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5 Ortho > L2 Elements of Exam and Eval > Flashcards

L2 Elements of Exam and Eval Flashcards

1
Q

Primary reasoning errors during patient encounters

A
  1. failing to generate a key hypothesis
  2. retaining a hypothesis in the face of conflicting reasoning
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2
Q

Three necessary elements of reflection

A
  1. active engagement in intellectual processess
  2. exploration of problems or experiences
  3. subsequent changed perspective or new insights
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3
Q

Skills needed for reflection

A

self-awareness
description
critical analysis
synthesis
evaluation

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4
Q

Shared Decision Making

A
  1. results in improved outcomes compared to not implementing SDM
  2. considers patients’ individual circumstances, values, and preferences

Motivational interviewing and decision aids can help you

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5
Q

Total musculoskeletal assessment

A

patient history
observation
movement exam
palpation
joint play movements
reflexes, cutaneous distribution
special tests
diagnostic imaging

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6
Q

Observation

A

not palpation
starts the moment you come into visual contact with patient and continues during the session

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7
Q

Overt pain behaviors to observe

A

guarding
bracing
rubbing
grimacing
sighing

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8
Q

Structural deformity

A

present even at rest (fracture)

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9
Q

Functional deformity

A

result of a particular posture and disappears when posture is changed (scoliosis due to short leg)

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10
Q

Dynamic deformity

A

caused by muscle action
valgus moment at knee

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11
Q

Why should you be interested in detecting asymmetries of limbs/muscle/bones?

A

Can be a fracture, tumor, complete tear
Or can be normal asymmetry, sprain/strain, inflammation

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12
Q

Movement Exam

A

confirms or refutes the working diagnosis/hypothesis, which was formulated during the history and observation

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13
Q

Red Flags during examination

A

severe unremitting pain
severe spasm
psychological overlay

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14
Q

12 principles of exam (1-6)

A
  1. unless bilateral movement is required, the normal side is tested first
  2. the pt does active movements before examiner does passive movements
  3. any movements that are painful are done last
  4. if active ROM is not full, overpressure is applied only with extreme care to prevent the exacerbation of symptoms
  5. during active movements, if ROM is full, overpressure may be carefully applied to determine the end feel of the joint
  6. each active, passive, or resisted isometric movement may be repeated several times or sustained
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15
Q

12 principles of exam (7-12)

A
  1. resisted isometric movements are done with the joint in a neutral or resting position so that stress on the inert tissues is minimal
  2. for passive ROM or ligamentous tests, it is not only the degree of opening, but also the quality of the opening
  3. when examiner is testing ligaments, appropriate stress is applied and repeated
  4. myotomes, each contraction is held for a min of 5 seconds to see if weakness becomes evident
  5. examiner warns the patient that symptoms might be exacerbated
  6. examiner does not hesitate to refer out if needed
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16
Q

Exam of specific joints

A
  1. pompjrsd
  2. adjacent joints to clear
  3. looking for pt subjective and objective findings
  4. include scan of spine
  5. acute injury preclude complete exam
  6. exam is extensive enough to allow pattern to emerge
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17
Q

Spinal scanning

A

scanning is a quick check of the portion of the spine that relates to the limb in question

purpose is to rule out symptoms which may be referred from one part of the body to another

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18
Q

When to use the spinal scanning exam

A
  1. no history of trauma
  2. radicular signs
  3. trauma with radicular signs
  4. altered sensation in limb
  5. patient presents with abnormal patterns
  6. suspected psychogenic pain
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19
Q

Movement Exam

A

Goal is to differentiate between muscle, tendon, ligament, nerve, bone

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20
Q

Contractile tissue

A

effected by contraction or stretch.
Muscle or tendon
tested by AROM and resistance

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21
Q

Non-contractile tissue

A

effected by loading, compression/pinching
ligament, capsule, cartilage, blood vessels, bursae, skin
tested by PROM and special tests

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22
Q

Nervous Tissue

A

effected by stretching, compression, pinching

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23
Q

Bone Testing

A

bone is impacted by direct pressure, compressive load, torsion

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24
Q

Active motion looks at

A

available range, control, power, willingness to move

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25
Q

Observations to do during active movement

A

when and where S/S occurs
whether movement increases intensity
reaction of patient
amount of restriction
pattern of movement
quality of movement
willingness to move

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26
Q

Classic presentations/patters of contractile tissues

A
  1. no pain, movement is strong
  2. pain, and movement is relatively strong
  3. pain, and movement is weak
  4. no pain, movement is weak
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27
Q

no pain and movement is strong

A

normal, even if muscle hurts to the touch

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28
Q

Pain and movement is relatively strong

A

local lesion of muscle and/or tendon, 1 or 3nd degree strain

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29
Q

Pain and movement is weak

A

2nd degree or greater strain, and/or a significant lesion around joint like a fracture

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30
Q

no pain and movement is weak

A

severe 3rd degree strain/rupture, neurological involvement

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31
Q

Passive motion

A

used to find the anatomical barrier to further motion vs AROM which determines the physiological barrier to further motion

32
Q

Examiner observations during passive movement

A

when and where symptoms begin
if intensity and quality increases with movement
pattern of limitation
end feel
ROM available

33
Q

End-feel

A

barrier to further motion at the end of passive ROM

each joint has unique structure that will provide a stopping point to mobility

34
Q

Abnormal end feel

A

early muscle spasm
late mucle spasm
spasticity
hard capsular
soft capsular
bone to bone
empty (bursitis)
springy block (meniscus)

35
Q

Inert Tissue Presentations of Pain

A
  1. ROm is full and there is no pain
  2. Pain and limitation of movement in every direction
  3. Pain and limitation or excessive movement in some directions but not others
  4. limited movement that is pain free
36
Q

ROM is full and there is no pain

A

no lesion in the direction of PROM

37
Q

Pain and limitation of movement in every direction

A

entire joint is affected, indicating arthritis or capsulitis

38
Q

Pain and limitation or excessive movement in some directions but not in others

A

ligament sprain or local capsular adhesion, non capsular pattern, internal derangement

39
Q

Limited movement that is pain free

A

moderate OA, bone to bone

40
Q

Capsular Patterns

A

pattern of limitation is the feature that indicates the presence of a capsular pattern in the joint

not well researched hence variations based on observations

41
Q

Resisted Isometrics

A

for inert tissues
make sure to test in the position that is causing issues

42
Q

Contractile tissue lesions

A

AROM and PROM are usually painful in the opposite direction

painful in opposite directions as they create opposing types of stress to the same tissue

43
Q

Inert Tissue Lesions

A

AROM and PROM are usually painful in the same direction
pain occurs as the limitation of motion occurs

44
Q

S/S of Upper motor lesions

A

spasticity
hypertonicity
hyperreflexia
positive pathological reflexes
absent or reduced superficial reflexes
extensor plantar response

45
Q

S/S of Lower motor neuron lesions

A

flaccid paralysis
loss of reflexes
muscle wasting and atrophy
lost of synergistic action of muscles
fibrosis, contractures, adhesions
joint weakness, instability
decreased ROM and stiffness
growth affected

46
Q

S/S of myopathy

A

difficulty lifting
difficulty walking
myotnia
cramps
pain
progressive weakness

47
Q

Palpation

A

determine tissue at fault before using palpation
practice makes perfect
relax and support area

48
Q

Assess during palpation

A
  1. tissue tension and tone
  2. tissue texture
  3. abnormalities
  4. tenderness
  5. temperature
  6. pulse, tremors
  7. pathological state of tissues
  8. dryness or excessive moisture
  9. sensation
49
Q

edema that comes on soon after injury

A

blood

50
Q

edema that comes on after 8 to 24 hours

A

synovial

51
Q

edema that is boggy, spongy feeling

A

synovial

52
Q

edema that is harder, tense feeling with warmth

A

blood

53
Q

edema that is a leathery thickening

A

chronic

54
Q

edema that is soft and fluctuating

A

acute

55
Q

edema that is thick and slow-moving

A

pitting edema

56
Q

Joint play movement

A

small ROM that can be obtained only passively by the examiner

accessory movement
required for nomal, pain free joint mobility

joints shoudl be tested in loose pack position

57
Q

Facet loose pack

A

midway between flexion and extension

58
Q

Hip loose pack

A

flexion, abduction, Er

59
Q

GH loose pack

A

abduction, horizontal adduction

60
Q

Knee loose pack

A

slight flexion

61
Q

Close packed position

A

no accessory movement is posisble

62
Q

Rules for joint play testing

A

pt should be relaxed and fully supported
one joint at a time
unaffected side first
movements aren’t forced and don’t cause discomfort

63
Q

Reflex grading

A

0–absent
2–normla
4–hyperflexia

64
Q

Sensory testing is used to

A
  1. determine extent of sensory loss, whether loss is caused by nerve root lesions, peripheral nerve lesions, compressive tunnel syndromes
  2. determine the degree of functional impairment
  3. determine nerve recovery after injury
65
Q

Purposes of special tests

A

confirm tentative diagnosis
make a differential diagnosis
differentiate between structures

66
Q

Caution w/special tests

A

osteoporosis, instability, severe pain, bone disease, apprehensions, major neuro

67
Q

Clearing the CS

A

perform AROM
perform over pressure for lateral flexion, flexion, rotation, extension

68
Q

If normal range of motion and overpressure is unremarkable

A

the clearance exam is negative

69
Q

If reproduction of shoulder symptoms occurs

A

perform the CS scan exam

70
Q

If a new pain/symptom is produced in CS or shoulder

A

perform the CS scan exam

71
Q

CS Scan Exam

A

used to rule out referral of symptoms from CS to the shoulder

AROM
PROM
Over pressure
RROM
UE myotomes
Reflexes
Dermatomes
Compression and Distraction
Neurodynamics test

72
Q

RROM for CS

A

Flexion
Extension
Lateral Flexion
Rotation

73
Q

Myotomes for CS

A

Neck flexion (C1/2)
Lateral flexion (C3)
Shoulder elevation (C4)
Shoulder abduction (C5)
Elbow flexion (C6)
Wrist extension (C6)
Elbow extension (C7)
Wrist flexion (C7)
Thumb extension (C8)
Finger abduction (T1)

74
Q

Cervical compression test

A

examiner exerts downward pressure on subjects head

Positive: increased pain or altered sensation indicates pressure on a nerve root

75
Q

Spurlings Test

A

Patients neck is in slight extension, laterally flexed. Apply downward axial compression

Positive: pain radiates down the neck

High spin and snout

76
Q

Cervical Distraction test

A

pull patients head at mastoid process

positive: patients symptoms are reduced with distraction

5 Ortho (14 decks)

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