CLINICAL REASONING

Question 1

Clinical reasoning definition & ≠ parts

Answer 1

= systematic approach to diagnosing musculoskeletal patho

• subjective assessment, objective assessment & diagnosis

Question 2

Subjective assessment: characteristics & composition

Answer 2

Question: first open & when begin understand: more specific

History of presenting condition, pain location, irritability, aggravating factors, easing factors, 24h symptoms, special question, red & yellow flags, social history & past medical history

Question 3

Subjective assessment: fct of end & characteristics

Answer 3

=> integrating info

• prioritize 3-4 diagnosis
• decide on format of objective assessment
• use objective assessment to complement subjective assessment & diagnosed condition

Question 4

History of presenting condition: def

Answer 4

Understand context of condition
- mechanism of injury
- Acute or chronic
- duration…

Question 5

Pain location: def

Answer 5

Pain or not?
Understand if it’s mechanical, neurogenic of inflammatory

Question 6

Irritability: def

Answer 6

Understanding about how easily symptoms exacerbated

• mvt cause pain?
• intensity of pain

Question 7

Aggravating factors

Answer 7

Understand what activities or mvts cause pain or discomfort

• pain or pb worse

Question 8

Easing factors

Answer 8

Understand activities, mvts, positions, medications & give patient relief

• what makes pain better

Ask question to try & understand if resting or activities make patient feel better

Question 9

24h symptoms

Answer 9

Understand pb & pain changes from morning to afternoon

Question 10

Red flags

Answer 10

Night pain:
- from changing position => not red flag

Neurological signs:
- Understand not only severity of condition but need to refer patient to doctor or consider alternative treatment

Spinal cord compression:
- clumsiness when walking
- pins & needles in both hands at same time

Cauda equina:
- change in bowel & bladder function
- numbness between legs

Question 11

Special questions

Answer 11

Depend on region of body to guide objective assessment
Help to identify non musculoskeletal sources of pain

• medication?
• weight loss?
• recent imaging?
• locking, clicking, catching?
• instability?
• Cauda equina & spinal cord compression questions
• VBI question

Question 12

Social history

Answer 12

Understand how injury affect patient’s life

• work ?
• hobbies?
• personal & domestic activities?

Question 13

Past medical history

Answer 13

Understand if patient had injury before or other injuries

• previous injury
• previous surgery
• illness or chronic conditions

Question 14

Objective assessment: ≠ parts

Answer 14

Observation
Functional tests
Active & passive ROM
Muscle strength / muscle length / palpation
Special tests