EEI 10/14a MSK Examination Flashcards
Importance of diagnosis and PT
It provides communication between PT and physician and insurance
Medical world differential diagnosis
- pathoanatomic Dx - ballpark > helps us inform prognosis
- anatomically based
- pathologically based
- can be non-musculoskeletal as well
PT world differential diagnosis
- movement diagnosis
- impairment based
- impairment drives Rx (prescription)
- based on the assumption that impairments relate to limitations in functional activity and participation
- non musculoskeletal: decreased endurance; generalized weakness
what drives PT treatment
- Dx/Pathology
- Impairment
- ICF
- Movement System
- Cyriax
- Maitland
Diagnosis/pathology vs Impairment
Diagnosis = one pathology
-impairment varies within the pathology
for example, you could have 100 people who have strokes, but not all of them would have the same symptoms/impairments
ICF model that drives PT treatment
Impairments are related to activity, but the correlation is NOT near 1, it’s a huge assumption to think that an impairment would be directly related to their activity limitation
ICF Model break down for PT treatment with impairments
- Health Condition: Diabetic neuropathy
- Body Structure/Function Impairment: Neuropathy in the legs yielding balance impairment
- Activity Limitation: trouble walking/going up stairs
- Participation Restriction: difficulty driving (more integrated in community/some social role)
- Environmental Factor: location of their house/needing a car
- Personal Factor: Motivation
Movement system model that drives PT treatment
- Impairments lie within Motion, Force, Motor Control, and Energy
- Movement task is analyzed as either normal or abnormal based on CASSS
- Hypothesis about impairment is made
- Specific tests and measures are determined
- Evaluation and movement diagnosis is completed
- Interventions
- Qualitative observation targets are defined
Cyriax approach to examination
- Orthopedic medicine = nonsurgical orthopedic specialist
- Diagnosis is by selective tension
- reproduce CC Sx (symptoms) by applying tension to find which tissue has the lesion
comparable sign
Maitland (a follower of Cyriax)
- reproduce the patient’s CC with a movement, position, or test (on exam findings***)
- record as a measure of progression for the patient
Cyriax approach to examination with musculoskeletal tissues
- all are capable of producing pain by themselves
1. Contractile: directly responsible for producing movement (muscle, tendon, tenoperiosteal jct)
2. inert: not capable of producing movement by themselves (capsule, ligament, menisci, bone, bursa)
can cartialge be a direct source of Sx’s?
No, cartilage cannot be a direct source of symptoms because they are void of nerves and vessels
what is the goal of the cyriax test
to diagnose the locatin of the symptomatic lesion
–can be applied to virtually all musculoskeletal regions (works better at the extremities and not at the spine)
Approach to examination after history
- AROM
- PROM
- Isometric Resistance
AROM in examination
-Always start with AROM except when there is a muscle or tendon tear where it isn’t safe to actively contract.
Track:
A. Ability and willingness to move
B. Quality of Motion - CASSS
C. Range (amount), Pain (symptoms), painful arc (pain in the middle of the arc of motion)
differentiate between ability and willingness to move of a patient
Ability - can move body, but it hurts so much that they are not able
Willingness - can’t move body, but patient tries to
What causes changes in CASSS?
Force, Energy, Motion, or Motor Control Issues
What is the painful arc?
pain in the middle of motion
-something is transiently getting stressed/pinched