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Orthopedics > Lec 2: Screening vs Eval > Flashcards

Lec 2: Screening vs Eval Flashcards

1
Q

What is an illness script?

A

a common story that a person would have with a common diagnosis

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2
Q

What is the purpose of doing a screen?

A

To find out an immediate risk of death. have a system if pt is safe or not.

  • Red flags
  • impairments
  • “cause of the cause”
  • what needs a more detailed examination
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3
Q

What is the purpose of an exam?

A

This is how you gather all the information you need in order to help the person

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4
Q

An UQ screen includes the portion of the body superior to

A

T6

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5
Q

What are the categories being tested in a screen

A 
vitals
observation
palpation
PROM w/ overpressure
AROM
Neuro screen
Other considerations
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6
Q

What are the components of a neuro screen

A

myotomes
dermatomes
DTRs
UMN signs

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7
Q

UE Myotome testing

C4 though T1

A

C4 – shoulder shrug
C5 – shoulder abduction
C6 – elbow flexion and/or wrist extension
C7 - elbow extension and/or wrist flexion
C8 – thumb extension, FDP
T1 – Finger abduction

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8
Q

Reflex Testing for C4 - T1

A 
◦ C4 - Rhomboids 
◦ C5 - Biceps 
◦ C6 - Brachioradialis 
◦ C7 – triceps 
◦ C8 – thumb ext 
◦ T1 – hypothenar
eminence
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9
Q

How do we grade a reflex?

A

0 No evidence of contraction

1+ Decreased, but still present (hypo-reflexic)

2+ Normal

3+ Super-normal (hyper-reflexic)

4+ Clonus: Repetitive shortening of the muscle
after a single stimulation

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10
Q

What UMN tests are performed in the UQ screen

A

Clonus of the wrist

Hoffman reflex

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11
Q

Why does a PT do a LQ screen?

A

If a pt p/w complaints of the upper quadrant

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12
Q

An LQ screen includes the portion of the body inferior to

A

T6

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13
Q

LQ exam is divided into (which positions)

A

standing
sitting
supine
prone

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14
Q

What procedures are done in the standing position?

A 
 Posture/Inspection
 Gait
 Standing squat
 AROM of Trunk/hips
 Neurologic Screening,
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15
Q

What procedures are done in the sitting position?

A

 Trunk ROM
 Vertical trunk compression/Decompression
 Neurologic Screening

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16
Q

What procedures are done in the supine position?

A 
 Neck Flexion
 Abdominal Palpation
 SI joint stress tests
 Lymph node palpation
 AROM/PROM of LE’s
 Straight leg raise (SLR)
 Neuro screening
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17
Q

LQ myotomes T1-S2 in sitting

A 
(T1-T12) Trunk flex and extension 
(L1,L2) Hip  flexion  
(L3) Knee extension  
(L4) Dorsiflexion  
(L5) Toe extension  
(S2) Knee flexion
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18
Q

DTRs for L3, L5 and S1

A

Quads
Medial Hamstrings
Achilles

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19
Q

Variations for SLR. How would you test the tibial nerve, sural nerve and common peroneal nerve

A
  • DF and EV
  • DR and Inv
  • Hip IR and PF
20
Q

What is the purpose of the orthopedic examination?

A
  • Is the person safe after the screen
  • find the tissue that is damaged
  • find the cause of the tissue damage
21
Q

How do you find the tissue that is damaged

A
  • Comparable sign (Produce pain)

* Determine irritability •PathoAnatomical

22
Q

How do you find the cause of the tissue damaged?

A

the “cause of the cause”

pathomechanical

23
Q

What is pathoanatomical

A

pathology of anatomy - the piece of that person’s body that has pathology. ex: town meniscus, frozen shoulder.

24
Q

Do PTs treat pathoanatomical or pathomechanical

A

Pathomechanical: the mechanics, how they are using their body is not optimal. this is what we treat. we indirectly treat pathoanatomical. ex torn meniscus we get their body moving in the right way. we as PTs do pathomechanical which influences the pathoanatomical

25
Q

What is a comparable sign

A

we at PTs try to do special test to find the comparable sign. We try to reproduce that symptom. ex: we have special tests for a shoulder impingement. If you recreate the pain and if you can then you did a comparable sign. You might also as your pt if there a position or activity that reproduces their pain. If they say no you have more investigations to do. But if yes then you can feel more comfortable that it is musculoskeletal.

26
Q

What are the components of an ortho exam

A 
observation
palpation
AROM/PROM
MMT
Accessory motion
special tests
27
Q

If no pain can be produced when checking AROM/PROM, then what do you do?

A
  • Check for irritability
  • Repeat
  • Sustained holds
  • Combined movements (functional)
28
Q

What structures may limit ROM

A 
muscles
capsules 
fascia
nerves
positional faults
29
Q

how do you treat a short muscle, a hypertonic muscle, and a contraction

A
  • stretch
  • PNF or manual therapy
  • Long prolonged stretching
30
Q

Can a PT ever treat pathomechanical

A

yes, through modalities

buy we basically treat pathomechanical

31
Q

how do joint capsules limit ROM after injury or lack of motion

A

Will become fibrotic (Tissue composed of bundles of collagenous white fibers between which are rows of connective tissue)

32
Q

Can dura affect ROM

A

yes

•With injury, dura becomes and may get scarred down This will limit ROM

33
Q

What is positional fault

A

• The joint is in abnormal position
• Most of the time due to a hypermobile joint
• Therefore the axis of the joint is affected, and thus will lead to a loss of ROM
-we treat this with joint mobilization

34
Q

If someone has decreases GHJ ER what is happening at the humerus?
How would we treat this?

A

head of the humerus is too far anterior

-we would do a posterior glide to “reset” head into optimal position

35
Q

what are some advantages of testing in WBing

A
  • Functional
  • See interaction/influence of adjacent structures
  • See influence of stabilizers
36
Q

what are advantages of testing in NWBing

A

•Test joints in isolation
•See compensations
IE: Test hip flex, and pt ERs hip

37
Q

How would you assess a peripheral nerve lesion

A

NCV-nerve conduction velocity

LMN

No muscle contraction

38
Q

How does poor stabilization lead to weakness

A

If the proximal bone is unable to remain static during static MMT testing, it will lead to weakness

39
Q

What is accessory movement

A

Is movements within the joint and surrounding tissues that are necessary for full ROM but cannot be performed actively in isolation

40
Q

What are the motions of accessory movement and what limits it?

A
  • spinning, rolling and gliding (translation)

* Capsule and ligament

41
Q

How is accessory movement graded

A

0: No movement / ankylosed
1: Stiff / Hypomobile
2: Normal
3: Excessive / hypermobile

42
Q

Treatment in the acute stage

A

Promote healing
◦ PRICE-MEM
◦ROM: Pain free range ◦Exercise: Isometrics

43
Q

What does PRICE-MEM stand for

A 
protect
rest
ice
compression
elevation
manual therapy
early motions
mediacion
44
Q

Why would you do early motion in the acute phase of healing

A
  • Reduce atrophy (primarily type 1 fibers)
  • Maintain joint function •Prevent ligamentous creeping
  • Avoid excessive scarring (arthrofibrosis)
  • Enhance cartilage nutrition & vascularization
45
Q

Treatment in the proliferation stage

A

Promote Healing
Increase ROM
◦ Not too aggressive, due to new scar
◦ Neuro re ed into new range

Exercise
◦ PROM → active assist → AROM → submaximal PRE’s
◦ Progression by no pain & good form

46
Q

Treatment in the maturation stage

A

Increase ROM
◦ More aggressive but don’t re start infl stage
◦ Neuro re ed into new range

Exercise
◦ PRE’s
◦ Specific Adaptation to Imposed Demand (SAID)

Promote healing
◦ Not necessary because out of healing stage, unless chronic inflamed

Orthopedics (12 decks)

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