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MSK 2 > MSK2 > Flashcards

MSK2 Flashcards

1
Q

Define Clinical reasoning

A

process of collecting and interpreting info and formulating predictions about outcomes

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2
Q

Define the different models of clinical reasoning:

1) hypothestico-deductive reasoning
2) Pattern Recognition
3) collaborative model of reasoning

A

1) design hypothesis and set out to prove it right or wrong through physical exam
2) using past experience with a specific injury to treat a patient with similar injury (BAD!)
3) collaborative means from patients perspective. engaging patient in treatment and incorporating their goals/beliefs

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3
Q

List the structure of taking a History

A 
Body Chart
Current History
Past History
Behaviour of symptoms (24 hrs, aggs/eases) 
irritability of symptoms
CI's / Precs
Social Hx
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4
Q

What do you find from the body chart?

6 things

A
  1. Exact area of pain (referral pain?, # of sites of pain)
  2. type of pain
  3. intensity
  4. depth
  5. constant or intermittent
  6. establish relationship to symptoms
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5
Q

What do you find from the current Hx

6 things

A
  1. when did symptoms begin
  2. which symptoms
  3. mechanism of injury
  4. progress of symptoms
  5. treatment since injury
  6. info on the behaviour of symptom (irritability, severity, nature of condition)
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6
Q

What do you find from the Past Hx?

2 things

A
  1. past injuries

2. nature of the previous injury (compared to current injury)

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7
Q

For each aggravating factor you want to know….?

3 things

A

the vigor
the intensity
how long does it take to settle

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8
Q

What does the 24 hour behaviour of symptoms include?

A

behaviour at…

night, morning, during the day/at end of day

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9
Q

Mechanical Pain vs Inflammatory Pain

A

mechanical

  • better in the morning
  • worse at end of day
  • worse with activity
  • obvious aggravating activity causes symptoms
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10
Q

What are the 3 aspects of Irritability

A

Ease of onset
intensity
duration of symptoms

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11
Q

CI’s and Precs/ Special Questions. What do you need to know?

7 things

A
  1. general health
  2. recent unexplained weight loss
  3. presence or history of: inflammatory disorder, cancer, osteoporosis
  4. x-rays/other investigations
  5. medications
  6. steroid use
  7. spinal conditions
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12
Q

What are yellow flags? provide some examples

A

Risk factors that are likely to delay recovery

ex. unhelpful attitudes/beliefs/behaviour about pain 
compensation issues
catastrophizing and fear
work issues
innapropriate family response
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13
Q

Whats included in the social hx

5 things

A 
age/gender
employment
domestic role
leisure activities
goals of treatment
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14
Q

What are the principles of a physical exam?

8 items

A
  1. develop routine
  2. compare both sides
  3. target: reproduce symptoms
  4. asess local structures
  5. assess for referred pain
  6. assess for neural tension
  7. may need to evaluate complete kinetic chain (foot –> spine)
  8. protocol: LOOK, FEEL, MOVE
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15
Q

What does a physical exam include

A 
Observation 
Functional Tests
Palpation 
AMT
PMT
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16
Q

Describe the Points in Range of a joint

A 
P1 = onset of pain 
P2 = Pain limiting motion
P3 = onset of resistance 
P4 = resistance limiting motion
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17
Q

What are the 5 types of Muscle testing

A 
Isometric
strength 
MMT
endurance
muscle control
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18
Q

What is the purpose of a muscle length test

A
  • to determine if the musculo-tendinous unit is capable of passivley lengthening
  • to isolate muscular damage
  • evaluate muscle length
  • isolate pain or symptom specific to anatomical site
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19
Q

Describe the process of a neuro exam

A

Sensation
strength (motor)
reflexes

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20
Q

Explain the aim of a neural tissue provocation test

A

to examine the response of movement of nerve, surrounding CT and the associated vessels

21
Q

List the Special tests for contractile and non contractile

A 
Contractile 
- iso mm test
- muscle strength 
- functional strength 
- muscle length 
Non-contractile 
- stressful procedures
- passive accessories
22
Q

Percentages for Specific, non-specific, and nerve root compromise

A
  1. 1-2%
  2. 90%
  3. 5-10%
23
Q

Somatic Pain vs Radicular Pain

A

Somatic
- evoked by stimulation of structure in lumbar spine
- aches, poorly localized, diffuse,
- can spread to lower limbs (referred) above knee
Radicular
- result of irritation of spinal nerves or nerve root
- dermatomal, shooting, sharp, localized, radiates below knee, distal worse than proximal

24
Q

Red Flags for serious pathologies

7 items

A
  • Signs/Symptoms of infection
  • Signs/symptoms of inflammatory spondylarthritis
  • Features of cauda equina syndrome or severe neruological deficit
  • History of malignancy
    significant trauma
  • Unexpected weight loss
  • Consider minimal trauma fractures in the elderly and those on corticosteroids where there are osteoporotic risk factors
25
Q

Describe Infection

A

cardinal feature is fever
pain
muscle spasm
decreased AMT due to pain

26
Q

Describe inflammatory disease

A
  • onset before age 40
  • morning stiffness lasting >30 mins
  • symptoms persisting > 3 months
  • not responsive to treatment
  • peripheral joint involvement
27
Q

Decribe Ankolysing Spondylitis

A
  • 2% is Aus (3:1 male to female)
  • deep aching in or across buttocks
  • pain in front of chest or between scapula
28
Q

Describe Cauda Equina

A
  • compression of multiple lumbar/sacral nerve root - 5th lumbar to sacral
  • may be caused by disc bulging (lumbosacral dis herniation)
  • clinical presentation: sphincter dysfunction, bilateral motor weakness, saddle anesthesia, gate disturbance
29
Q

Describe Spinal Canal Stenosis

A

> 65 yrs old

  • narrowing of spinal canal - hypertrophic degeneratic process
  • clinical presentation: burning pain, increase in symptoms with spinal extension - standing , decrease of symptoms with spinal flexion, neurogenic claudication
30
Q

Describe Vascular Claudication

A

throbbing pain

  • absent pulses
  • trophic changes
  • pain not related to spinal position
  • increased pain with activity
31
Q

Describe Metastatic Cancer

A

tumours arising from breast, prostate, thyroid, lung and kidney - spread to bone

32
Q

Describe osteoporosis

A
  • decrease in bone density - increase risk of fracture
33
Q

Describe spondylolysis

A
  • defect or stress fracture of pars interarticularis or vertebral arch (L5)
  • unilateral tenderness
  • pain aggravated by activity and spinal extension
34
Q

Red Flags for children with LBP

9 items

A
  1. progressive pain not responding to analgesia
  2. night pain
  3. fever
  4. unexplained weight loss
  5. severe constipation
  6. abnormal postures
  7. scoliosis
  8. gait abnormality
  9. sphincter dysfunction
35
Q

How do you manage people with LBP

A
  • education
  • active physical therapy
  • analgesic meds
  • address impairment
36
Q

What percentage of people in Australia suffer from LBP? globally?

A

29% - 6.1 million

12%

37
Q

What are the risk factors for LBP?

A
  • depression
  • previous episode
  • job dissatisfaction
  • lifting, bending, sleep disturbance, genetics, social support, health status, type of work, obesity, smoking, physical activity
38
Q

What is the Prognosis of LBP

A
  • 1/3 of acute episode result in persistent symptoms

- 50% of patients experience a recurrence within 1 year

39
Q

What are some prognostic factors for LBP?

A
  • older age
  • higher pain intensity
  • longer duration LBP
  • more days of reduced activity
  • patient reports feeling depressed
  • patients belief pain will persist
  • compensation
  • fear avoidance
  • catastrophizing thoughts
40
Q

What advice would you give to a person with NS-LBP?

A

reassure
advise to stay active and increase activity progressively
discourage bed rest
early return to work

41
Q

When do you perform imaging in a patient with NS-LBP?

A

when severe or progressive deficits are present or when a serious underlying conditions are suspected

42
Q

Indications for Spinal Manual therapy (SMT) - from the history

A

NS-LBP
msk mechanical problem
absence of CI’s
absence of red flags

43
Q

Indications for SMT from physical exam

A 
reproduced symptoms/restricted ROM on AMT 
tension 
absence of NRC
symptoms reproduced in PAIVM
restriction of mvmnt on PPIVM
44
Q

Contraindications for SMT

A

tumour, metastatic disease, active inflammatory disease, fracture, infection
cancer

45
Q

Grades and Dosage for Irritable people

A

grade 1/2, 1-3 sets, 30-45 secs

46
Q

Grades and Dosage for non irritable people

A

grade 3-4, 3-5 sets, 45-60 secs

47
Q

What do the superficial muscles of the spine do? (global muscle system)

A

torque generation
control of orientation
balance the external loads applied at trunk

48
Q

What muscles control intersegmental movement

A

Deep muscles

  • Transverse abdominus
  • diaphragm,
  • pelvic floor
  • multifidus

MSK 2 (15 decks)

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