Lab Manual Stuff Flashcards
occurs prior to seeing the patient
- Review of patient reported materials
- Intake form, pain diagram, functional scales.
- Radiological and/or other information from medical sources
What examination process occur before history?
- Review of patient reported materials (Intake form forms, imaging)
- Initial observation prior to seeing the patient
Steps of the examinations process:
- Review of reported materials
- Initial observation
- Hisotry
- Review of systems
- Decission: refer out/ continue exam/focus on exam specific
- Structural inspections
- Screening (asses neurological sympstoms)
- Movement analysis (demo of what hurts)
- AROM
- PROM: ostokinematic (en feel), arthorkinematic
- resistive test
- muscle lenght
- special tets
Why is it recommened to no review MRI’s or X-Rays until the end of the examination?
So that the therapist is not influenced by those results
What are the 2 tasks in initial observation?
- Stablishing rapport
- observing movement , affect, posture, and ability to communicate
What is the purpose of the history?
- Idenditying red flags
- understanding the location and nature of the complain and its severity, irritability, potential mechanism and impact on function
At a minimum, every patient should be questioned regarding the following red-flags, whether verbally or by intake form:
- Fatigue which decreases function
- Malaise
- Fever/chills: greater than 99.5 more than 2 weeks.
- Unexplained weigh loss/gain: more than 5%-10% body weight
- Dizziness, lightheadedness
- Billateral paresthesia/numbness
- Weakness: that can not be explained
- N/V
- Change incognition abilities: time/place/person
For every YES answer to a red flag the thrapist must determine what?
- Is there an explanation for it?
- Have you explained this to a physician?
- If the physician is aware of it, has it become worse?
History questions:
- Why have you come to see me? (pain or loss of function)
- When did the pain first started?
- Where did it occur the 1st time? (Anatomic location)
- How did it change over the time from its first occurrence?
- How do you feel now?
- Have you had anything similar to this complaint in the past?
- What makes it worse?
- What makes it better?
- How does it change over the course of a day?
- Is it getter better, worse, or staying the same?
- What do you think is causing this complaint?
- Are you taking any medications?
- What are your goals for physical therapy?
- Have you seen a physician or do you plan to see a physician?
- Is there anything else you want to tell me?
The REVIEW OF SYSTEMS is designed to determine two things:
- Referal to another practicioner
- Which systems require further investigation
Primary systems reviewd in the ROS:
- Musculoskeletal
- Cardiopulmonary
- Integumentary
- Neuromuscular
- Communication ability, affect, cognition, learning ability
After history and ROS, what decission do you make?
- continue to examine
- refer to another practicioner
- continue the examination, but then refer to another practitioner after the exam.
Sometimes this is appropriate if you feel you can safely continue the examination but need “clearance” from the MD prior to initiating the treatment. This can also serve to provide you more information to give to the MD regarding the patient when you arrange the referral.
True or false:
structural inspection involves palpation to determine tenderness
False
- structural inspection is to determine landmarks, temperature, skin condition, scars, etc..
- determining tederness comes later in the physical exam
Structural inspection by palapation and observation to determine what?
- skin condition
- muscle tonicity
- edema
- temperature
- scars
- moistness or dryness
- symmetry of landmarks
Why shoulder and hip problems require inspection of the spine?
because the motion at those joints is so dependent on normal spinal function
When non shoulder extremity problems (elbow, wrist, ankle, etc.) require examination of the spine?
if the symptoms and screening exam point to any potential central (spinal) involvement (nerve roots, brachial plexus, thoracic outlet, etc.). If not, you do not need to look at the spine.
When is the first time that you may touch the pt?
structural ispection
genu valgum (knock-knee)
genu varum
the screening exam will be performed when…
the history indicates any symptoms which indicate the possible presence of radiculopathy or stenosis
Spinal stenosis is…
narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine
The primary question answered by the screening exam is:
Is the complaint arising from the tissue or from the spine?
A screening exam should reveal if it is a root level problem or a peripheral nerve problem
What is the Upper limb tension test?
- median nerve test
- abb, sup, ext rot, extend the elbow
which side gets tested firts during the screening?
uninvolved side
C5 radiculopathy
(motor, sensory, reflex, deficits)
- shouldr abdduction
- lateral superior shoulder
- bicepr reflex
where is the source of information for physical stress (mechanical causation)?
history
where is the source of information for anatomic location of complaint?
- history
- screening
- physical exam
recommended treatment progression on a single PT session:
- STM
- JM
- Stretching short tissues
- Neuromuscular re-education
- Strenght training
recommended treatment progression across sessions:
- control pain/inflammation - restore integrity of injured tissue
- addresss muscle inhibition / restores ROM
- Restore reflex reactions / muscle strenght and endurance
- restore functional movement patterns
- return to functional activities
where is the source of information for red flags?
- intake forms
- history
- ROS
where is the source of information for acute, sub-acute, and chronic?
- history
- acute: 24-48h
- sub-acute: 48h-12 weeks
- chronic: 12 wks and on
- combined with physical exam findings ( reactivity)
where is the source of information for tissue functional reactivity?
history
where is the source of information for tissue reactivity/irritability?
- history
- physical exam
C6 radiculopathy
(motor, sensory, reflex, deficits)
- elbow flex, wrist ext,
- digit 1
- brachioradialis
C7 radiculopathy
(motor, sensory, reflex, deficits)
- elbow ext, wrist flex
- digit 3
- triceps
C8 radiculopathy
(motor, sensory, reflex, deficits)
- finger flexion
- digit 5
- no reflex
T1 radiculopathy
(motor, sensory, reflex, deficits)
- finger abb
- medial forearm
- no reflex
motor, sensory and reflex deficit of radial nerve (C6-T1)
- elbow, wrist, and MCP extension
- web space between thumb and index
- triceps reflex
motor, sensory and reflex deficit of median nerve (C6-T1)
- M: pronation, wrist flexion, redial deviation, thenar muscles
- S: distal phalanges digits 1-3
- R: none
kneee ROM needed for stairs:
110
In addition to potential red-flag, what other type of problem may suggest that referral is appropiate?
the lack of motion related to pain or dysfunction. If pt cannot describe a movement that causes pain.
