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THY 422 Eval and Assess > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Why is the examination process important?

A

Helps determine the patient’s initial functional level
- also reveals interests and goals

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2
Q

What are the other rationales for the examination process? (3)

A
  • set goals based on the findings in the exam
  • re-evaluate functional level
  • reset goals for the rehab plan
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3
Q

What is objective data?

A

What you see
- HR, BP, # of feet a person can walk (signs)

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4
Q

What is subjective data?

A

What the patient tells you
- I feel tired, im in pain, (symptoms)

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5
Q

What does the documentation consist of?

A
  1. Medical records
  2. Physical chart
  3. Communication tool w/ other health care providers
  4. it is legally required
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6
Q

True of False:
If it is not documented, it did not happen.

A

True

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7
Q

What do you NEED to include in the documentation of a patient?

A
  • history
  • outcomes measure questionnaire
  • Inspection
  • Palpation
  • Joint and Muscle Function (ROM, MMT)
  • Joint Stability Tests
  • Special Tests (MD, PT, OT, KT)
  • Neurologic Testing
  • Vascular Screening
  • Mobility tests
  • Ability to perform ADLs
  • Standardized testing
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8
Q

True or False:
You shouldn’t examine the right leg if the left leg is injured.

A

False, you must examine BOTH legs for comparison purposes.

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9
Q

Which limb should you measure first in the examination process and why?

A

Measure the non-injured limb first because this will decrease apprehension (nerves) and help the patient relax because he/she will know what to expect.

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10
Q

What are the 4 main special considerations for a clinical assessment?

A
  1. Keep modesty in mind if patient needs to wear a hospital gown. (patient needs to be comfortable)
  2. Keep patient covered as much as possible
  3. Religious and cultural considerations
  4. Physician’s order for KT (specifically)
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11
Q

True or False:
You always need a physician’s order when doing a clinical assessment.

A

True

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12
Q

True or False:
Medical records can be computerized or written.

A

True

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13
Q

When should you and should you not use open ended questions when assessing a patient?

A

SHOULD: to find more information about them to understand their situation better

SHOULD NOT: time running out, critical pain, bad mood

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14
Q

What does Past Medical History consist of?

A
  1. Medical records, Non-actue examinations
    - health conditions, known pathologies
    - previous injuries/surgeries
    - predisposing factors
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15
Q

What do Previous History Questions consists of?

A
  1. Is there a history of injury to the body area? On either side?
    - describe and compare current injury
    - do the current symptoms duplicate the old symptoms?
  2. Are there any possible sources of weakness from a previous injury?
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16
Q

What are the 4 main points of Past Medical Health?

A
  1. General medical health (current health status)
  2. Relevant illness and lab work (review radiology reports)
  3. Medications (what are they currently taking? CHECK VITALS)
  4. Smoking/heavy alc use (decrease exercise tolerance, increased risk for CVD, may delay healing time)
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17
Q

What does MOI stand for?

A

Mechanism of Injury

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18
Q

What is the difference between macrotrauma and microtrauma?

A

Macro: happens immediately
Micro: happens overtime

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19
Q

What should you document when dealing with pain?

A
  • location
  • type
  • referred (heart, back, neck, arm)
  • radicular
  • daily pain patterns
  • provocation and alleviation patterns
    1. other symptoms
    2. treatment to date
    3. does the patient want to get better?
    4. disability or limitations
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20
Q

What are the goals of the physical examination process? (2)

A
  1. physician determines clinical diagnosis
  2. therapist identifies impairments and functional limitations
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21
Q

When does inspection of the patient begin?

A

as soon as the patient walks through the doors

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22
Q

What does inspection consist of?

A
  • gait
  • posture
  • function
  • guarding
  • splinting
  • walking aids
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23
Q

How should you palpate a patient with pain?

A

bilaterally moving out to towards the pain

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24
Q

What should you look at in a physical examination?

A
  1. deformities
  2. swelling
  3. skin condition(s)
  4. signs of infection
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25
Q

What does the joint and muscle function assessment function involve?

A
  • AROM
  • PROM
  • MMT
  • Joint stability tests (stress test, joint play)
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26
Q

What is laxity?

A

clinical sign of the amount of “give” within a joint

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27
Q

What is instability?

A

joint’s inability to function under the stresses of functional activity

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28
Q

What is hypomobile?

A

below normal laxity

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29
Q

What is hypermobile?

A

above normal laxity

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30
Q

What are special tests?

A

Specific tests designed to indicate particular injuries or problems. These tests can either decrease or increase symptoms. Reported as positive or negative.

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31
Q

What is dermatone?

A

area of skin innervated by a spinal nerve root

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32
Q

How is sensory testing performed?

A
  • patients eyes are closed
  • use of feeling in the skin (dull or sharp feeling from an object)
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33
Q

True or False:
If one muscle is weak, suspect muscle pathology or peripheral nerve pathology.

A

True

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34
Q

True or False:
If both muscles are weak, suspect nerve root or peripheral nerve pathology.

A

True

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35
Q

In reflex testing, an increased response leads to …

A

higher motor neuron lesion

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36
Q

In reflex testing, a decreased response leads to …

A

lower motor neuron lesion

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37
Q

In deep tendon reflex (DTR), how should it be performed?

A
  • muscle stretched and relaxed
  • patient should look away
  • strike tendon with reflex hammer
  • Jendrassik maneuver for difficult patients (distract them from area being tested)
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38
Q

What does bed mobility testing consist of?

A

rolling left and right, scooting, moving, supine to sit, sit to stand

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39
Q

What do transfers testing consist of?

A

bed to chair
chair to chair
wheel chair to toilet
wheel chair to car

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40
Q

What do gait evaluation testings consist of?

A

stability, level of dependence, distance, velocity

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41
Q

What are the 3 normal curvatures of the spine?

A
  1. lordotic (cervical)
  2. kyphotic (thoracic)
  3. lordotic (lumbar)
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42
Q

What are the facet joints?

A

the connections between the bones of the spine

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43
Q

What are the intervertebral foramen?

A

the holes where the nerves run through

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44
Q

What is nerve plexus?

A

a branching or intersecting of efferent and afferent nerve fibers

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45
Q

Where is the lumbar plexus and what does it innervate?

A

T12-L5
innervated anterior and medial muscles of the
- thigh
- medial leg
- foot

L2-L4
- posterior branches form the femoral nerve, innervates hip flexors and knee extensors
- anterior branches form the obturator nerve, innervates hip adductors

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46
Q

Where is the lateral cutaneous nerve and what does it innervate?

A

L2-L3
innervates the lateral part of the thigh

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47
Q

Where is the sacral plexus and what does it innervate?

A

L4-S3
innervates the buttocks, posterior thigh, and entire lower leg

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48
Q

Where is the sciatic nerve and what is special about it?

A

L4-S3
longest and widest nerve in the body, can feel pain, burning, tingling, and numbness when damaged

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49
Q

What are the following symptoms of a vertebral disc lesion?

A
  • loss of water
  • decreased protein
  • altering chemical structure
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50
Q

What is a disc herneation?

A

extrusion of the nucleus pulposus through the annulus fibrosus

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51
Q

True or False:
Spinal stenosis is the narrowing of the spinal canal or intervertebral foramen

A

True

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52
Q

In which age population is spinal stenosis most common in?

A

50+

53
Q

Which pathology is known as the Collared Scotty Dog?

A

Spondylolysis

54
Q

What is spondylolysis?

A

defect in the pars interarticularis (Fx)
- the lower back pain restricts extension

55
Q

What is spondylotisthesis?

A
  • can be a progression of spondylysis
  • decapitated scotty dog
56
Q

What is a sacroilliac dysfunction?

A

ilium rotates and subluxates on the sacrum
- mobility at SI joint is 2 mm or less

57
Q

What are the causes of a SI dysfunction?

A

injury of pubic symphysis
tight hamstrings
tight hip flexors

58
Q

What is the clinical evaluation of the thoracic and lumbar spine?

A
  • past med history, back surgeries, gen health, changes in activity, mental health status
  • history of present conditions
  • location of pain
  • onset of pain
  • severity of pain
  • MOI
  • consistency of pain
  • bowel or bladder control
  • disability with LBP
59
Q

Outcome questionnaire for LBP interpretation of scores:

A

0-20%: minimal disability
21-40%: moderate disability
41-60%: severe disability
61-80%: crippled
81-100%: patient is either bed-bound or exaggerating their symptoms

60
Q

Inspection of the thoracic spine:

A
  • breathing patterns
  • bilateral comparison of skin folds
  • shape of the chest
61
Q

Inspection of the lumbar spine:

A
  • lordotic curve
  • standing posture
  • paraspinal muscle tone
62
Q

What are the spinal landmarks?

A

T2- posterior from the jugular notch of the sternum
T3- even w/ medial border of scapular spine
T7- even w/ inferior angle of scapular
L3- posterior to umbillicus
L4- level w/ illiac crests
L5- back dimples
S1-S2- level of the PSIS

63
Q

Which landmarks of the spine do you use for tape measuring ROM of spine flex and ext?

A

C7 and S1

64
Q

What is the Hoover Special Test?

A

Used to identify if a patient is actually exerting effort during the test. Positive test shows patient is malingering
- performed in supine position
- attempt straight leg raise on involved side
- Positive test indicates patient does not attempt to lift the leg and the examiner does not sense pressure from the uninvolved leg pressing down on the hand

65
Q

What is Adam’s Special Test for Scoliosis?

A

Postieror view of the spinal column while the patient flexes the spine; note the presence of a hump over the left thoracic spine, suggesting scoliosis
- standing with hands in front arms straight
- patient bends forward sliding hands down legs
- Positive test indicates an assymetrical hump is observed over the lateral aspect of the thoracolumbar spine

66
Q

What is the SLR Test?

A

The uninvolved leg is flexed at the hip until symptoms are experienced. The involved leg is extended approx 10 degrees and ankle is passively dorsiflexed
- performed in supine position
- therapist gently raises leg in air until pain.
- if pain is before 70 degrees, the test is positive for sciatic nerve irritation
- if pain is before 30 degrees, the test is HIGHLY positive

67
Q

What is the Slump Test?

A

Designed to place progressively more tension on the nerve and nerve roots by changing positions and then systematically positioning the patient to provoke or alleviate symptoms
- sitting over edge of table
- patient flexes thoracic spine, forward shoulders, flex neck, extend legs, dorsiflex ankle
- if pain begins then relieve the last movement
- pain at anytime is positive for sciatic nerve or other spinal root irritation or irritation of the dural lining of the spinal cord

68
Q

What is the Quadrant Test?

A

The patient (standing) moves into extension, followed by side bending and rotation to the same side. The examiner applies pressure to emphasize the position
- if patient is older, may have them sit for balance reasons
- have patient extend spine, side bend, and rotate toward the involved side. Therapist apply pressure downward on shoulders
- Positive if patient complains of any pain on the involved side which indicates nerve root compression

69
Q

What is Femoral Nerve Test?

A

The femoral nerve (L2,L3,L4) is placed on stretch by passively flexing the patient’s knee. Nerve root impingement will result in radicular pain the in anterior and or lateral thigh
- patient is in prone position
- therapist passively flexes the knee and extends hip while stabilizing body.
- Positive is complaints of pain in anterior thigh which indicates femoral nerve irritation

70
Q

What is Sacroiliac Special Test?

A

SI joint compression test. Spreading the ASIS compresses the SI Joint.
- compression is side-lying and distraction is supine
- compression: examiner applies pressure to spread ASIS…distraction: the examiner applies pressure down through the anterior portion of the ilium
- Positive score if pain is felt

71
Q

What is Fabere Test?

A

Also known as Patrick’s Test
- patient is supine with involved leg crossing over the other making a triangle (flexed, abducted, externally rotated)
- place one hand on the knee and the other over the opposite ASIS, press on both at the same time
- if complaints of pain, test is positive for SI joint or hip joint pathology

72
Q

Pathologies and Related Special Tests of the Thoracic Spine (3):

A
  • can affect respiration
  • pathologies can refer to pain in thoracic spine
  • cancer, gallbladder, and gastroesophageal conditions
73
Q

Pathologies and Related Special Tests of the Lumbar Spine (1):

A
  • pathologies that can be mistaken as LBP can be kidney infection, CA, or other pathologies. Kidneys are located just above the pelvis and lumbar spine.
74
Q

Regarding the spine, what are 3 typical KT treatments?

A
  1. Postural Control Education
  2. Core Stability Exercises
  3. Biomechanical Education
75
Q

Mobility testing regarding the spine (11)

A
  1. Bed mobility, transfers, gait
  2. Independent (no help)
  3. Modified independent (assistive device only)
  4. Supervision (cueing, set-up)
  5. Stand-by assist (needs a helper close by)
  6. Contact guard assistance (helper holds onto gait belt)
  7. Minimal assist (patient does 75%+)
  8. Moderate assist (patient does 50-74%)
  9. Maximal assist (patient does 25-49%)
  10. Total assist (patient does 24-0%)
  11. Log roll technqiue
76
Q

True or False:
There are a total of 7 bones in the pelvis.

A

True
2 ischium
2 pubic
2 illial bones
sacrum

77
Q

How many joints are in the hip and what are they?

A

5 joints
- 2 acetabularfemoral
- 2 SI
- 1 pubic symphysis

78
Q

What type of joint is the hip?

A

ball and socket

79
Q

What is the iliofemoral ligament also known as?

A
  1. Y ligament
  2. Ligament of Bigelow
80
Q

True or False:
The iliofemoral ligament is supposed to be the strongest ligament in the body

A

True

81
Q

What action does the iliofemoral ligament help prevent?

A

hyperextension of the hip

82
Q

True or False:
The TFL (tensor fascia latae) is on the posterior side of the leg.

A

False, it is on the lateral side

83
Q

What is the site called where the iliotibial band meets the tibia?

A

Gerdy’s tubercule

84
Q

What are the motor functions of the femoral nerve?

A

leg flexion at the hip
leg extension at the knee

85
Q

What are the motor functions of the obturator nerve?

A

adduction of the thigh

86
Q

True or False:
The name of the sciatic nerve changes with each bone it passes by.

A

True

87
Q

Pertaining to the pelvis and thigh, what should you get from the patient’s past medical history?

A
  • prior medical conditions
  • surgeries
88
Q

What should be included with the history of the present condition?

A
  • location of symptoms
  • onset
  • MOI
  • aggravating activities
  • what alleviates pain
  • training techniques
  • pre-program hip pain and “hip disability questionnaire”
89
Q

What is coxa vara known as?

A

genu valgus

90
Q

What is coxa valga known as?

A

genu valgum

91
Q

What is the angle of inclination in the hip

A

125 degrees, slightly decreased in women

92
Q

What is the normal degrees for angle of torsion?

A

15-20 degrees anteversion

93
Q

What are anteroverted hips?

A

(increased angle 21+ degrees) internal femur rotation and toe in gait

94
Q

What are retroverted hips?

A

(decreased angle less than 15 degrees) external femur rotation and toe out gait

95
Q

What can anteversion lead to?

A

tibial torsion

96
Q

What should the inspection of the pelvis and thigh consist of looking at?

A
  • limping or iliac crests unequal could be leg length discrepancy (pain with >2cm difference
97
Q

What is the femoral triangle? (muscles/ligament)

A
  1. inguinal ligament
  2. sartorius muscle
  3. adductor longus
97
Q

What is in the femoral triangle? (nerve, vein, artery)

A
  1. femoral nerve
  2. femoral artery
  3. femoral vein
98
Q

Where is the inguinal ligament?

A

between the ASIS and the pubic tubercles

99
Q

True or False:
If feel unusual bulges along the inguinal ligament, it may be an inguinal hernia.

A

True

100
Q

Where is the femoral artery?

A

Passes under the inguinal ligament and is palpable inferior to the midpoint of the inguinal ligament

101
Q

True or False:
The femoral nerve and the femoral vein are palpable.

A

False

102
Q

A ______ sac overlies the greater trochanter of the hip.

A

bursa

103
Q

True or False:
The bursa sac itself is not palpable unless inflamed

A

True

104
Q

Where should you palpate for the guided by “point to where it hurts test”

A

gracillis
adductor longus/magnus/brevis

105
Q

Palpation points of the anterior structures of the pelvis and thigh:

A
  1. pubic bone
  2. inguinal ligament
  3. ASIS
  4. AIIS
  5. Sartorius
  6. Rectus femoris
106
Q

Palpation points of the lateral structures of the pelvis and thigh:

A
  1. Iliac crest
  2. TFL
  3. Glute med
  4. IT band
  5. Greater trochanter
  6. Trochanteric bursa
107
Q

Palpation points of the posterior structures of the pelvis and thigh:

A
  1. Median sacral crest
  2. PSIS
  3. Glute max
  4. Ischial tuberosity and bursa
  5. Sciatic nerve
  6. Hammies
108
Q

What is the Trendelenburg Test for Glute Med Weakness?

A

Patient is asked to stand on affected leg. In presence of weak glute med, the pelvis lowers on the opposite side of the affected leg.
- patient is standing
- positive test indicates weak glute med

109
Q

What is the Thomas Test/Rectus Femoris Contracture Test?

A

TT: Tests for tight hip flexors. Patient’s left leg is tested. Tightness of left rectus femoris muscle, tightness of iliopsoas muscle group.
RFCT: (a modification of the TT). patient is positioned so the knee of the test leg is off the table. tightness of hip flexors results in the opposite knee and hip flexing.

  • TT: lying prone on table
  • RFCT: lying supine with knees bent at end of table
  • one leg is passively flexed to patient’s chest allow the knee to flex during the movement, the opposite leg rests flat on the table
  • Positive test indicates the the lower leg moves into extension and the involved leg rises off the table
110
Q

What is Ely’s Test?

A

Ely’s test for hip flexor tightness. Passive flexion of the knee results in hip flexion, causing it to rise off the table
- patient is lying prone
- knee is passively flexed towards patient’s buttocks
- Positive test indicates that the hip on the side being tested flexes causing it to rise from the table.

111
Q

True or False:
A slipped capital femoral epiphysis is the displacement of the femoral head relative to the femoral neck.

A

True

112
Q

In a slipped capital femoral epiphysis, the femoral head __________ in acetabulum.
In a slipped capital femoral epiphysis, the femoral neck __________ anteriorly

A

remains / displaces

113
Q

True or False:
slipped capital femoral epiphysis is the most common hip disorder in older adolescents that are overweight.

A

True

114
Q

What are 3 degenerative hip changes?

A
  1. Arthritis
  2. Acetabular labrum tears
  3. Avascular necrosis
115
Q

What does the “C” sign indicate? (patient uses hand in a C shape around area of pain.)

A

indicates intra-articular pathology

116
Q

What is the Hip Scouring (Hip Quadrant) Test?

A

This procedure moves the hip through its ROM while an axial load is placed on the femur.
- patient is supine
- the examiner passively flexes patient’s knee and applies pressure downward along the shaft of femur to compress the joint surfaces internal and external rotate
- Positive score indicates pain or symptoms felt in the hips

117
Q

What are 2 causes of labral tears?

A
  1. Hip dislocations
  2. Repeated subluxations
118
Q

What is piriformis syndrome?

A
  • sciatic nerve passes under or through the piriformis
  • tightness spasm or hypertrophy
  • pressure on the sciatic nerve
119
Q

What is the Piriformis Syndrome Test?

A
  • Patient in supine position
  • Tester flexes the leg to 90 degrees and then carefully applies pressure moving the knee toward the opposite shoulder.
  • Positive test means pain was felt in the buttock and sciatica areas
120
Q

What are the 3 precautions for a total hip arthroplasty?

A
  1. No hip flexion beyond 90 degrees
  2. No adduction past the midline
  3. No internal rotation past the midline
121
Q

What is the goal of the precautions concerning a total hip arthroplasty?

A

prevent dislocation

122
Q

Posterior lateral approach notes:

A
  • involves cutting the hip ext rotators and posterior hip capsule with an incision between the glute max and med
  • spares the hip abductors but most suceseptible to posterior dislocation
  • Individual should avoid
    1. hip flex past 90 degrees
    2. hip adduct past midline
    3. hip int rot past neutral
  • rules typically followed for the first 8 weeks
123
Q

Anterior lateral approach notes:

A
  • utilizes a lateral curved incision that cuts through the glute mini, glute max, TFL, vastus lat, and anterior capsule
  • spares the posterior elements of the hip but violates the hip abductors
  • Individual should avoid:
    1. combined hip ext rot and flexion
    2. hip adduct past midline
    3. hip int rot beyond neutral
  • decreased dislocation rate
124
Q

Anterior approach notes:

A
  • utilizes an anterior incision between the TFL and sartious, which affects only the anterior capsule
  • the anterior incision does not violate the contractile and connective tissues around the hip, except for the surgical site
  • Individual should avoid:
    1. hyperextension of the hip
    2. extreme hip ext rotation
125
Q

What does ORIF stand for?

A

Open reductio internal fixation

126
Q

True or False:
ORIF will not have the same precautions as a total hip replacement

A

True

127
Q

What weight bearings are included with ORIF?

A

(most likely to be partial weight bearing)
- non weight bearing
- toe touch weight bearing
- touch down weight bearing
- partial weight bearing
- 50% weight bearing
- weight bearing as tolerated

THY 422 Eval and Assess (3 decks)

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