lecture 1A: UQ scanning exam and clinical decision making Flashcards
what is regional interdependence
unrelated impairment that could be the reason for the main problem
• If a pt’s presentation is unclear OR response to tx is less than favorable … consider impact of ____ ____
regional interdependence
Traditional biomedical model mandates that a ____ is required to prescribe treatment
diagnosis
is the biomedical model suited for managing common no op MSK disorders
no
regional interdependendce initially focuses on what
physical impairments (pain and ROM)
what are the 3 impairments that are not related to MSK system
neurophysiologic - impact of pain on function
biopsychosocial - impact of depression
somatovisceral - impact of referred or radicular pain
lateral elbow pain can be associated with what impairments
cervical, shoulder and wrist/hand impairments
what can low back pain be associated with
hip impairments
patellofemoral pain syndrome is associated with what impairments
low back and hip
foot and ankle
what does thoracic HVLAT treatment decrease and increase
- ↓’s cervical spine pain
- ↑’s lower trap strength
Thoracic HVLAT treatment has improved outcomes in pts with ____ ____ and ___ ____
RC tendinopathy
adhesive capsulitis
t/f: does PT evaluation and treatment replace the biomedical model
no
what does PT evaluation and treatment use as a starting point
pathoanatomy
what is the first thing we need to figure out when a patient comes into clinic
do they belong there
-refer
-refer + PT
- PT
what is the main goal for the scanning exam
determine that no serious pathology is present and exam can continue
always scan __- and ___
above and below
how do u know when to scan or not to scan
scan if…
-no obvious MOI
- proximal cause for distal symptoms
- non MSK sounding symptoms
what is included in the UQ scanning exam
• Observation
• Patient history
• Review of systems
• Medical screening questions
• Cervical AROM (overpressure as appropriate) • UE ROM: shoulder, elbow, wrist and hand
• Myotomes (C5-T1)
• Dermatomes (C4-T1)
• Cervical compression and distraction
• Neuroprovocation testing (ULTT 1)
• Common UQ DTRs
• Pathologic reflexes
• Palpation (pulses, glands and lymph nodes
what are the different list of systems
• General health/constitutional screening
• CV, peripheral vascular and pulmonary systems
• Hematologic system
• Gastro-intestinal (GI) system
• Genito-urinary (GU) system • Nervous system
• Integumentary system • Psychologic system
• Musculoskeletal system
what are the 8 things that are included in a general health screen
- fatigue
- malaise
- fever, chills, sweats
- weight loss , groin
- nausea, vomiting
- dizziness, lightheadedness
- paresthesia , numbness, weakness
- changed in mentation, cognitive abilities
what is it when someone is uneasiness , feeling that something isn’t right
malaise
when is a fever significant
> 99.5° for longer then 2 weeks
what is the significant weight loss, gain that is concerning
5-10% of BW lost or gained , unexplained
what are the 4 symptoms of nausea, vomiting
• Metabolic, CV, liver dysfunction
• Pregnancy
• Meds
• ↑ intracranial pressure, HA, hemorrhage
dizziness and lightheadedness can be from what 2 things
• Neurologic, CV dysfunction
• DM, anxiety, psychosis
what can cause changes in mentation and cognitive abilities
- Delirium, dementia
- Head injury
- Adverse drug reactions
- Infection
what is considered a blue flag
socioeconomic factors that may impact PT outcomes
what is a yellow flag
psychological factors that may impact pt outcomes
t/f: One red flag automatically means a serious pathology and that u need to refer
F: One red flag does NOT automatically mean serious pathology and that you need to refer
• Build a case w/ subjective and objective data
• Look for patterns that do NOT match MSK conditions and pain generators
what is the myotome for shoulder abduction? what mm is being test ? peripheral n?
C5
deltoid
axillary
what is the myotome for elbow flexion? what mm is being test ? peripheral n?
C6
Biceps brachii
musculocutaneous
what is the myotome for elbow extension? what mm is being test ? peripheral n?
c7
triceps
radial
what is the myotome for wrist extension? what mm is being test ? peripheral n?
c6
extensor carpi radialis longus , brevis and extensor carpi ulnaris
radial
what is the myotome for wrist flexion? what mm is being test ? peripheral n?
c7
flexor carpi radialis and flexor carpi ulnaris
median n
what is the myotome for finger flexion ? what mm is being test ? peripheral n?
c8
flexor digitorum superficialis , flexor digitorum profundus , lumbricals
median n
what is the myotome for finger abduction? what mm is being test ? peripheral n?
t1
dorsal interossei
ulnar
when assess myotomes, u can try and find the gaps to determine if weakness is what
- localized
- CNS dysfunction
- PNS dysfucntion
where are the dermatomes of C6, C7, C8
C6: thumb and pointer finger
C7: middle finer
C8: 4th finger and pinky
pain reproduced with cervical compression suggests what 5 things
• Disc herniation
• Vertebral end plate fx
• Vertebral body fx
• Acute arthritis/joint inflammation
• Nerve root irritation (if radicular symptoms produced
pain reproduced with cervical distraction suggests what 5 things
• Spinal ligament tear
• Tear/inflammation of annulus fibrosis
• Muscle spasm
• Large disc herniation
• Dural irritability (if non-radicular arm pain produced
what is the main difference of location for UMN and LMN lesions
UMN: CNS
LMN: cranial n nuclei and anterior horn cells , spinal roots and peripheral n
what is the main difference of tone for UMN and LMN lesions
UMN: increased - velocity dependent
LMN: decreased - hypotonia , flaccidity
what is the main difference of reflexes for UMN and LMN lesions
UMN: increased - hyperreflexia, clonus ,babinski
LMN: decreased or absent - hyporeflexia
what is the main difference of involuntary movement for UMN and LMN lesions
UMN: mm spasms - flexor or extensor
LMN: fasciculations - with denervation
what is the main difference of volunatary movements for UMN and LMN lesions
UMN: impaired or absent- dyssynergic pattterns
LMN: weak or absent
what is the main difference of strength for UMN and LMN lesions
UMN: weakness or paralysis - ipsilateral for stroke and bilateral for SC
LMN: ipsilateral weakness or paralysis in limited distribution
what is the main difference of mm appearance for UMN and LMN lesions
UMN: disuse atrophy
LMN: neurogenic atrophy
what is the foundation for rational pt care
clinical decision making
what is the main tools that PT used for clinical decision making
diagnostic reasoning
