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DPT 730/1: MSK > E1-MSK Exam/Eval > Flashcards

E1-MSK Exam/Eval Flashcards

1
Q

what is the process of taking a proper hx

A

open ended questions initially for a narrative
narrow to more specific questions
no leading questions

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2
Q

what are the key components of a hx

A

symptoms and behavior
onset/prior to injury
symptom impact/function
imaging and diagnostic tests
patient prospective
past medical hx/meds
S&S of severe MSK or non-MSK conditions (RED FLAGS)

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3
Q

what are key questions for symptoms and behavior

A

location
duration
changes
irritability
type

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4
Q

why is knowing the duration of the symptoms imporatant

A

can help with stages of tissue healing
not all tissues are in a stage of healing

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5
Q

why are not all tissues in a stage of healing

A

there may not be real damage to the tissue, it may just be irritated or inflamed

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6
Q

what are the questions needed to be asked when asking about the changes in symptoms

A

intensity (set boundary)
frequency
location
improving, worsening, or stay the same

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7
Q

when asking about the irritability of a symptom, what are we looking for

A

aggravating or easing factors
mechanical or non-mechanical
immediate or delayed symptoms upon activity

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8
Q

how can we differentiate types of symptoms

A

questionnaires
may indicate tissue involved or the condition of tissues

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9
Q

paresthesias may indicate

A

spinal nerve or nerve root

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10
Q

numbness may indicated

A

peripheral n

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11
Q

deep ache may indicate

A

joint pain

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12
Q

sharp pain may indicate

A

inflammation

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13
Q

why is onset questions important to discuss

A

timing- whether gradual or traumatic
circumstances and severity

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14
Q

T/F: imaging tests should be used in isolation

A

false

they should be compared with clinical findings.

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15
Q

should a patient with high sensitivity have imaging done

A

yes, it is better at ruling out

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16
Q

should a patient with low specificity have imaging done

A

no, not as good at ruling in

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17
Q

why is it so important to have the patients perspective and goals

A

+/- toward their condition and PT
does it match with their condition

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18
Q

what information is important in past medical hx

A

personal, immediate family, and allergies
influence on present condition
influence on prognosis

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19
Q

what topics need to be questioned on social hx

A

smoking
alcohol
drugs
with type, frequency, and duration

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20
Q

what is a suspicious MSK S&S red flag

A

neck splinting with lack of side bending could indicate a dens fracture after trauma

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21
Q

what is a suspicious Non-MSK S&S red flag

A

chest and shoulder pain only on exertion could indicate cardiovascular issue

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22
Q

when does observation start

A

from the moment you are introduced to the patient

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23
Q

what does observation consist of

A

conversation- slurred speech, hoarseness
structural- body type, skin markings, posture, orthotics, etc
functional
guarding
facial grimaces
mental

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24
Q

what is a rigid body type

A

flatter spine with tighter hips and genu and calcaneal varus
more propulsive

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25
Q

what is a flexible body type

A

excessive spinal curves with hypermobile hips and genu and calcaneal valgus
more absorbing

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26
Q

can the body have normal dominance asymmetries, if so, what are they

A

yes
ipsilateral shoulder depression, more hyperextended knee, and flatter foot

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27
Q

what are the parts to tests and measures

A

scans- general assessment
biomechanical exam- greater detailed assessment from scan findings

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28
Q

what are the purpose of scans

A

further assessing red flag S&S
neurological status
determine if symptoms are referred or radicular
severity of condition
identify need for more in-depth biomechanical exam

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29
Q

what are the certain situations you will do a scan

A

w/o recent trauma start with a spinal scan, ESPECIALLY with past hx of spinal P!, then cont to extremity
with recent trauma start with involved area then surrounding
always check neuro status

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30
Q

what is a selective tissue tension test

A

A/PROM with overpressure
combined motions
resisted testing
discerning contractile from non-contractile tissue intergrity

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31
Q

what is WNL

A

within normal limits= full, pain free, coordinated, smooth movements

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32
Q

if ROM is limited and painful in multiple planes, what is indicated

A

more severe injury

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33
Q

if ROM is aberrant, what is indicated

A

joint hypermobility/instability

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34
Q

if ROM has sharp curves or fulcrums, what is indicated for the joint

A

joint hypomobility

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35
Q

if ROM is lacking, but it is not a mechanical restriction or joint hypomobility, what is indicated and how can we fix it

A

misalignment—- manipulation plus stability exercises

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36
Q

what are essential ADLs

A

walking
squatting
reaching
bending
turning

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37
Q

what are higher level ADLs

A

jumping
throwing
lifting
running

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38
Q

what can an AROM test indicate

A

willingness to move
unwillingness to move or splint= red flag
may be deferred if too limited
uniplanar motions
might also assess response to repitions

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39
Q

if improved pain and function is found in repetitive AROM test, what is possible

A

inhibited muscle
regional interdependence or disc injury

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40
Q

if worse pain and function is found in repetitive AROM test, what is possible

A

acute injury

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41
Q

if pain occurs in the same direction of AROM and PROM, what is indicated

A

non contractile tissue is the problem

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42
Q

if PROM is similarly restricted as AROM in the same plane, what is indicated

A

joint hypomobility or protective guarding

what is the end feel like?

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43
Q

if PROM is significantly greater than AROM in the same direction, what is indicated for the joint

A

joint hypermobility/instability

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44
Q

Pt was tested in WB and NWB motions and was found to be limited. What is the likely cause and general Rx

A

fused, fixated or hypomobile joint
improve joint mobility

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45
Q

Pt was tested in WB and NWB motions, WB was limited but NWB was WNL. What is the likely cause and general Rx

A

joint hypermobility/instability paired with impaired neuromuscular control
improve neuromuscular control

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46
Q

what characteristics describe capsular restriction

A

loss of motion due to capsular restrictions= firm end feels
varies among joints

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47
Q

what causes a firm end feel in capsular restriction

A

arthritis, adhesions, prolong disuse/immobilizations

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48
Q

why use combined motion if uniplanar motion is inneffective

A

applies greater stress and challenges on the joint

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49
Q

a Pt has a consistent block when performing combined motion, what does this mean

A

differing paths to the same point indicates hypomobility
follow up with accessory motions

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50
Q

a Pt has an inconsistent block when performing combined motions, what does this indicate

A

hypermobility/instability
follow up with stability tests

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51
Q

how long should you hold resisted testing

A

3 secs

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52
Q

what does resisted testing indicate

A

general integrity of contractile tissue and severity of condition

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53
Q

if resisted testing results come back painful but strong, what is indicated

A

mild injury
only painful in lengthened range

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54
Q

if resisted testing results are painful and weak, what is indicated

A

acute
moderate to severe injury

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55
Q

if resisted testing results are painless but weak, what is indicated

A

neurological damage or chronic contractile rupture

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56
Q

if the same pain is produced in one direction of AROM and/or resisted testing and is opposite direction of PROM, what tissue would cause the problem

A

contractile tissue

57
Q

if symptoms are reproduced upon release during resisted testing, what is the problem

A

non contractile tissue as glide is released when muscle relaxes

58
Q

if one joint is weak at multiple planes during resisted testing, what is the problem

A

possible acute or severe injury

59
Q

if multiple joints are weak during resisted testing, what is indicated

A

possible CNS issues

60
Q

if there is weakness throughout a range and not just midrange during resisted testing, what might be the issue

A

possible pathology

61
Q

if improved pain and function is found in resisted testing, what is possible

A

inhibited muscle
regional interdependence

62
Q

if decreased force is found with repetitive resisted testing, what is possible

A

n palsy

63
Q

if consistent weak force is found with repetitive resisted testing, what is possible

A

deconditioned/torn muscle

64
Q

if pain and function are worse with repetitive resisted testing, what is possible

A

acute condition

65
Q

what is a stress test testing

A

non contractile tissue: location of P! and severity

66
Q

how do you perform a stress test

A

apply a rapid but shallow force

67
Q

If P! happens in a stress test, what is indicated

A

acute conidtion

68
Q

if no P! happens in a stress test, what is the next step

A

apply a slower, larger, and deeper force and hold for 10 secs

69
Q

if a 10 sec hold causes pain in a stress test, what condition is indicated

A

hypermobility/instability

70
Q

what are the symptoms of joint hypermobility/instability when doing a stress test

A

late, empty/soft end feels
click, clunk/spasm

71
Q

Pt has increased pain with the distraction stress test, what tissue is possibly damaged

A

capsule, ligament, annulus

72
Q

Pt has decreased pain with distraction stress testing, what tissue might be the issue

A

cartilage, disc, bone, spinal n

73
Q

are both compression and distraction stress test indications the same

A

no, they are opposites
if the capsule is the issue, distraction would tighten the injured tissue making it more painful, whereas compression puts the tissue on slack decreasing the pain

74
Q

Pt describes increased pain with compression stress test, what tissue is the problem

A

cartilage, disc, bone, spinal n

75
Q

Pt describes a decrease in pain with compression stress test, what tissue is the issue

A

capsule, ligament, annulus

76
Q

if both distraction and compression stress testing produce pain, what is indicated

A

acute condition

77
Q

how do you perform a sensory test

A

assess light touch without moving the skin
light touch is lost first
check sharp with pinprick

78
Q

what happens next if sensation is diminished in a sensory test

A

repeat to find if it is either a spinal n or peripheral n

79
Q

if both light and sharp touch are WNL in the presence of paresthesia, what should happen next

A

use a pinwheel to check for hyperesthesia due to nociplastic pain

80
Q

what proceeds if the pt has lost fine touch in sensory testing

A

check vibration
2 pt. discrimination
proprioception for possible dorsal column issue

81
Q

what proceeds if the pt has lost sharp touch in sensory testing

A

check temperature and crude touch for possible spinothalamic tract issue

82
Q

what is the scale for sensory testing

A

0= absent
1= diminished
2= WNL
3= hyperesthesia

83
Q

what is DTR or myotatic reflex

A

loop from muscle spindle afferents to ventral horn efferents

84
Q

how do you perform a DTR

A

brisk tap 3 times

85
Q

how would you distract a pt to successful perform a DTR

A

jendrassik maneuver or teeth clinching

86
Q

what is the scale for DTR

A

0= absent
1+= hyporeflexive
2+= WNL
3+= hyperreflexive
4+= clonus

87
Q

what does 1+ mean on the DTR scale

A

hyporeflexive- LMN condition

88
Q

what does 3+ mean on the DTR scale

A

hyperreflexive- large arc with normal dampening; UMN condition or nociplastic pain

89
Q

what does 4+ mean on the DTR scale

A

clonus- >3 beats when dampening; UMN condition

90
Q

what is pathological reflexes

A

assess for normal reflexive suppression by UMN system

91
Q

what are abnormal findings of pathological reflexes

A

release of primitive reflex indicating UMN impairment

92
Q

how do you perform a pathological reflex test

A

hoffman or babinski
3x

93
Q

what is myotome testing

A

key m or group of mm innervated by a single spinal n

94
Q

what are we looking for when testing myotomes

A

fatiguing weakness during a 10 sec hold

95
Q

what is dural mobility

A

sequential/progressive assessment of neural mechanosensitivity

96
Q

what is tension restriction

A

inelasticity
pain or symptoms increases from both ends

97
Q

what is gliding restrictions

A

adhesions
pain or symptoms increase from one end and relieved from the other

98
Q

what might inelasticity or inflammation of a nerve produce

A

reproduction of achy or sharp symptoms or paresthesia

99
Q

what indicates the need to perform an accessory motion test

A

limited ROM and/or consistent block in combined motions

100
Q

is accessory motion testing better at picking up on hypo or hypermobility and why

A

hypo

it is much easier to compare the affected side to the unaffected side, so it is easier to see if the affected side has limited range

101
Q

what is PPM in accessory motion

A

passive physiological mobility
assessing glides with extremity osteokinematics

102
Q

what is PAM in accessory motion

A

passive accessory mobility
assessing glides without osteokinematics
more common in extremities

103
Q

what is PPIVM in accessory motion

A

passive physiologic intervertebral mobility
assessing glides with spinal osteokinematics
more commonly performed in spine

104
Q

what is PPAIVM in accessory motion

A

passive physiologic accessory intervertebral mobility
assessing glides without osteokinematics

105
Q

in the accessory motion scale, what would a 0 grade mean

A

fused joint- no accessory motion
fibrosed capsule or bony bridge

106
Q

in the accessory motion scale, what would the grade 1-2 mean

A

joint hypomobility
joint fixation, articular, capsule/ligamentous shortening

107
Q

in the accessory motion scale, what would the grade 4-5 mean

A

joint hypermobility
capsule/ligamentous laxity, local muscle insufficiency

108
Q

in the accessory motion scale, what would the grade 6 mean

A

pathologically unstable joint
tissue rupture, unable to stabilize with neuromuscular function

109
Q

if a joint has reduced accessory motion, what is indicated

A

hypomobility

110
Q

if a joint has increased accessory motion, what is indicated

A

hypermobility/instability

111
Q

if the accessory motion and ROM is limited, what is the restriction

A

articular- capsular shortening or cartilage

112
Q

if the accessory motion is WNL but ROM is limited, what is the restriction

A

extraarticular- muscular shortening, guarding, hypermobility

113
Q

what does abnormalities of accessory motion mean

A

indicates improper axis of joint motion and puts excessive stress on adjacent tissue (noncontractile)

114
Q

what is a normal axis of motion

A

should never be on articular surfaces
should always be changing due to gliding and rolling

115
Q

what is an abnormal axis of motion

A

indicates excessive compression and friction forces with limited gliding

116
Q

what are the consequences of abnormal axis of motion

A

decrease in synovial fluid leads to degenerating noncontractile tissue of the joint

117
Q

what can special tests help indicate

A

identify more specific tissue
the integrity
assess progress

118
Q

what is a provocative test

A

identify tissues by the reproduction of symptoms during the test

119
Q

what info is given from stability tests

A

integrity of noncontractile tissues
provocation
laxity with late, soft, or empty end feels
segmental play

120
Q

what is segmental play

A

assessing for excessive linear shearing of vertebra

121
Q

what is the indication to perform a stability test

A

excessive ROM or inconsistent block in combined motions

122
Q

what do you do if no symptoms are reproduced in a stability test

A

hold for 10 secs like stress test

123
Q

if a pt reports pain and /or laxity during a stability test, what happens next

A

retest with m activation, correct posture, closed packed position or external support

124
Q

after retesting a pt for a stability test, they report improved pain and/or laxity, what does this indicate

A

confirmation of a hypermobile joint with instability and a better prognosis

125
Q

what is a muscle length test

A

a special test testing the passive flexibility of muscles

126
Q

what is an anthropometric test

A

a special test testing body dimensions with a tape measure

127
Q

what is MMT and how do you perform it

A

attempting specific m testing and grading
midrange muscle test

128
Q

what does a fully lengthened muscle correlate to in strength testing

A

passive insufficiency
tightens inert component of muscle
tests for muscle tears with minimal force

129
Q

what does a midrange lengthened muscle correlate to in strength testing

A

muscle in strongest position
full strength power

130
Q

what does a fully shortened muscle correlate to in strength testing

A

muscle in weakest point
used to detect palsies, especially an eccentric contraction

131
Q

why hold a MMT for 3 secs and what are we looking for

A

better assess neuromuscular adaptation capacity and not maximal strength
smooth, exponential increase to linear force

132
Q

what are the cons to MMT

A

not good at finding smaller deficits
not reliable or valid
subjective to scoring
overestimate strength
can not predict function
very objective

133
Q

what are the differences between resisted testing and MMT

A

resisted testing is testing a group of muscle where as MMT is testing a specific muscle for function

134
Q

what can we assess with palpation

A

temperature
turgor and possible pain
swelling
muscle function
hypertonicity of a msucle

135
Q

what might be indicated by the presence of a red flag

A

a severe condition that is not appropriate for physical therapy

136
Q

how is an end feel described

A

PROM with overpressure

137
Q

A patient presents directly to an outpatient physical therapy clinic without seeing a physician and with a gradual onset of multiple segment weaknesses and multiple segments with decreased sensation. What should be your next action?

A

refer pt to physician

These findings indicate an upper motor neuron lesion (brain/spinal cord), is inappropriate for out-patient physical therapy and should be referred for differential diagnosis.

138
Q

if statistics are high, indicates a special test is better at ruling in a condition if the test is positive?

A

specificity

DPT 730/1: MSK (11 decks)

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