Lec 2: Screening vs Eval Flashcards
What is an illness script?
a common story that a person would have with a common diagnosis
What is the purpose of doing a screen?
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
What is the purpose of an exam?
This is how you gather all the information you need in order to help the person
An UQ screen includes the portion of the body superior to
T6
What are the categories being tested in a screen
vitals observation palpation PROM w/ overpressure AROM Neuro screen Other considerations
What are the components of a neuro screen
myotomes
dermatomes
DTRs
UMN signs
UE Myotome testing
C4 though T1
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
Reflex Testing for C4 - T1
◦ C4 - Rhomboids ◦ C5 - Biceps ◦ C6 - Brachioradialis ◦ C7 – triceps ◦ C8 – thumb ext ◦ T1 – hypothenar eminence
How do we grade a reflex?
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
What UMN tests are performed in the UQ screen
Clonus of the wrist
Hoffman reflex
Why does a PT do a LQ screen?
If a pt p/w complaints of the upper quadrant
An LQ screen includes the portion of the body inferior to
T6
LQ exam is divided into (which positions)
standing
sitting
supine
prone
What procedures are done in the standing position?
Posture/Inspection Gait Standing squat AROM of Trunk/hips Neurologic Screening,
What procedures are done in the sitting position?
Trunk ROM
Vertical trunk compression/Decompression
Neurologic Screening
What procedures are done in the supine position?
Neck Flexion Abdominal Palpation SI joint stress tests Lymph node palpation AROM/PROM of LE’s Straight leg raise (SLR) Neuro screening
LQ myotomes T1-S2 in sitting
(T1-T12) Trunk flex and extension (L1,L2) Hip flexion (L3) Knee extension (L4) Dorsiflexion (L5) Toe extension (S2) Knee flexion
DTRs for L3, L5 and S1
Quads
Medial Hamstrings
Achilles
Variations for SLR. How would you test the tibial nerve, sural nerve and common peroneal nerve
- DF and EV
- DR and Inv
- Hip IR and PF
What is the purpose of the orthopedic examination?
- Is the person safe after the screen
- find the tissue that is damaged
- find the cause of the tissue damage
How do you find the tissue that is damaged
- Comparable sign (Produce pain)
* Determine irritability •PathoAnatomical
How do you find the cause of the tissue damaged?
the “cause of the cause”
pathomechanical
What is pathoanatomical
pathology of anatomy - the piece of that person’s body that has pathology. ex: town meniscus, frozen shoulder.
Do PTs treat pathoanatomical or pathomechanical
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
What is a comparable sign
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.
What are the components of an ortho exam
observation palpation AROM/PROM MMT Accessory motion special tests
If no pain can be produced when checking AROM/PROM, then what do you do?
- Check for irritability
- Repeat
- Sustained holds
- Combined movements (functional)
What structures may limit ROM
muscles capsules fascia nerves positional faults
how do you treat a short muscle, a hypertonic muscle, and a contraction
- stretch
- PNF or manual therapy
- Long prolonged stretching
Can a PT ever treat pathomechanical
yes, through modalities
buy we basically treat pathomechanical
how do joint capsules limit ROM after injury or lack of motion
Will become fibrotic (Tissue composed of bundles of collagenous white fibers between which are rows of connective tissue)
Can dura affect ROM
yes
•With injury, dura becomes and may get scarred down This will limit ROM
What is positional fault
• 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
If someone has decreases GHJ ER what is happening at the humerus?
How would we treat this?
head of the humerus is too far anterior
-we would do a posterior glide to “reset” head into optimal position
what are some advantages of testing in WBing
- Functional
- See interaction/influence of adjacent structures
- See influence of stabilizers
what are advantages of testing in NWBing
•Test joints in isolation
•See compensations
IE: Test hip flex, and pt ERs hip
How would you assess a peripheral nerve lesion
NCV-nerve conduction velocity
LMN
No muscle contraction
How does poor stabilization lead to weakness
If the proximal bone is unable to remain static during static MMT testing, it will lead to weakness
What is accessory movement
Is movements within the joint and surrounding tissues that are necessary for full ROM but cannot be performed actively in isolation
What are the motions of accessory movement and what limits it?
- spinning, rolling and gliding (translation)
* Capsule and ligament
How is accessory movement graded
0: No movement / ankylosed
1: Stiff / Hypomobile
2: Normal
3: Excessive / hypermobile
Treatment in the acute stage
Promote healing
◦ PRICE-MEM
◦ROM: Pain free range ◦Exercise: Isometrics
What does PRICE-MEM stand for
protect rest ice compression elevation manual therapy early motions mediacion
Why would you do early motion in the acute phase of healing
- Reduce atrophy (primarily type 1 fibers)
- Maintain joint function •Prevent ligamentous creeping
- Avoid excessive scarring (arthrofibrosis)
- Enhance cartilage nutrition & vascularization
Treatment in the proliferation stage
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
Treatment in the maturation stage
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
