Lab 1: Intro to Orthopedic Exam Flashcards
this guides clinician in determining which structures need more investigating (MSK, neuro, CVP, integ, GI, GU)
includes assessments of gen health intake forms and vitals
systems review
based on Pt’s health history and subjective interview, what is MOST LIKELY going on w/ pt?
have. a list of top 3 ___ ___
diff dx
test the (involved/uninvolved) side first
uninvolved
order of ROM testing
AROM>PROM>resisted testing to save time
arom limited- contractile structure
both limited- non contractile structure
keep the painful tests ____
apply ____ w/ care to test and feel
repeated movements or sustain certain postures/positions if hx indicates
perform resisted testing in _____ position
remember w/ PROM and ligamentous testing, both the ____ and quality (end feel) of opening are important
w/ ligamentous testing, repeat with _____ stress
w/ myotome testing, hold contractions for ____ sec and repeated 3-5x if necessary
warn pt for possible exacerbations before they happen
maintain pt dignity
refer if necessary
- last
- overpressure
- resting
- degree and quality (end feel)
- increasing stress
- 5 sec
to scan or not to scan
- no MOI
- proximal cause for distal sx
- non mechanical sounding symptoms
go over scanning exam steps on slide 10
skilled hand movements and passive movements of joints/soft tissue intended to improve tissue extensibility, increase ROM, induce relaxation, mobilize or manipulate soft tissue/joints, modulate pain, decrease soft tissue swelling, inflammation and restriction.
Manual Therapy Techniques
passive technique designed to restore full painless joint function by rhythmic, repetitive passive movements, well within the patient’s tolerance, in voluntary and or accessory ranges
mobilizations
accurately localized or globally applied single, quick and decisive movement of small amplitude, following a careful positioning of the patient.
manipulaiton
manually assisted method of stretching/mobilizing where the patient actively uses their muscles on request while maintaining a targeted preposition against a distinctly executed counterforce
muscle energy technique
when convex surface moves on concave: roll and glide is in the ____ direction
concave moving on convex: roll and glide in the _____ direction
OPPOSITE
SAME
during joint play assessment: look for these things at baseline
symptoms
ROM
mobility
how to grade joint play assessment:
hypomobile
normal
hypermobile
joint play:
1. know the joint shape and ROM available at each joint
2. determine hand placement and line of ____ based on joint surfaces and motion
3. grade available joint motion as compared to ?
4. assess these 2 things for each joint glide examined:
- force
- opposite side, expected motion available, other joints (if need)
- hyper or hypomobile or normal? pain or no pain?
grade 1
small amplitude technique (25%) BEGINNING of available joint play
grade 2
large amplitude movement (50%) in MIDDLE of joint play
grade 3
large amplitude movement (last 50%) at the end of joint lay (to tissue resistance)
grade 4
small amplitude movement (last 25%) at end of joint play (to tissue resistance)
grade 5 also known as?
quick movement that exceeds resistance (picking up all the slack)
High Velocity Low Amplitude Thrust into tissue resistance
first tissue resistance
second tissue resistance
btw grade 1 and 2
btw grade 4 and 5
ALWAYS reassess ____ , _____ and _____ after joint treatments (grades)
symptoms
ROM
mobility
during talocrual distraction manipulation, bring the foo into ____ amount DF and take up slack to 2nd tissue resistance
neutral (zero degrees)
muscle energy technique: alternating add/abd isometric holds for:
pelvic/SIJ Dysfunction (anterior pain)
PT provides the resistance: “squeeze into my hands for about 3-5 seconds then relax” and repeat with abduction: “push your knees out”
____ ____ _____ prior to joint play
take up slack
mobilizing arm should be ____ w/ direction (line) of force
parallel
determine appropriate grade based on
stage of condition
type of impairment
irritability of sx
what are the 3 items to assess at baseline and after every treatment?
S&S and pain
ROM and strength
concordant signs
INDICATIONS for manual therapy
mild MSK pain
low irritability MSK (worse with motion, better with rest)
relieved or provoked with certain motion
pain related to changes in sitting or standing posture
CONTRAINDICATIONS for manual therapy
infection (i.e. osteomyelitis)
febrile state
circulation issues
malignancy
open wound
recent fracture
hematoma
DM
hypersensitive skin
inappropriate end feel (hypermobile or ankylosing)
RA during exacerbation
cellulitis
constant severe pain (i.e. at night)
extensive pain radiating
ANY CONDITION THAT HAS NTO BEEN FULLY EVALUATED
***prior to application of ANY intervention
pt needs to be screened for precautions and/or contraindications for the selected technique
PRECAUTIONS for manual therapy
joint effusion/inflammation
RA (not during exacerbation)
presence of neuro signs
osteoporosis
pregnancy (if techique applied to SPINE)
Dizzy
steroid or anti-coagulant therapy
test designed to assess the contribution of spinal nerve roots and peripheral nerves to extremity pain… employ a sequential and progressive stretch to the dura… place tensile stresses on dura of spinal roots and peripheral nerves until pt symptoms are reproduced…. anatomic knowledge is imperative for the proper assessment of adverse neural tension
nerve tissue provocation (tension) tests
3 signs of a POSITIVE NTPT
- reproduce pt’s symptoms (concordant pain)
- test responses altered by movement of distant body parts that would not be attributable to any other tissue except neural tissue (i.e. sensitization)
- test differences from L side to R side or from normal (i.e. differences in pain, ROM)
research suggests that a relationship may exist b/t repetitive ______ strains and adverse neural tension of the sciatic nerve (i.e. + slump)
hamstring
simulates extremes of spinal motion associated w/ symptoms as slouched sitting or entering/exiting a car
slump test
which test is recognized as 1st NTPT and assess neural tension in sciatic nerve distribution?
SLR
SLR sensitizers
Tibial
Sural
Common Fib
tibial: DF, eversion, toe extension
sural nerve: DF, inversion
common fib: PF, inversion
load opposite ends of a nerve in oscillatory fashion (on/off very quick)
tension
load 1 end of a nerve while relieving stress on the opposite end, repeat in oscillatory fashion
gliding
load nerve system and sustain for a predetermined period of time (7-30 sec)
stretching
INDICATIONS for neurodynamic mobilization
neuro sx (pain, spasm, paresthesias)
antalgic postures
active of passive movement dysfunction
TTP superficial neural tissue
CONTRAINDICATONS for neurodynamic mobilization
recent repaired peripheral nerve
malignancy
active inflammatory condition (RA)
acute inflammatory demyelinating disease (MS)
PRECAUTIONS FOR NEURODYNAMIC MOBS
irritable
SC signs
nerve root signs
severe unremitting night pain (w/ no dx)
recent paresthesia/anesthesia
mechanical spine w/ peripheralization of sx
treat this before moving onto adverse neural tension…
remembering that neural glides are a part of the tx not the tx itself.
treat pain and mobility deficits first before adverse nerual tension
remember that neural tissue is _____. avoid overstressing bc it can lead to significant increase in sx
oversensitive
