Lecture 1: Assessment Flashcards
What is a therapy differential diagnosis
Comparing neuromusculoskeletal signs and symptoms to identify movement dysfunction
What is the order for a MSK assessment
- Patient history
- Observation
- Screening
- Special tests
- Special tests
- Reflexes and cutaneous distribution
- Joint play
- Palpatin
- Diagnostic imaging
Define SOAP
S: Subjective (what they tell you)
O: Objective (what you see)
A: Assessment
P: Plan
What do nurses use and how is it different than a SOAP note
They use a SOAPIE:
I: Implement (what you’ve done)
e: Evaluation (Has the care so far been effective in helping the patient goals)
In what order is an assessment done in Canada
History of client
History of injury
Observations
Stress tests
Palpation
Physician diagnostic (radiology)
Physician diagnostic (lab test)
What are examples of words to describe pain that are worthy of further investigation
cramping
colicky
throbbing
aching
pressure
tightness
heaviness
weakness
poor balance
numbness
severe
disabling
worst pain I have ever had
What are the red flags
cancer
cardiovascular
GI
genitourinary
neurological
miscellaneous
What are the yellow flags
Abnormal s&s
Bilateral symptoms
Symptoms peripheralizing
Neurological symptoms
Multiple nerve root involvement
Abnormal sensation patterns
Saddle anesthesia
Upper motor neuron symptoms
Fainting drop attacks
Vertigo
ANS symptoms
progressive weakness
Gait disturbances
Multiple inflamed joints
Psychosocial stresses
Circulatory or skin change
What are the Cancer red flags
- Persistent pain at night
- Constant pain anywhere in the body
- Unexplained weight loss
- Loss of appetite
Unusual lumps or growths - Unwarranted fatigue
What are the cardiovascular red flags
- Shortness of breath
- Dizziness
- Pain o a feeling of heaviness in the chest
- Pulsating pain anywhere in the body
- Constant and severe pain in lower leg or arm
- Discolored or painful feet
- Swelling
What are the GI and genitourinary red flags
- Frequent or severe abdominal pain
- Frequent heartburn or indigestion
- Frequent nausea or vomiting
- Change in or problems with bowel and/or urinary function
- Unusual menstrual irregularities
What are the neurological red flags
- Changes in hearing
- Frequent or severe headaches with no history of injury
- Problems with swallowing or changes in speech
- Problems with balance, coordination, or falling
- Fainting spells
- Sudden weakness
What are the miscellaneous red flags
- Fever or night sweats
- Recent severe emotional disturbances
- Swelling or redness in any joint with no history of injury
- Pregnancy
What 4 things should be asked during injury HX
MOI
Onset timing (slow, sudden)
Symptoms
OPQRST
What does pain that us not affected by rest or activity usually indicate?
Bone pain, organic/systemic disorders, or other severe pathologies
What does pain with activity that decreases with rest usually indicate?
Mechanical pain from something being pinched, stretched, or contracted
What does pain and stiffness in the morning, which improves with activity usually indicate
Chronic inflammation & edema that decreases with activity
What does pain and aching that increases as the day progresses usually indicate
Congestion in the joint (swelling) from the joint being overstressed
What are systemic descriptions of pain?
disturbs sleep, deep, pressure relieves, not mechanical, associations (fever, rash, fatigue, infection)
What are musculoskeletal descriptions of pain?
Lessens at night and with less activity, sharp and superficial, no associations
Muscle pain
cramp, dull, ache
Ligament, joint, capsule pain
dull, ache
Nerve root pain
Sharp, shooting
Nerve pain
Sharp, bright, lightening
Sympathetic nerve pain
Burning, pressure, stinging, ache
Bone pain
Deep, nagging, dull
Fracture pain
Sharp, severe, intolerable
Vasculature
Throbbing, diffuse
What are common constitutional symptoms of a systemic disease
Fever, diaphoresis, night sweats, nausea, vomiting, diarrhea, pallor, dizziness/syncope, fatigue, weight loss
T/F, The IOS is made from the history and special tests
False, it is made from history alone
What should you look for in terms of pain with posture
Guarding
Bracing
Rubbing
Grimacing
Sighing
Define SHARP
Swelling
Heat
Altered function
Redness
Pain
What are 3 things that should be looked for during a screening exam
- Red or yellow flags
- Perform quick systems check and review of systems
- Rule out the suspected condition or refer
What does a scanning examination involve?
Peripheral joint scan
Motor scan
Sensory scan
In which 7 situations would you use a scanning exam?
- No history of trauma
- Radicular signs present
- Trauma with radicular signs
- Altered sensation in limb
- Spinal cord signs
- Abnormal patterns
- Suspected psychogenic pain
What does a peripheral joint scan rule out
Movement (mechanical) pathology in joints
What does a scan help differentiate
Nerve root symptoms (from spine) and peripheral nerve symptoms
What is cleared in the cervical scan
Cervical spine
TMJ
Scapular area, joints to fingers
What is cleared in the lumbar scan
Lumbar spine joints to toes
What ROM is done in the cervical spine scan
Flexion
Extension
Side flexion R & L
Rotation R & L
What movement is done in the TMJ scan
Open and close of jaw
What movements are done for the scapula scan
Elevation through flexion, abduction
Apley scratch
Rotation at 90 abduction
