to lig even if pt is unable to flex knee, as test is done in resting position and prevents hamstrings from going into spasm
  • femur stabilized with one hand while opposite hand moves proximal aspect of tibia forward
  • positive is pain and/or increased movement or soft mushy end feel in comparison to unaffected leg
61
Q

How is McMurray’s meniscal test conducted, what does it test, and what’s a positive sign?

A
  • tests primarily the posterior horns of menisi
  • supine, grasp heel and rest plantar aspect of foot on my forearm
  • free hand grasps around knee with fingers on medial joint line and thumb on lateral joint line
  • fully flex knee, then internally and externally rotate tibia on femur (listen to the knee), then
    • extend knee while heel turned in and valgus applied (heel in push in)
    • extend knee while heel turned out and varus applied (heel out push out)
  • positive is pain and/or palpable or audible click
62
Q

Meniscal test: How’s Apley’s compression test conducted, what does it test, and what’s a positive sign?

A
  • prone, leg flexed to 90 degrees
  • grasp heel and push down, compressing joint while interally and externally rotating lower leg
  • positive is pain and possibly a click
  • tests both menisci simultaneously, though pt may report more pain on one side than the other
63
Q

Meniscal test: How is the bounce home test conducted, what does it test, and what’s a positive sign?

A
  • supine, take heel in palm of my hand
  • flex knee and let it passively extend
  • positive is when kneee stops short and rubber resistance felt
64
Q

What are the knee tests for the lateral and medial collateral ligaments?

A
  • valgus and varus stress tests
  • apley’s distraction test
65
Q

What are the knee tests for the anterior and posterior cruciate ligaments?

A
  • anterior and posterior drawer tests
  • sag sign
  • lachman’s test
66
Q

What are the meniscal tests?

A
  • McMurray’s meniscal test
  • Apley’s compression test
  • Bounce home test
67
Q

What are the patellar tests?

A
  • patella femoral grinding test (clark’s sign)
  • patella femoral compression test
  • Patellar apprehension sign/test
  • Noble compression test
68
Q

How is patella femoral grinding (Clark’s sign) test conducted, what does it test, and what’s a positive sign?

A
  • tests for chondromalacia patellae (softness of the articular cartilage)
  • will generally cause pain even if no s/s (don’t do it unless necessary for CMTO exams)
  • push patella distally and trap upper pole with web space btwn thumb and finger, have pt contract quads
  • positive is pain and/or palpable crepitus
69
Q

How is patellar femoral compression test conducted, what does it test, and what’s a positive sign?

A
  • tests for patellofemoral pain syndrome by testing quality of articular cartilage btwn posterior aspect of patella and femoral condyles
  • pt high seated, knee fully extended, therapist pushes patella posteriorly against femoral condyles
  • repeat at 30, 60, 90 degrees of flexion
  • positive is pain
  • can also be done with pt contracting quads first
70
Q

How is patellar apprehension sign/test conducted, what does it test, and what’s a positive sign?

A
  • tests for patella dislocation/subluxation
  • supine, knee flexed to 30 degrees, therapist slowly and carefully pushes the patella laterally
  • positive is client showing signs of apprehension and/or contracting quads to bring patella back into alignment
71
Q

How are mm tests for flexion performed?

A
  • hamstrings: prone with knee flexed 50-70 degrees, stabilize thigh on table, apply resistance in direction of knee extension
  • semimembranosus and semitendinosus: as above, but position thigh and leg in slight medial rotation
  • biceps femoris: as above, position thigh and leg in slight lateral rotation
72
Q

How are mm tests for knee extension performed?

A
  • quadriceps: high sitting with knee almost fully extended, pressure applied in direction of knee flexion
  • if pt leans backward, suggests attempt to extend hip and max action of rec fem
73
Q

How is Popliteus activity (as opposed to strength) tested for internal rotation?

A
  • high sitting, have them actively internally rotate leg starting from position of external rotation
74
Q

What’s closed packed/loose packed positions of hip?

A
  • closed packed: maximum extension, medial rotation, abduction
  • loose packed: 30 degrees of flexion and abduction with slight lateral rotation
75
Q

How is ober’s test performed and what’s it testing for?

A
  • pt on side not being tested
  • therapist abducts upper leg as far as possible and extends, then drops (while stabilizing pelvis at iliac fossa)
  • positive would be leg staying above table height
  • tests TFL and IT band
76
Q

How’s Piriformis test conducted?

A
  • side lying, upper hip and knee flexed to 90 degrees
  • therapist places one hand on pelvis for stability while other pushes knee toward floor
  • positive: pain felt in buttock or may also radiate down leg if sciatic nerve is being impinged
77
Q

How is Trendelenburg test conducted?

A
  • tests strength and/or innnervation of hip abductors (secifically gute med L5 of the stance leg)
  • ask px to stand on one foot
  • positive is opposite hip dropping (perform opposite side first so pt understands what to do)
78
Q

How is Patrick’s/Faber test conducted?

A
  • supine, leg being tested is flexed and foot placed on knee of opposite leg in fig 4 pos (avoid malleolus being directly on patella)
  • leg being tested is then abducted toward table and allowed to relax
  • primarily tests flexibility of adductors
  • if pain is felt in inguinal region, may be hip joint pathology
  • sacroiliac joint may also have pain/be affected
  • Faber = F Ab ER = Flexion, abduction, external rotation
79
Q

How is the scouring (aka quadrant) test performed?

A
  • tests articular surfaces of head of femur and acetabulum
  • supine, hip and knee flexed, hip adducted (so knee is pointing to opposite shoulder)
  • therapist maintains longitudinal force down femur while abducting and laterally rotating femur (tests outer aspect of hip jt)
  • therapist maintains longitudinal force down femur while adducting and interally rotating femur (tests inner aspect of hip jt)
80
Q

How’s Ely’s test performed?

A
  • prone, therapist passively flexes knee and notes when buttock starts to rise (should be possible to flex 90 degrees before buttock starts to rise)
  • indicates injury to, contracture of, or just tight rec fem (watch closely in first 30 degrees of knee flexion)
81
Q

How is Pelvic rocking/squish test performed?

A
  • client supine, place my hands over ASIS on both sides, my elbows slightly bent so my forearms are at 45 degree angles, rock client back and forth
  • positive is pain at SI joint
  • tests posterior sacroiliac ligs
  • an immediate translation of pressure on one ASIS into the other implies the ASIS being pressured is locked
82
Q

How is Pelvic Gapping (aka anterior transverse stress) test performed?

A
  • supine, therapist crosses arms and places hands over client’s ASISs and applies pressure down and out so ASISs move apart
  • positive is pain
  • tests primarily anterior SI ligs
83
Q

How is Pelvic Compression/Approximation test done?

A
  • sidelying, therapist places hands over iliac crest and pushes toward table in order to increase pressure in SI joint
  • may indicate SI lesion
  • only needs to be done on one side because both SIs are being tested at same time
84
Q

How is Gaenslen’s sign (S-I joint dysfuntion) conducted?

A
  • supine at edge of table, both knees flexed to chest, outer leg allowed to drop over edge of table while inner knee is kept to chest
  • forces ipsilateral innominate to anteriorly rotate (sagittal plane) while contralateral SI joint is stabilized by flexed hip
  • positive is pain
  • indicates SI joint dysfunction
85
Q

How is the situp test conducted?

A
  • supine, legs flex 90 degrees
  • have client lift buttocks of table and drop (to relax)
  • note malleoli to see if either leg appears longer
  • client does situp – watch malleoli to see if either leg appears to get longer/shorter
  • starts short and finished long = posterior sagittal rotation
  • starts long and finishes short = anterior sagittal rotation
86
Q

How is the leg length measurement: anatomic vs functional conducted?

A
  • supine
  • measure from medial malleolus to ASIS of each leg, difference in measurement indicates true length discrepancy
  • if no true length discrepency, measure from medial malleolus to umbilicus, difference in measurement indicates and APPARENT (functional) leg length discrepency (may be cause by pelvic obliquity
  • next position client in hook lying and observe relative height of knees to see if the true discrepency is coming from a shorter tibia (knee will be lower); also observe laterally to see if one knee extends past other indicating longer femur
  • mesaure tibia from medial knee joint line to medial malleolus; measure femur from greater trochanter to lateral knee joint line
  • ultimately best way to measure true length discrepancies is by measuring X-rays
  • Magee suggests true discrepancies of up to 1.5cm can be considered normal
87
Q

What neurology is being tested with shoulder abduction?

A
  • C5
  • Axillary nerve

T2 Clinical Assessment (1 decks)

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