Clinical Reasoning

Question 1

What is Clinical Reasoning?

Answer 1

Systematic approach to diagnosing MSK pathologies.
Analyzing and interpreting info received from subjective and objective assessments.

Question 2

Subjective Assessment (5)

Answer 2

Interview. To form hypothesis (3-4)
1. History of presenting condition
2. Pain location and type / irritability
3. Aggravating/easing factors / 24h symptoms.
4. Special questions/red flags/yellow flags.
5. Social/Past medical history

Question 3

Objective Assessment (5)

Answer 3

To test hypothesis.
1. Observation
2. Functional tests (squat, jump, run…)
3. Active/Passive ROM
4. Muscle strength/length / Palpation
5. Special Tests

Question 4

Subjective Assessment - History of Presenting Condition (3)

Answer 4

What happened? Mechanism of injury.
Sudden/gradual onset?
For how long? (phase of healing)

Question 5

Subjective Assessment - Pain location and type / irritability (6)

Answer 5

Differentiate between mechanical, neurogenic and inflammatory pain.
Type of pain? (Deep, dull, sharp, throbbing?)
Pain rating (NRS, VAS)
Constant(red flag) or intermittent? changed since the injury?
What movement causes pain?
How long does it take for pain to settle?

Question 6

Subjective Assessment - Aggravating/Easing factors / 24h symptoms (4)

Answer 6

What makes the pain/problem worse?
What makes it better? (rest, lie down)
Does pain change from morning to evening? stiffness?
Wake up from pain at night? that is not relieved by a change in position.

Question 7

Subjective Assessment - Special Questions / Red Flags / Yellow Flags (7)

Answer 7

Neurological signs: pins, needles, numbness, change in sensation.
VBI: dizziness, nystagmus, drop-attacks, trouble speaking/understanding.
SC compression: clumsiness when walking, bilateral pins/needles in hands or feet at the same time.
Cauda equina: Change in bowel/bladder function. Saddle anesthesia.
General health. Medication?
Unexpected weight loss?
Locking, clicking, catching, giving way? (instability)

Question 8

Subjective Assessment - Social / Past medical history (6)

Answer 8

Work? lifting/manual labor.
Hobbies or sports you play?
Personal/domestic activities you can’t perform?
Have you injured are before?
Previous surgery/treatment.
Illness or chronic condition?