Examination 1 Flashcards
1
Q
what are the 5 factors included in the drivers of disability model? (hexagon thing)
A
nociceptive/pain nervous system dysfunction comorbidity cognitive emotional contextual
2
Q
the examination consists of 3 components w/i the PCMM
A
history
systems review
tests and measures
3
Q
open ended questions
A
encourage the pt. to provide narrative info and decrease the opportunity for biasing on the part of the PT
4
Q
close ended questions
A
more specific and are asked as the examination proceeds
helps focus in on relevant information
5
Q
cramping, dull, sore, aching pain
A
muscle
6
Q
dull, aching
A
ligament, joint capsule
7
Q
sharp, shooting, pinching, gnawing
A
nerve root
8
Q
sharp, shooting, burning
A
nerve
9
Q
deep, nagging, dull
A
bone
10
Q
sharp, severe, incapacitating
A
fracture
11
Q
throbbing, pulsing, beating, diffuse
A
vasculature
12
Q
acute symptoms
A
less than 2 week duration
inflammatory stage
13
Q
msk conditions are typically influenced/aggravated w/…
A
movements and positions
14
Q
inflammatory pain is more ___ and is less affected by ___?
A
constant, movement and positions
15
Q
reports of numbness and tingling suggests a
A
neurological compromise
16
Q
referred pain
A
used to describe those symptoms that have their origin at a site than where the patient feels them
17
Q
centralize(s)(d)
A
as a condition improves, the symptoms tend to become more localized
18
Q
peripheralize(s)(d)
A
as conditions worsen, in general, the pain distibutution becomes more widespread and distal
19
Q
signs and symptoms of serious pathology
A
fever, chills, night sweats unexplained weight changes malaise, fatigue unexplained nausea, vomiting shortness of breath night pain increase in intensity in pain
20
Q
when examining pts. active ROM notice…
A
willingness to move ROM integrity of contractile tissue pattern of restriction quality of motion symptom reproduction
21
Q
when examining pts. passive ROM notice…
A
integrity of contractile tissue
ROM
end-feel
sensitivity
22
Q
the contralateral, nonsymptomatic joint should always be…
A
examined first if possible before the symptomatic side
this allows for true comparison
23
Q
Dynamic testing
A
repeated movements in specific directions
follows cardinal plane motion testing
can give the PT some valuable insight into the pts. condition
can determine the direction of motion to be used as part of the intervention
24
Q
Cardinal plane motion test
A
usually tested first
25
non-specific LBP
a symptom for which we are currently unable to reliably identify the pathology
26
factors that involved w/ LBP
psychological
biological
social
environmental
27
nociceptive pain drivers
pain that arises from actual/threatened damage to non-neural tissue
28
categories of the ICF model
responders to classification systems (inner circle)(PTs can effect these)
non-responders to classification systems (outter circle)
29
Nervous system dysfunction drivers
neuropathic pain
| EX: Nervous system hypersensitivity
30
comorbidity drivers
pts. can also present with certain physical/mental health comorbidities that can influence the severity of the disability/condition.
31
Cognitive-emotional drivers
cognitions and behaviors are part of personal factors that influence pain severity and disability
32
contextual drivers
elements related to the pts. occupation, and social context
33
epidemiology
the study of people in populations
34
prevelence
who in a population that has a disease at the moment
35
incidence
who in a population just developed the disease/number of new cases in a population
36
prognosis
the prediction of what will happen w/ a disease or injury
| how well a specific treatment in this pt. population likely to do
37
risk factors
associated w/ the disease
38
screening
casting a big net in order to detect a diagnosis, usually in the early stages
you want the screening test over 90% sensitivity
39
likelihood ratio
positive or negative
helps determine if a test is valuable
high LR+ influence post-test probability w/ a positive finding (value >1 rules in a diagnosis)
low LR- influence post-test probablility w/ a negative finding (value close to 0 is best, rules out)
40
positive LR
moving closer to the diagnosis
41
negative LR
moving away from that diagnosis
42
1, 2, 5 and 10
43
PSFS
pt. specific functional scale
0-10 grading scale
MCID= 2 points
asks the pts. about 3 or more tasks they cannot perform/what they would like to perform
44
SANE
single assessment numeric evaluation
0-100% scale
asks the pt. to rate themselves/the affected limb/etc.
EX: rate your affected shoulder as of today?
45
palpation
```
do it to AFFIRM and QUANTIFY
helps to find bony landmarks, and should be done throughout the examination to help the PT to clarify the cardinal sign
when palpating you will feel 5 things:
skin
subcutaneous tissue
mm.
ligament/tendon
joint/capsule
***if it feels atypical, it may not always be abnormal
```
46
what is the chance of recurrence of LBP
24. 1% at 12 months
| 58. 6% at 2 years
47
what instrument may be useful in identifying influential social determinants of health findings?
PRAPARE
| collects data needed to better understand and act on patients social determinants of health
48
PEG-3
tool that measures pain intensity and interference
49
Oswestry Disability Index
region specific scale used to measure disability specifically in subjects w/ lumbopelvic pain
50
SF-36
QUALITY OF LIFE assessment that has functional subscales but not focused on function
0-100 score
lower scores indicate disability
51
how many outcomes measures should be used to capture the full extent of lumbar recovery?
research suggests a minimum of 3 outcomes
1- physical functioning
2- pain
3- quality of life
52
relationship regarding awkward postures and LBP
strong evidence that there is no association between awkward postures and LBP
53
relationship regarding occupation and LBP
strong evidence of no association between awkward occupational postures and LBP
54
lumbar list
can be caused by a number of structures/diagnoses
55
category 1 RF
involve findings that require immediate medical attention
56
category 2 RF
involve findings that require a more careful history and questioning
57
category 3 RF
involve findings that require additional physical tests
58
cluster of findings that is best at ruling in an active case of cancer (4)
50+ yrs old
CX history
unexplained weight loss
failure of conservative tx
59
the triage process
```
targeted management for pts. who present w/ acute LBP ("put them in a grouping")
population odds=
- LBP w/ significant neurological deficits (5-10%)
- nonspecific LBP (90%)/
- serious/systemic pathology (1-2%)
3 triage groupings=
1. high disability
2. moderate disability
3. low disability
```
60
STarT Back screening tool
validated tool that stratifies pts. into risk groups (low risk, medium risk, and high risk)
these groups are predictive of chronicity, disability and work absenteeism
provides a basis for targeted care
61
MLT
muscle length testing
| used to determine the length/stiffness of a muscle
62
when MMTing the trap...
pt. is prone w/ arm at 90 degrees, thumb pointing up
| stabilize the opposite scapula
63
Scapula Jog test
support the pts. arm on your shoulder
passively flex the arm to 110
ask pt. to maintain this position as you release the arm
if the scapula "jogs" it suggests a weak serratus ant.
64
mastoid process palpation
place finger behind earlobe
| bone feels round and superficial
65
styloid process
between mastoid and posterior aspect of mandible
| deep and tender
66
transverse process C1
move inferior and anterior from mastoid process
67
"Rules of threes"
```
Spinous processes placement
T1-T3 are level w/ their own body
T4-T6 are 1/2 level below
T7-T9 are level w/ the body below
T10-T12 are level w/ their own body
```
68
posterior rib angles
palpate approx. 1" lateral to the corresponding TP
| ribs are oriented inferior and lateral
69
8 step scale
1: intake form
2: pt. history
3: observation
4: triage or screening tests
5: movement examination
6: palpation, endurance tests
7: physical performance tests
8: confirmation tests
70
QISS TAPED
```
quality
impact
site
severity
temporal characteristics
aggravating/alleviating factors
```
71
SIJ pain may be responsible for how many LBP cases?
literature reports that up to 25% of LBP cases are due to SIJ pain
72
pelvic girdle questionnaire
specific to pregnant and post-partum women
captures ADLs and symptoms
0-100 score (100 being the worst)
73
MCID
minimally clinical important difference
74
OSPRO-YF
YELLOW FLAGS assessment tool that allows for grading of depressive symptoms, anxiety, anger, fear-avoidance, kinesiophobia, catastrophizing, self efficacy, pain acceptance
PSYCHOLOGICAL SCORE
75
OREBRO Musculoskeletal Pain questionnaire
identifies barriers to recovery and therapeutic targets for examination and care
76
Visual observation
when examining your pt. be aware of nonverbal clues such as...
weight shifting away from involved side
pain increased w/ walking
pain rising to sitting
77
most important components during observation of pelvis/SIJ
stance and gait
78
non-mechanical conditions
conditions that may mask as pelvis/SIJ/LBP pain in the absence of a traumatic hx
79
ankylosing spondylitis
```
age at onset <40
pain not relieved by supine
morning back stiffness
pain duration >3 months
pain improves w/ exercise
```
if pt. is + on 4/5 on questions, +LR is 1.27
80
OR
odds ratio
81
how to rule out the lumbar spine
general lower quarter screen
PA's of the lumbar spine
AROM w/ overpressure (flexion, extension, side flexion, rotation)
82
how to rule out the hip
```
AROM hip flexion w/ overpressure
FADIR test (end range flexion + adduction + internal rotation)
```
83
what clinical finding is consistent w/ a sacral fracture
diffuse pain throughout pelvis
84
pain adaptive
a person has the ability (endogenously, within their body) to modulate pain without the help of medical interventions
good candidates for modulation of pain movements
people are or are not pain adaptive
85
those who are not pain adaptive are...
central sensitization
chronic pain syndrome
fibromyalgia
addicted to pain killers
86
step and bend for posterior rotation
have pt. bring involved side foot up on box (this will create posterior tilt innominate on that side)
have pt. bend forward at the hips
have pt. repeat process for concordant sign
87
lunge for anterior rotation
put pts. involved side at extension of the leg (lung opposite foot forward)
pt. will lean forward
have pt. repeat this motion to test concordant sign
88
Sacral Nutation
pt. is side lying w/ involved/painful side up (will create posterior rotation) and flexed
wrap pts. involved leg around your body and support the limb (bottom limb is extended)
place hands at ASIS and ischial tuberosity
passively move pt. into posterior rotation
***look for any pain/concordant sign
89
Sacral Counternutation
pt. is side lying w/ involved side up and extended (bottom leg will be flexed and wrap around PT for support of limb)
perform passive extension (creates anterior rotation
90
Passive Accessory movement for SIJ
uni/bilateral A/P movements of the innominate (posterior rotation)
uni/bilateral P/A movements of the innominate (anterior rotation)
5-30 secs in each position
provide oscillations
91
active SLR test
pt. in supine
have pt. raise leg off the table
ask if pain is present
have pt. score the effort need to lift each leg (0: none)
provide stabilization at ASIS and rescore
***this test will help determine if pt. will benefit from pelvis stabilization device
92
sensitivity
the number/percent of people who test positive for a specific disease/condition among a group of people who have the disease
93
specificity
percentage of people who test negative for a specific disease among a group of people who do not have the disease
94
thigh thrust test
pain provocation test
pt. is supine
PT stands on opposite side of the pts. involved leg
pt. flexes involved hip to 90 degrees
PT places hand under the sacrum
downward pressure is applied thru the femur to provoke pain
hold for 30 sec, if no pain occurs a slight bounce is used at the end to provoke pain
95
distraction test for pelvis
pt. lies supine
PT crosses arms and applies force over medial aspect of the ASIS @ PL direction
force applied for 30 secs w/ slight bouce if no pain is reproduced
96
Patrick's test
pt. supine
figure 4 position of the involved leg w/ lateral malleolus proximal to opposite knee
stabilize opposite ASIS
apply downward force to knee until end ROM
97
Compression test of the pelvis
pt. in side lying position, involved side up
PT cups the iliac crest and applies force through the ilium for 30 sec
bounce is performed if no pain produced
98
Sacral thrust/spring test
pt. is prone
PT applies downward force near the peak of the sacrum
if no pain, 5-7 hard thrusts are performed
99
Gaenslen's test
pt. is supine
noninvolved hip in flexion
involved leg will be hanging off the edge of the table
push upward on the flexed thigh and downward on the extended thigh
hold for 30 sec, bounce at the end
100
Laslett test cluster includes what tests
sacral spring
compression
distraction
thigh thrust
