Introduction package Flashcards
term denoting the disease or syndrome a person has or is believed to have
diagnosis
appraisal or evaluation of a patient’s condition
assessment
Any loss or abnormality of psychological, physiological, or anatomical structure or function
impairment
what are the 5 reasons to assess
devise a safe treatment plan, effective treatment plan, monitor progress, communicate with other health care professionals, required by law
What does SOAP stand for?
subjective data, objective data, assessment, plan
what is subjective data
patient’s perception, health history, interview answers
what is objective data
practitioner observations, test/assessment results, physical findings
what is assessment
an interpretation of the subjective and objective data. a clinical impression
what is plan
the outline for what the therapist will do to treat the problem
what should all treatment plans include
goals/aims, techniques used to achieve an effect, structures those techniques are applied to and how long/often, number and frequency or future treatments, re-examination date
what are the 10 steps of assessment protocal
- Case history
- Observation
- Palpation
- Rule Outs
- Functional Tests (ROM tests AF,PR,AR)
- Special Tests
- Muscle Tests
- Neurological Tests
- Joint Play examination
- Lesion site palpation
how should one perform observations and testing
bilaterally, with the unaffected side first
in bilateral testing, which side should be tested first and why?
unaffected, to get a sense of what is normal
when should the tests likely to be the most painful be performed?
last in the sequence
what do you do if the patient experiences pain during a particular movement or test
stop and identify the location and nature of the pain
why should we take a thorough case history first?
save time by avoiding unnecessary testing
how do we support the limbs we test
in a secure an neutral position
why do we rule out the proximal and distal joints?
ensure that we’re assessing the proper joint, as complaints may be the result of dysfunction at another location/referred pain
what are 3 forms of referred pain
neurological, trigger point, visceral
what is the high seated testing position
hips and knees are at 90 degrees of flexion
what is the long seated testing position
hips at 90 degrees flexion, knees extended
what is the hook lying testing position
supine, hips at 45 degrees of flexion, knees at 90 degrees of flexion
how should an RMT phrase their questioning during assessment?
don’t ask leading questions where possible
what is the Presenting Complaint
why the patient is coming to see us, their primary complaint, and their goals/expectations of treatment
what is General Health
information from the health history form
how does a patient’s occupation factor into assessment?
potentially identifying repetitive motions or prolonged postures that may contribute to their complaint
why do we ask about previous medical consultation about a patient’s complaint
test results and/or a diagnosis can be extremely helpful
why do we ask if a patient is taking medication
may require a modification of treatment
why do we ask if a patient has had any previous injuries
a previous injury either to or near the site of the present complaint may have affected the area of the present complaint
a physical and emotional response to tissue irritation, derangement, damage, or tissue death
pain
the most common symptom for which patients seek care
pain
type of pain: results from the release of chemical irritants, also a result of swelling/edema that compresses nociceptors
inflammatory pain
type of pain: results from the stretch or compression of pain sensitive structures
mechanical pain
type of pain: provoked by noxious stimulation produced by injury/disease
acute pain
type of pain: persist beyond the usual course of healing
chronic pain
a clinical syndrome in which patients present with high levels of pain that is chronic in duration
chronic pain syndrome
pain as a result of non-inflammatory dysfunction of the peripheral or central nervous system that does not involve nociceptor stimulation or trauma
neurogenic pain
pain that is felt at another location of the body that is distant from the tissues that have caused it
referred pain
radicular or nerve root pain, involves a spinal nerve or spinal nerve root
radiculopathy
an area of skin supplied by one dorsal nerve root
dermatome
a group of muscles supplied by one nerve root
myotome
an area of bone or fascia innervated by a nerve root
sclerotome
Referred pain arising from a trigger point
trigger point pain
What are the words behind LOFDSAAQ
Location, Onset/Origin, Frequency, Duration, Severity, Ails/Alleviates, Quality
Define Location
where the pain is and does it travel
what does local pain indicate
a lesion/injury to a superficial structure
what is diffuse pain
pain that is not localized
what is local pain
pain to a specific area
Define Onset
When and How the pain begain
Define Frequency
how often the pain/symptoms occur
define Duration
for how long the pain/symptoms last during a flare-up
define Severity
how bad the pain is, usually on a 1-10 scale
Define Ails/Alleviates
What makes the pain worse/better
Define Quality
putting descriptor words to the pain
what would sharp pain indicate?
injury to skin/fascia, superficial muscle/ligament, periosteum. Acute inflammation
What would dull pain indicate
injury to joints, deep muscles, chronic muscle injuries, subchondral bone, deep/peripheral nerve, trigger points, referred pain. Chronic inflammation
what would tingling/parasthesia indicate
nerve injury, circulatory problems
what would numbness indicate
damage or impingement of a nerve
what would a twinge with a movement that repeats the MOI indicate
injury to local muscle/ligament
what would clicking/snapping indicate
tendon flipping over a bone, thickened bursa, meniscal tear, or synovial plica
what is synovial plica
a fold in the synovium of a joint
what causes grating
osteoarthritic changes to a joint
what would locking or catching indicate
a loose body within the joint
what would instability or giving way indicate
severe joint damage, especially to primary stabilizing ligaments
what would popping indicate
negative pressure within a tendon sheath, a tendon flipping over a boney prominence, or a rupture of a ligament or tendon
what are observations
what we can see with our eyes
what constitutes observations
swelling, altered function, redness, deformities, imbalances, postural assessment
what is palpation
what we feel
what are the four Ts we look for with palpation
texture, tenderness, tone, temperature
how do we perform rule-outs
check the joints immediately above and below the effective area
why do we perform rule-outs
ensure we are treating the cause of the impairment/pain
What are the three forms of functional testing
active free, passive relaxed, active resisted
what is active free testing
patient performs unassisted voluntary joint motion
what is passive relaxed testing
therapist performs joint motion without assistance from the patient, who remains relaxed
what is active resisted testing
patient exerts effort against the therapist’s pressure towards joint motion
what test is always done last
most painful test
what test is always done first
active free
what does passive testing do
engages inert tissue and passively elongates contractile tissue
what does isometric resisted testing do
engages contractile tissue
what do we look for with active free testing
patient’s willingness to move the joint, ROM, amount of observable restriction, pain during movement
when testing for a tendon injury, what order should the tests be performed?
AF, PR, AR
When testing for a ligament injury, what order should tests be performed
AF, AR, PR
what do we look for with passive relaxed testing
hyper/hypomobility, end feel, pain
how many different end feels are there
7
what is overpressure
taking the joint to the end of its range and noting how the tissue feels at the end of the particular movements
define the end feel and normality of tissue approximation
movement is stopped by compression of tissue, considered normal
define the end feel and normality of bone to bone
when bone touches another bone. can be abnormal
define the end feel and normality of tissue stretch
springy type movement with slight give, found when the capsule and ligaments are providing resistance to movement. normal when at the end of ROM
define the end feel and normality of muscle spasm
sudden dramatic arrest of movement, often accompanied by pain, usually the result of protective reflex, abnormal.
define the end feel and normality of capsular
very similar to tissue stretch, occurs early in ROM, tends to feel thicker, usually indicates that the joint capsule is at fault. abnormal
define the end feel and normality of springy block
usually indicates an internal derangement within a joint, may be caused by a loose body within a joint, slight rebound may be noted at end range, abnormal
define the end feel and normality of empty
patient stops the movement due to intensity of the pain, movement is stopped before end of range is felt, abnormal
What can be concluded from a cyriax testing result of Strong and Painless
no lesion or neurological deficit, normal
What can be concluded from a cyriax testing result of Strong and Painful
1-2 degree muscle strain, minor lesion of the musculotendinous unit
What can be concluded from a cyriax testing result of Weak and Painless
interruption of nerve supply compression syndromes, complete rupture of a muscle or tendon
What can be concluded from a cyriax testing result of Weak and Painful
Partial rupture of a muscle or tendon, painful inhibition caused by pathology
what may be indicated by pain with repetitive movements
problem with vascular supply to the region
What are the 6 levels on the Oxford Manual Muscle Testing Scale
- Normal
- Able to overcome some resistance
- Able to overcome gravity
- Able to produce movement without gravity
- Muscle tightens but no movement is produced
- No contraction
What is the purpose of special tests
confirm or rule out injury to specific structures
Define muscle testing and its purpose
length and strength tests for specific muscles, used to determine if a muscle is weak/strong and short/long
define neurological testing and what is tested
tests to confirm or rule out neurological involvement. tests dermatomes, myotomes, and deep tendon reflexes
define joint play examination
testing accessory joint motion within a joint without voluntary control
define lesion site palpation
systematic and purposeful palpation of the lesion site
