Clinical Assessment Introduction Flashcards
Find the Cause - Then treat the cause
____ : A physical & emotional response to tissue irritation, derangement, damage, or tissue death?
Pain
What is the most common symptom for which patients seek care?
Pain
What is Pain?
a) An unpleasant sensation associated with actual or potential tissue damage
b) Mediated by specific nerve fibres to the brain
c) Conscious appreciation may be modified by various factors
d) All of the above
e) A & C
D) all of the above
What is inflammatory pain?
a) Pain results from the stretch or compression of pain sensitive structures
b) Pain results from the release of chemical irritants of inflammation
c) Pain as a result of swelling/edema that compresses nociceptors
d) A & C
e) B & C
E) B&C
What is Mechanical pain?
a) Pain results from the stretch or compression of pain sensitive structures
b) Pain results from the release of chemical irritants of inflammation
c) Structures that contain nociceptors, when stimulated produce painful sensations
d) A&C
e) All of the above
D) A&C
T/F: Acute pain is pain provoked by noxious stimulation produced by injury/disease
True
T/F: Chronic pain is pain that persists beyond the usual course of healing
True
Chronic pain Syndrome
a) involves functional limitations and often times depression
b) is a clinical syndrome in which clients present with high levels of pain that is chronic in duration
c) All of the above
d) B
c) all of the above
T/F: Neurogenic pain is pain as a result of non-inflammatory dysfunction of the peripheral or central nervous system that involves nociceptor stimulation or trauma
False: It DOES NOT involve nociceptor stimulation or trauma
____ : Pain that is felt at another location of the body that is distant from the tissues that have caused it
Referred pain
Radiculopathy
a) known as radicular or nerve root pain
b) involves spinal nerve or spinal nn root
c) pain that is felt in a dermatome, myotome, or sclerotome
d) A&C
e) All of the above
e)all of the above
T/F: A dermatome is an area of skin supplied by one dorsal nerve root
True. Injury can cause sensory alteration to the skin, or pain (usually burning or electric)
What is myotomal pain?
Group of muscles supplied by one nerve root
What is sclerotomal pain?
Area of bone or fascia innervated by a nerve root
T/F: Pain can be felt in a dermatome as a result of visceral injury
True
T/F: Untreated TrPs can be associated w/ pain syndromes that include but not limited to: Radiculopathy, tension headaches, frozen shoulder, tennis elbow ..
True
As a lesion worsens, the area of pain enlarges and moves distally from the original lesion. This concept is referred to as _____
Peripheralization
If pain is resolving, the area decreases and becomes localized, this is called ______
Centralization
If Onset of pain is immediate, it is an indication of
a) Gradual or insidious onset
b) Traumatic/more serious injury
c) Repetitive strain injury
B) Traumatic injury
Frequency & Duration of Pain Q 20 - 26
Pain all the time indicates
a severe injury or an active inflammatory state
Pain when repeating the mechanism suggests
Local lesion, Ligament or muscular
Ligament cause pain when
Stretched
Muscles cause pain when
Contracted
Pain in the morning …
Caused by adaptive shortening (Plantar Fasciitis)
If accompanied by stiffness may indicate intracapsular swelling that builds overnight d/t inactivity (common w/ arthritis)
Pain at end of day…
Suggests inflammation d/t overuse (excessive stress on structures through the day)
Postural strain or TrPs d/t muscle fatigue
Pain when weight bearing..
Pain only w/ weight bearing suggests articular (joint surface) or muscular injury
Quality of Pain Q 27 - 37
Sharp pain…
Strain
Superficial ligament (MCL/LCL)
Acute inflammation
Radicular pain
Dull ache
Joints Deep muscles (Glute med) Chronic mm strain Chronic inflammation Deep or peripheral nerve TrPs or Referred pain
Tingling or Parasthesia
Nerve injury
Circulatory problems
Numbness
Damage or impingement of a nerve innervating a particular area
Twinge
Injury to local muscle or ligament
Noises/sensations
Clicking/snapping
Clicking/snapping: tendon flipping over a bone, thickened bursa, meniscal tear
Noises/sensations
Grating
Caused by osteoarthritic changes to a jt
Sound of tearing
Indicates muscle or ligament tear
Locking or catching
Loose body within joint
Giving way or instability
commonly caused by severe jt damage
Popping can be caused by
Negative pressure within a tendon synovial sheath, tendon flipping over bony prominence, rupture of ligament or tendon
Name the 4 Ts when palpating
Texture
Tone
Tenderness
Temperature
T/F: Active Free movement differentiate b/w contractile or insert tissue
False
Six End Feels Q 40 - 46
- Tissue Approximation
Mushy Feel - Normal end feel
- Bone to Bone
Elbow extension
Normal or abnormal (if occurs before normal end range)
- Tissue Stretch
Hard or firm(springy) type of mov't w/ slight give occur toward end ROM Elastic resistance/springy Providing resistance to movement Most common type of normal end feel
- Muscle Spasm
Sudden dramatic arrest of movt, often accompanied by pain
“sudden and hard”
result of protective reflex to prevent further mov’t /injury
Abnormal end feel
- Capsular
Thicker feeling to it
ROM is obviously reduced
Capsule is at fault
normal/abnormal end feel
- Springy
Abnormal end feel
loose body within jt
- Empty end feel
No end feel
abnormal end feel
client stops mov’t before end range is felt d/t intensity of pain
Findings w/ resisted testing
Strong and Painless
Normal
No lesion or neurological deficit in the muscle or tendon
Strong & Painful
1st or 2nd degree muscle strain
A minor lesion of the musculotendinous unit
Weak and Painless
Complete rupture of muscle or tendon
Myotome issue
full tear of nerve, pain d/t swelling
Weak and Painful
Partial rupture of muscle or tendon
Strain
Muscle testing scale
No contraction
0
Normal - Overcomes maximal resistance
5
Slight contraction - muscle tightens but no mov’t produced
1
Able to produce mov’t w/ gravity eliminated
2
Able to overcome some resistance
4
Able to overcome gravity but not resistance
3
Localized, subconscious muscle contractions that do not involve the whole muscle; result from the contraction of the muscle cells innvervated by a single motor axon
Fasciculations
Rhytmic mov’ts of a jt result from involuntary contractions of agonist and antagonist muscle groups
Tremors
Vibraton associated w/ roughened gliding surfaces of a tendon, tendon sheath, articulating surface
Crepitus ; often inaudible in addition to being palpable
What are the 3 barriers of resistance?
- Physiological barrier: midrange is the range w/ least amount of resistance
- Elastic barrier : felt at end range + beyond, when tissue is engaged at end of passive rom
- Anatomical barrier: final resistance to normal range anymore will cause injury
