Exam 1: Examination, Radiography, C-Spine, & TMJ Flashcards
Examination includes gathering data about:
health condition (ICD-9/10); bodily structure & function; activity capacity (functional limitation); participation restriction (disability)
Six main steps of an examination
examination, evaluation, diagnosis, prognosis, intervention, & outcomes
An examination consists of:
history; systems review; scan exam; observation; joint play, ROM, MMT; palpation; special tests; neurologic testing; functional tests
A systems review consists of:
cardiovascular, neuromuscular, cardiopulmonary, cognition, & integumentary
According to Dr. English, the physical examination can be broken down into what three steps?
- systems review
- scanning exam
- focused exam
What are some important considerations when choosing tests & measures?
reliability, validity, who it was originally developed for, sensitivity to change, & efficiency
Short term vs. long term goals
short term goals are goals that you anticipate the pt. achieving before the end of treatment, while long term goals are the expected outcome of the treatment
Examples of therapeutic interventions include:
therapeutic exercise, neuromuscular reeducation, manual therapy, therapeutic activities, gait training, modalities, soft tissue/joint mobilizations
Pain assessment
site (origin); onset; characteristics; radiate; associations; time; exacerbating/relieving factors; severity
Words used to describe the quality of pain
- cramping, dull, aching: muscle
- dull aching: ligament, joint capsule
- sharp, shooting: nerve root
- sharp, bright, lightning-like: nerve
- deep, nagging, boring: bone
- sharp, severe, intolerable: fracture
- throbbing, diffuse: vascular
Red flags (general)
sudden onset with no precipitating event; a traumatic precipitating event; intensity that is not reduced with changes in position or medication; age; pain that interferes with sleep; bilateral, multiple locations
Red flags (cancer)
persistent night pain, constant pain, unexplained weight loss, loss of appetite, unusual lumps or growths, unwarranted fatigue
Red flags (cardiovascular)
shortness of breath; dizziness; chest pain or heaviness; pulsating pain in the face, neck, arm, or stomach; constant and severe pain in calf or arm; discolored or painful feet; swelling with no history to explain
Red flags (gastrointestinal)
frequent or severe abdominal pain, frequent heart burn or indigestion, frequent nausea or vomiting, change or problems with bowel & bladder, unusual menstrual irregularities
Red flags (neurologic)
changes in hearing or vision; frequent or severe headaches with no history of injury; problems with speech or swallowing; sudden weakness; problems with balance, coordination, or falling; drop attacks
The five steps of a physical exam are:
1) inspection
2) mobility
3) neuromuscular
4) palpation
5) special tests
Assessment of mobility includes:
AROM, PROM, resisted motion, passive accessory motion, functional movement
Inert tissue involvement will exhibit:
pain in the same direction
Contractile tissue involvement will exhibit:
pain in opposite directions
Options for assessing passive and active ROM and their indications
1) Pain and decreased ROM in all directions: entire joint involvement
2) Pain and decreased ROM in 1-2 directions: acute pathology
3) No pain, decreased range: progressed pathology
4) No pain, full range: no lesion of inert tissue
Options for assessing passive accessory motion and their indications
1) normal range and painless: no lesion
2) normal range and painful: mild sprain
3) decreased range and painless: contracture/adhesion
4) increased range and painful: moderate or severe sprain
5) increased range and painless: complete rupture
Options for assessing resisted ROM and their indications
1) strong and pain-free: no lesion
2) strong and painful: mild or moderate strain
3) weak and pain-free: interruption of nerve supply or complete muscle/tendon rupture
4) weak and painful: moderate to severe strain; or painful inhibition d/t acutely inflamed adjacent structure
PNS lesions
peripheral nerve, nerve roots, trunks/plexus, axon, cell bodies, neuromuscular junctions
Neurologic testing of C5
dermatome: lateral aspect of the shoulder to the elbow; myotome: deltoid or biceps; DTR: biceps
Neurologic testing of C6
dermatome: aspect of elbow to thumb and index finger; myotome: biceps or wrist extension; DTR: brachioradialis
Neurologic testing of C7
dermatome: middle finger; myotome: triceps or wrist flexion; DTR: triceps
C8 dermatome
ring and little finger
T1 dermatome
medial aspect of arm
CNS lesions
spinal cord & brain, muscle tone (spasticity), DTRs (hyperreflexia), balance (decreased)
Signs of upper motor lesions
ataxia (present), clonus (more than 2 beats), Babinski’s (positive: upgoing), Hoffmann’s (positive: flexion of thumb)
Grading of DTRs
0: absent
1: diminished (hyporeflexia)
2: normal
3: exaggerated (hyperreflexia)
4: clonus
Radiating vs. referred pain
radiating (radicular) pain is pain felt due to direct irritation of a nerve root and usually follows a dermatomal distribution; referred pain is pain felt in a part of the body which is a distance from the tissues that caused the pain and is usually referred distally