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Ortho 1-first half > General exam scheme > Flashcards

General exam scheme Flashcards

1
Q

traditional exam flow

A

listen
look
feel
move

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2
Q

Listen

A 
Let the pt. talk: pts need ~120s to voice complaints
Active listening throughout encounter
Open ended questions
"What else?"
History taking
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3
Q

History

A

Keep in mind:

  • pain is usually the reason pt is there
  • emotional overlay
  • pts forget details and context
  • “musculoskeletal” pain may come from other sources

pain scale?
what makes pain better? worse?

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4
Q

What if pain never changes?

A

could mean it is NOT musculoskeletal

MS should at least vary with different positions

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5
Q

what should you do after listening?

A

pause and reflect: “Does this patient belong here??”

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6
Q

Look

A 
Posture/alignment
Swelling/edema/girth
Muscle hypertrophy/atrophy
Skin/nail changes
Splinting, spasm, guarding
Willingness to move
Facial expressions
Use of adaptive/supportive devices
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7
Q

How gentle must I be in the exam??

A

SINSS

S=severity: relates to function effected: mild, moderate, severe

I=irritability: relates to stimulus needed to irritate, time to baseline: mild, mod, severe

N=nature of the problem: in pt’s view, what is wrong?

S=stability: is the problem getting worse, better, same?

S=stage: acute, subacute, chronic

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8
Q

Feel

A

Work superficial to deep
Dermal & subdermal flexibility, density/edema, tenderness, temperature
Muscle spasm, trigger points, tender points
Fascial tightness, tenderness
Joint line and boney prominences

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9
Q

Move

A 
*good source for objective asterisks (used to gauge progress- make a problem list)
Clearing tests
Movement tests
Muscle strength
neurological
special tests
functional tests
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10
Q

Clearing tests

A

2 joint rule: “clear” at least 1 joint above and 1 below area of complaint
usually want to clear spine also

AROM/PROM with overpressure
rigorous break tests

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11
Q

Movement testing

A

AROM->PROM -> Resisted isometric

normal=PROM>AROM (endfeel painfree)

  • Selective Tissue Tension (Cyriax)
  • Irritability
  • Arthrokinematic motion (joint play) (0-6 scale: 0=anklyosed, 6=hypermobile)
  • Location & type of pain elicited (^ pain w/ w/load? repetitions?)
  • Compare to contralateral side
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12
Q

Selective tissue tension (cyriax)

A

separate contractile from inert lesions

Inert= pain from AROM & PROM in the same direction

Contractile= pain from AROM & PROM in opposite directions

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13
Q

Irritability

A

determined by sequence of pain and movement barrier

pain BEFORE barrier- acute= Take it easy

pain AT barrier- subacute = more aggressive

pain AFTER BARRIER- chronic = aggressive

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14
Q

If pain with AROM AND PROM:

A

problem is probably not muscle but joint

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15
Q

If pain with PROM AND Isometric

A

probably muscle

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16
Q

Muscle strength tests

A

MMT:

  • is pain elicited?
  • Bilateral comparison
  • watch for compensatory movements

ISOKINETICS

PLYOMETRICS/ FUNCTIONAL TASKS

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17
Q

Neruological Tests

A

Sensation/light touch/ temp/ vibration

DTR: know the nerve root levels

Proprioception

Peripheral nerve provocation: tinel, neurodynamics

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18
Q

Special tests

A

must follow pathological based model
most have no or little research support
some have to be used in clusters

19
Q

Functional tests

A
  • hand behind back/head
  • squat: 1/4, 1/2, 3/4, full
  • stand on 1 leg
  • hop on both legs, then one

measures of function:

  • gait/transfers
  • ADLS
  • Get up and go, hop test, etc.
20
Q

the eval process

A 
Exam
Eval
Diagnosis
Prognosis
Intervention
Outcomes (re eval)

*for every intervention there has to be a goal and an impairment. for each goal you have a tx

21
Q

musculoskeletal therapy assessment

A

numerous models exist

  • cyriax
  • kaltenborn
  • maitland
  • mckenzie
  • mennell
  • osteopathic

philosophical approaches:

1: biomechanical
2: patient response model
3: mixed

22
Q

biomechanical/ pathological model

A

ex: concave/convex rule applied to adhesive capsulitis

23
Q

patient response model

A

use of pain production/reduction methods applied to adhesive capsulitis

24
Q

mixed model

A

one model applied to assessment the other applied to treatment
both models applied to both assessment and treatment

25
Q

all musculoskeletal therapy assessment models use what systematic process?

A

Clinical examination
Treatment
Re-examination

*should result in a generation of a diagnostic label

26
Q

diagnostic labels

A

1: pathology based
2: impairment based

27
Q

pathology based diagnostic label

A
  • traditional medical diagnosis (adhesive capsulitis, tendonitis)
  • linked to pathology
  • by themselves seldom useful in guiding PT clinical decisions/txs
  • provide little info on severity, irritability, nature, or stage of disease
28
Q

impairment based diagnostic label

A

clinical subjective & objective findings
pt response to tx

independent examination findings drive tx selection; do what relieves symptoms of reduces impairments
-approach advocated by the Guide

*generated through a systematic process:

1: Generate hypotheses:
- history/intake: find subjective, functional asterisks
- systems review
- lab tests and imaging studies

2: eliminate and refine hypothesis
- physical exam/special tests: find objective asterisks

29
Q

follow up visits

A 
"how did you feel when you left last time?"
"how did you feel the next day?"
progress on subjective asterisks?
"are you doing your HEP? Show me."
Progress on objective asterisks

occasional formal re-eval:
progress on existing condition; revise goals?
new problems surfacing?

30
Q

Red flag findings

A

1: do they belong here?? these findings require immediate medical attention
2: factors that require subjective questioning or are contraindications to selected manual therapy techniques
3: factors that require further physical testing and differentiation analysis

31
Q

red flag category #1

A

*these findings require immediate medical attention

  • pathological changes in bowel or bladder function
  • symptoms not compatible with mechanical pain (symptoms don’t change w/ movement)
  • blood in sputum
  • numbness or parasthesia in perianal region
  • progressive neurological deficits
  • pulsatile abdominal masses
  • neurological deficits not explained by momradiculopathy
  • elevated sedimentation rate
32
Q

red flag category #2

A

*factors that require subjective questioning or are contraindications to selected manual therapy techniques

  • impairment precipitated by recent trauma
  • writhing pain
  • nonhealing sores or wounds
  • fever
  • clonus (upper motor damage)
  • gait defects
  • history of cancer
  • long term steroid use
  • hx of a disorder w/ predilection for infection or hemorrhage
  • hx of metabolic bone disorder
  • recent unexplained wt loss
  • age>50
  • litigation for the current complaint
  • long term worker’s comp
  • poor relationship w/ employment supervisor
33
Q

clonus

A

ankle/upper
sign if problems in CNS
repeated beating of muscle contractions when put in a quick stretch
indicated upper motor damage

34
Q

Red flag category #3

A

*factors that require further physical testing and differentiation analysis

  • bilateral or unilateral radiculopathy or parathesia
  • unexplained limb weakness
  • abnormal reflexes
35
Q

what is myelopathy?

A

spinal cord pathology

36
Q

contraindication to orthopedic manual therapy

A

absolute vs. relative

different txs have different amounts of risk, so 1 list doesn’t cover all tis

lower risk -> higher risk
AROM-> PROM, AAROM, stretching, mobilization -> manipulation

37
Q

absolute contraindications to active movement

A
  • malignancy of the targeted region
  • cauda equina lesions
  • rheumatoid collagen necrosis
  • red flags indicating neoplasm, fracture, or systemic disease
  • signs of VBI
  • unstable upper C-spine (except specific movements for stabilizing procedures)
38
Q

VBI: vertebral basilar insufficiency

A 
Drop attacks, sudden weakness, loss of consciousness
Dysphagia= trouble swallowing
Dysarthria= trouble speaking
Dizziness
Diplopia=double vision

Numbness on 1 side of face/body
Nystagmus= involuntary eye beating
Nausea

Headaches
Hearing disturbances (ringing not loss)

Ataxic gait disturbances

39
Q

Relative contraindications to active movement

A
  • active, acute inflammatory conditions
  • significant segmental stiffness
  • systemic disease
  • neurological deterioration
  • irritable patient
  • osteoporosis
  • quickly worsening condition
  • hamstring and upper limb active stretching on acute nerve root irritations
40
Q

absolute contraindications to passive movement

A

**same as active movement!

  • malignancy of the targeted region
  • cauda equina lesions
  • rheumatoid collagen necrosis
  • red flags indicating neoplasm, fx, or systemic disease
  • signs of VBI
  • unstable upper C-spine
41
Q

relative contraindications to passive movement

A

**same as active movement! PLUS*

  • acute nerve root irritation (when S & O don’t add up; any pt condition (handled well) that is worsening; oral contraceptives (c-spine); long term oral corticosteroid use
  • immediately post-pardum
  • blood clotting disorder
  • active, acute inflammatory conditions
  • significant segmental stiffness
  • systemic disease
  • neurological deterioration
  • irritable patient
  • osteoporosis
  • quickly worsening condition
  • hamstring and upper limb active stretching on acute nerve root irritations
42
Q

absolute contraindications to manipulation

A

**same as active & passive movement. PLUS*

  • practitioner lack of ability
  • spondylolithesis
  • gross foraminal encrochment
  • children/teens
  • pregnancy
  • fusions
  • psychogenic disorders
  • immediately post pardum
  • malignancy of targeted region
  • cauda equina lesions
  • rheumatoid collagen necrosis
  • red flags indicating neoplasm, fx, or systemic disease
  • signs of VBI
  • unstable C-spine
43
Q

relative contraindications for manipulations

A

**same as passive movement

  • active, acute inflammatory conditions
  • significant segmental stiffness
  • systemic disease
  • neurological deterioration
  • irritable patient
  • osteoporosis
  • quickly worsening condition
  • hamstring & upper limb active stretching on acute nerve root irritations
  • acute nerve root irritation
  • immediately post pardum
  • blood clotting disorder

Ortho 1-first half (10 decks)

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