Intro/Shoulder Flashcards
Why do most MSK patients come to us for help
Pain
How do we begin to help a patient with their pain?
1 Very thorough subjective examination
2 Planning an objective exam
3 Based on info gathered, employ detailed exam with the goal of reproducing your patient’s complaints of pain
Why would we not be able reproduce the patients pain (the pain that they are coming to see us for)?
1 They may not have a MSK problem
2 We may be missing something
3 We need to know when it is time to refer them to another physician
What gives clues as to if the symptoms are mechanical or inflammatory?
The behavior of symptoms in response to activity and rest
For the subjective exam, we establish SIN which is?
S: Severity - severe symptoms make holding a position difficult
I: Irritability - a small amount of activity provokes symptoms, and they last
N: Nature - mechanical vs. inflammatory
In order to ensure safety of the patient you must first know ?
Must know how far they can go so that we do not push them too hard
MSK is mostly?
Mechanical
What are the 5 categories that the subjective exam is divided into?
Kind of disorder
Site and nature of symptoms
Behavior of symptoms
Special questions
History
When asking a patient about their pain should you ..
1 keep it general/ vague
2 ask specific questions
and why?
example?
After you establish the disorder you are dealing with, you should ask the patient …?
1 keep it vague
you will get more information if you ask general questions in an open way and let the patient speak
for example: “what brings you in to see us” “what do you think your main problem is”
What is their goal, what would they like to be able to do that they cannot at the time of the evaluation
Using a body chart is recommended in order to help find
It is very important to know specifically where the ___ is coming from on the patient
site and nature of symptoms
pain
In regards to pain….
1 a constant ache indicates?
2 acute nerve pain is more likely to be?
3 somatic referred pain is more likely to be?
4 chronic nerve pain is more likely to be?
5 catching pains may indicate?
1 inflammation or venous congestion
2 sharp, burning, or shooting
3 deep, dull, and aching
4 aching in quantity
5 fragment in a joint
In regards to unvarying or constant pain what should be done
Everything that you as a therapist can do, but if it cannot be treated it may not be a MSK problem so they should be referred
You should always aim to establish a patients ___
SIN
Mechanical pain symptoms can usually be relieved or eliminated by?
But inflammatory pain in nature cannot always be relieved by? What are characterized by?
When inquiring about a patients pain in regards to rest and intensity what should be asked? (3)
Why does mechanical pain get worse at the end of the day?
A position or movement
Rest, they are characterized by soreness or stiffness lasting longer than 1/2 - 1 hour after a prolonged rest period
What reproduces your pain and can you relieve it? Can you find a comfortable position to sleep in at night? - What makes your pain worse? Is the pain constant?
Overuse during the day
Compare and contrast chemical vs mechanical pain
Morning or nocturnal?
When does pain occur?
Does rest relieve it?
Duration of morning stiffness?
Chemical: constant or continuous nocturnal, pain is unaffected by rest, night pain may disturb sleep, morning stiffness lasting longer than 2 hours
Mechanical: intermittent, eased by rest, can sleep without waking from pain, morning stiffness lasting less than a few minutes and relieved with appropriate activity
What are a few general health questions that should be asked (special questions category or subjective exam)? (3)
1 How is your general health (heart/lung issues, recent surgeries)?
2 Any recent weight loss (>5% BW in 4 weeks is considered significant)
3 Are you taking any medication (blood thinners, prolonged steroid use, dizziness is a common side effect)
For history (category of subjective exam) what should be asked?
We should inquire about if they have been treated for this before and if so ….
When and how did the current episode begin - if it is specific find out the position at the time of injury and the magnitude of force
Ask what worked/what didn’t/ if the treatment was successful, must be very specific
Possible cauda equina issues
Bowel or bladder problems
Saddle area tingling
Sexual dysfunction
Severe bilateral sciatic pain
Innert vs Contractile tissues
Innert: joint capsules, bursae, ligaments
Contractile: muscle-bone attachments, muscle belly, body of tendon
For non contractile tissues AROM, and PROM are painful the ____ direction
Where does pain usually occur
For contractile tissues PROM and AROM are in ____ direction
same
end range
opposite (because it is being stretched)
Normal end feels for elbow and knee
bone to bone
capsular
soft
abrupt stop (elbow extension)
abrupt stop (hip rotation)
Interpreting resisted testing results:
strong and painless
strong and painful
weak and painless
weak and painful
all painless
all painful
-working nerve or muscle
-working nerve or “minor” muscle problem/tendon
-potential nerve lesion and/or “old” complete muscle rupture (nervous system disorder)
-potential nerve lesion and/or significant muscle tear - gross lesion
-no contractile lesion
-very low threshold or FOS (:
physiologic movements
vs
accessory movements
plane movements (external rotation)
vs
2 joints moving on each other (patient cannot do it themselves)
most common dislocated major joint in the shoulder
ultimate key to pain free function
where is the greatest bony congruity/ what are the other stabilizers of this joint
glenohumeral joint
functional glenohumeral stability
between 60 and 120 degrees, glenoid labrum, shoulder capsule
