Musculoskeletal Examination & Evaluation Flashcards
1
Q
8 performance expectations for entry to practice
A
- screen
- examine
- Evaluate
- Diagnose
- Prognosticate
- plan of care
- intervention
- outcomes
2
Q
purpose of the examination
A
to reach to the proper diagnosis
3
Q
How to reach the proper diagnosis through the examination?
A
systematic and complete
4
Q
Aspects of the Examination? (7)
A
-patient history
-observation
-ROM/MMT
-Special tests
-Reflexes/Sensations
Accessory motions/ palpation
5
Q
Question to ask for HPI/ Chief Complaint
A
- What brings pt to PT. pt describe in own words
- mechanism of injury (MOI)
- Pre-injury status
- Assistive devices/equipment
6
Q
Mechanism of Injury
A
Trauma vs overuse: seek detail description
7
Q
Examples of assistive devices/ equipment
A
braces, crutches, immobilizers, orthoses, splints
8
Q
Questions to ask for onset
A
What happened/ mechanism of injury
Was onset insidious
Was onset related to a trauma: macro trauma
Was onset related to repetitive use: Microtrauma
When did onset occur
9
Q
Macrotrauma
A
Onset related to a trauma
10
Q
Microtrauma
A
Onset related to repetitive use
11
Q
Questions to ask for Location
A
Where is the pain
Was initial location of pain different than current location of pain
12
Q
Where is the pain follow up questions?
A
localized
non-specific/general/diffuse
peripheralization/centralization
referred pain
13
Q
Was initial location of pain different than current location of pain follow up question?
A
has it moved or spread
14
Q
Duration questions
A
How long has pain been present
Constant (chemical) vs intermittent (mechanical)
If intermittent, how long does pain last when present
15
Q
What do you want to find out when asking how long pain has been present?
A
stage of healing: acute/subacute/chronic
-days,weeks, months, years
16
Q
Questions to ask for Character
A
Patient descriptors
Is pain changing
17
Q
What are patient descriptors
A
Sharp/ lancinating burning dull/aching deep/boring aching throbbing
18
Q
what are aggravating conditions/ activities
A
- sitting/ standing (flex/ext)
- Walking/running
- lifting/carrying
- Stairs/jumping
- throwing
- ROM/ Resisted motions
19
Q
What are relieving conditions/ activities
A
Resting (sitting, lying) vs moving
standing vs sitting
ice vs heat
position of comfort
20
Q
What are examples of temporal component
A
Worse in am when waking
worse as day progresses
worse at beginning of an activity, relieved during activity
worse during the night
21
Q
What can be used to assess Severity
A
Pain intensity VAS or NPRA
22
Q
VAS
A
current, past 7 days (best. worst), most severe at any time
23
Q
NPRS
A
Verbal rating on a 0-10 scale
24
Q
Other questions to ask about patient history
A
- other symptoms
- previous episode
- previous treatment for condition
25
examples of other symptoms
locking, instability/ giving way, numbness/tingling
26
What information do you want to know about current functional level
- basic home ADLs
- Instrumental (community) ADLs
- Patients goals and expectations
27
Information you want to get from the physician
- sling, brace, immobilizer, orthoses
- WB status
- Post- operative protocol/ precautions
28
Information about environment
home/living environment
29
Information about occupational
job duties
30
information about past medical history
- medical/surgical history
- Systematic diseases
- Allergies
- Pregnancy
- anything else important
31
Do you want to know what medications they are taking?
Yes
32
What test and measures
EMG/NCV
| Radiographic imaging: xray, MRI, CT scan
33
Why do you want so much details about patient history ?
- forms working diagnosis
- Differential diagnosis
- Indication of progress or decline
- Goal setting
- Insurance
- can help drive treatment/interventions
34
What systems should be reviewed?
Cardiovascular, integumentary, musculoskeletal, neuromuscular
35
Components of observation
- waiting room assessment
- Visibility
- Dominant eye
- View from ant. post, right and left
36
what are you looking for when assessing the pt in the waiting room?
Posture and gait
37
how do you want to approach posture?
top-down or bottom up
38
What are you looking at for posture
```
head position
shoulder/ scapula positioning
spine
pelvis
lower extremities
```
39
When observing head position what are you looking for
forward head, C/S rotation, side bending
40
When observing shoulder/scapula positioning what are you looking for
forward shoulders.
| scapula protraction/retraction/elevation/ depression
41
When observing the spine what are you looking for
scoliosis
| normal kyphosis/lordosis
42
When observing pelvis position what are you looking for
- level iliac crest/ obvious rotations
- Deviated umbilicus
- Excessive tilt
43
When observing the LE postures what are you looking for
- Hip/knee/ankle joint angles
- Varus/valgus/recurvatum
- rearfoot varus/ valgus
- pes planes, rectus, cavus
44
What are you observing for the integumentary system
color, texture, temperature
45
What are you observing the wound/incision for?
- stage of healing
- Exudate
- Scar: red/vascularized, white/ vascularized
46
what are you observing when there is swelling ?
- edema/effusion
- Masses
- Girth (swelling vs atrophy)
47
what are you examine with AROM
Physiological motion
48
what are the components to physiological motion ?
-cardinal planes of motion
49
what do you want to observe with AROM
- willingness to perform
- quality/ pattern of movement
- pain, where?
50
what are you examining with PROM
Anatomical motion
51
Is AROM or PROM usually greater?
PROM
52
what do you want to look for with PROM
- weakness, active insufficiency
- Pain
- Joint or muscle contractures
- Muscle spasticity
- compare uninvolved side. norm
53
What do you want to asses for in PROM
- Crepitus
- Joint motion/ muscle length
- Pain/pattern of pain to resistance
- End Feel
54
What are you looking at for joint motion for PROM
Excessive, normal, limited
55
What are some causes for Excessive joint motion for PROM
trauma/disease, repetitive exposure (pitcher), genetic predisposition
56
what are some causes for limited joint motion for PROM
Muscle length/spasm, pain, adhesions,
57
Pattern of restriction can be ?
capsular pattern or non capsular pattern
58
Motion restriction in a proportional pattern
capsular pattern (cyriax)
59
what indicates total joint irritation, capsular contraction, arthritis, arthrosis
capsular pattern (cyriax)
60
motion restriction doesn't follow capsular pattern?
non capsular pattern
61
what indicates local restriction, ligamentous adhesions, internal derangement, extra-articular lesion ?
non capsular pattern
62
what is the stage of injury when there is pain before tissue resistance
acute
63
what is the stage of injury when there is pain at tissue resistance
sub acute
64
what is the stage of injury when there is pain with overpressure (if painfree at tissue resistance) tissue resistance
chronic
65
what is the stage of injury when there no pain with overpressure?
No injury
66
Normal End feels for PROM
soft
firm
hard
67
soft end feel
soft tissue approximation
68
Firm end feel
Tissue stretch (muscle or capsule)
69
Hard end feel
bone to bone (elbow)
70
Abnormal end feels
```
muscle spasm
empty
hard/bony
springy block
capsular
```
71
Empty end feel
restricted by pain
72
hard bony end feel
occurs early in ROM (ostephyte)
73
Springy block end feel
Typical of meniscal tear
74
Capsular end feel
Occurs with restricted ROM
75
What is a MIDRANGE examination
resisted isometrics
76
Resisted Isometrics asses for
contractile tissue and peripheral n
77
Is resisted Isometric a break test?
NO
78
Strong and painfree
uninvolved contractile tissue or supplying nerve
79
Strong and painful
Mild lesion of contractile tissue, 1st or 2nd degree strain, tendinopathy
80
weak and painfree
Rupture of tendon or neurological involvement
81
Weak and painful
Severe lesion around joint, fracture causes reflex inhibition
82
What does MMT interpret
Muscle STRENTH grade
83
what does resisted isometric interpret
Assessing contractile tissue and peripheral nerve INTEGRITY
84
Examples of examination of task analysis for LE
- sit/stand
- stair ascent/descent
- squat/lift
85
Examples of examination of task analysis for UE
- Lift/ reach
- Grooming/feeding
- Writing/ turning pages
- opening jars
86
Special test are selected by
specific to a joint or structure
87
Special tests are what in nature
provocative
88
What do special test confirms
suspected diagnosis
89
Special test assists with what?
differential diagnosis
90
Grade 1 sprain for ligamentous testing
increased pain, no increased joint laxity, end feel softer than unaffected side
91
Grade 2 sprain for ligamentous testing
increased pain, increased joint laxity, end feel softer than unaffected side
92
Grade 3 sprain for ligamentous testing
no pain/ minimal pain, increased joint laxity, hard or soft end feel
93
What are findings for deep tendon reflexes
hyporeflexia (LMNL, aging)
Areflexia (LMNL)
Hyperreflexia (UMNL)
94
what must be relaxed to perform DTR
patient
95
what must be on stretch to perform DTR
tendon
96
grading of 0 for DTR
Absent
97
grading of 1 for DTR
diminished
98
grading of 2 for DTR
Normal
99
grading of 3 for DTR
Increased/ exaggerated
100
grading of 4 for DTR
clonus
101
When screening for sensation what do you do
Light touch, side-to-side difference, dermatomal distribution
102
What do you look for when examining sensation
pain, pressure, temp
103
accessory motions
movement between joint surface
104
Osteokinematic motion
cardinal planes of motion
105
Normal accessory movement is necessary for what?
full pain free ROM
106
Accessory motion is also referred as?
joint play
107
When looking at accessory motions, how must one assess the joint?
resting, open, loose packed position
108
When performing accessory motion what do you have to do to the segments?
stabilize one and mobilize the other
109
during traction/distraction the movement is in what direction from the concave joint surface
perpendicular and away
110
movement for traction/distraction is through what
up to and slightly through tissue resistance
111
During glide movement is what to the concave joint surface
parallel
112
movement for glide is through what
up to and slightly through tissue resistance
113
What are you examine for accessory motions?
mobility and pain
114
what is mobility for accessory motions
based on how much excursion is present from the beginning position to tissue resistance
115
How is mobility measured for accessory motions
7 grades
116
Grade 0 for accessory motions
fused
117
Grade 1 for accessory motions
considerably hypo mobile
118
Grade2 for accessory motions
slightly hypo mobile
119
Grade 3 for accessory motions
normal
120
Grade 4 for accessory motions
slightly hyper mobile
121
Grade 5 for accessory motions
considerably hyper mobile
122
Grade 6 for accessory motions
unstable
123
interpretation of hypomobility, no pain
chronic joint contracture/adhesion
124
interpretation of hypomobility, pain
acute joint contracture/ adhesion. muscle guarding
125
interpretation of normal excursion, pain
minor sprain
126
interpretation of normal excursion, no pain
normal
127
interpretation of hypermobility, no pain
chronic joint laxity or partial ligament tear, acute/chronic complete ligament tear
128
interpretation of hypermobility, pain
acute joint laxity or partial ligament tear
129
pain with distraction means what?
joint capsule
130
Pain with compression means what ?
joint surface , shortening the capsule
131
why do you palpate ?
alignment, tissue tension/texture/thickness, warmth, tenderness, pulses
132
Palpation grading of 1
compliant of pain
133
Palpation grading of 2
compliant of pain & winces
134
Palpation grading of 3
Winces & withdraws
135
Palpation grading of 4
No palpation allowed
136
Why do we exam diagnostic imaging?
confirm vs establish diagnosis
137
Radiography
Bone integrity, cartilage thickness (joint space)
138
Arthography? CT Arthrography
Peripheral joints
139
MRI
Joint pathology, spinal/ neural structures
140
CT scan
disc/ facet, complex fractures
141
Diagnostic US
Soft tissue injuries/ masses
142
what four things do you want for goals
structure (ABCDE), measurable, meaningful/functional, timely
143
what does A mean for goals
Actor: who will accomplish the goal
144
what does B mean for goals
Behavior: the action, task, or function that the individual will be able to perform
145
what does C mean for goals
Circumstances: The context, circumstances, and support needed to perform the behavior
146
what does D mean for goals
Degree: a quantitative specification of performance
147
what does E mean for goals
Expected time: the time period within which the goal will be achieved
148
Short term goals are
time frame within therapy episode of care
149
Long term goals are expected to met what?
as a result of PT interventions
150
Each STG should have what?
appropriate intervention
151
Plan of care should include?
```
Frequency and duration
patient input
STG and its interventions
direct intervention
patient education
discharge planning
```
152
Patient input should be based on what?
their expectations and previous experience with PT
153
Direct interventions include?
```
TE
Neuromuscular re-education
manual techniques
functional training
physical agents
```
154
Patient education includes?
HEP
posture/ergonomics/body mechanics
activity modification
