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exam and Intervention II > Musculoskeletal Examination & Evaluation > Flashcards

Musculoskeletal Examination & Evaluation Flashcards

1
Q

8 performance expectations for entry to practice

A
  1. screen
  2. examine
  3. Evaluate
  4. Diagnose
  5. Prognosticate
  6. plan of care
  7. intervention
  8. outcomes
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2
Q

purpose of the examination

A

to reach to the proper diagnosis

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3
Q

How to reach the proper diagnosis through the examination?

A

systematic and complete

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4
Q

Aspects of the Examination? (7)

A

-patient history
-observation
-ROM/MMT
-Special tests
-Reflexes/Sensations
Accessory motions/ palpation

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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
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6
Q

Mechanism of Injury

A

Trauma vs overuse: seek detail description

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7
Q

Examples of assistive devices/ equipment

A

braces, crutches, immobilizers, orthoses, splints

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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

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9
Q

Macrotrauma

A

Onset related to a trauma

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10
Q

Microtrauma

A

Onset related to repetitive use

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11
Q

Questions to ask for Location

A

Where is the pain

Was initial location of pain different than current location of pain

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12
Q

Where is the pain follow up questions?

A

localized
non-specific/general/diffuse
peripheralization/centralization
referred pain

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13
Q

Was initial location of pain different than current location of pain follow up question?

A

has it moved or spread

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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

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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

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16
Q

Questions to ask for Character

A

Patient descriptors

Is pain changing

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17
Q

What are patient descriptors

A 
Sharp/ lancinating 
burning 
dull/aching
deep/boring
aching
throbbing
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18
Q

what are aggravating conditions/ activities

A
  • sitting/ standing (flex/ext)
  • Walking/running
  • lifting/carrying
  • Stairs/jumping
  • throwing
  • ROM/ Resisted motions
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19
Q

What are relieving conditions/ activities

A

Resting (sitting, lying) vs moving
standing vs sitting
ice vs heat
position of comfort

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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

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21
Q

What can be used to assess Severity

A

Pain intensity VAS or NPRA

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22
Q

VAS

A

current, past 7 days (best. worst), most severe at any time

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23
Q

NPRS

A

Verbal rating on a 0-10 scale

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24
Q

Other questions to ask about patient history

A
  • other symptoms
  • previous episode
  • previous treatment for condition
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25
Q

examples of other symptoms

A

locking, instability/ giving way, numbness/tingling

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26
Q

What information do you want to know about current functional level

A
  • basic home ADLs
  • Instrumental (community) ADLs
  • Patients goals and expectations
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27
Q

Information you want to get from the physician

A
  • sling, brace, immobilizer, orthoses
  • WB status
  • Post- operative protocol/ precautions
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28
Q

Information about environment

A

home/living environment

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29
Q

Information about occupational

A

job duties

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30
Q

information about past medical history

A
  • medical/surgical history
  • Systematic diseases
  • Allergies
  • Pregnancy
  • anything else important
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31
Q

Do you want to know what medications they are taking?

A

Yes

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32
Q

What test and measures

A

EMG/NCV

Radiographic imaging: xray, MRI, CT scan

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33
Q

Why do you want so much details about patient history ?

A
  • forms working diagnosis
  • Differential diagnosis
  • Indication of progress or decline
  • Goal setting
  • Insurance
  • can help drive treatment/interventions
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34
Q

What systems should be reviewed?

A

Cardiovascular, integumentary, musculoskeletal, neuromuscular

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35
Q

Components of observation

A
  • waiting room assessment
  • Visibility
  • Dominant eye
  • View from ant. post, right and left
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36
Q

what are you looking for when assessing the pt in the waiting room?

A

Posture and gait

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37
Q

how do you want to approach posture?

A

top-down or bottom up

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38
Q

What are you looking at for posture

A 
head position
shoulder/ scapula positioning 
spine
pelvis
lower extremities
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39
Q

When observing head position what are you looking for

A

forward head, C/S rotation, side bending

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40
Q

When observing shoulder/scapula positioning what are you looking for

A

forward shoulders.

scapula protraction/retraction/elevation/ depression

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41
Q

When observing the spine what are you looking for

A

scoliosis

normal kyphosis/lordosis

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42
Q

When observing pelvis position what are you looking for

A
  • level iliac crest/ obvious rotations
  • Deviated umbilicus
  • Excessive tilt
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43
Q

When observing the LE postures what are you looking for

A
  • Hip/knee/ankle joint angles
  • Varus/valgus/recurvatum
  • rearfoot varus/ valgus
  • pes planes, rectus, cavus
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44
Q

What are you observing for the integumentary system

A

color, texture, temperature

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45
Q

What are you observing the wound/incision for?

A
  • stage of healing
  • Exudate
  • Scar: red/vascularized, white/ vascularized
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46
Q

what are you observing when there is swelling ?

A
  • edema/effusion
  • Masses
  • Girth (swelling vs atrophy)
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47
Q

what are you examine with AROM

A

Physiological motion

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48
Q

what are the components to physiological motion ?

A

-cardinal planes of motion

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49
Q

what do you want to observe with AROM

A
  • willingness to perform
  • quality/ pattern of movement
  • pain, where?
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50
Q

what are you examining with PROM

A

Anatomical motion

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51
Q

Is AROM or PROM usually greater?

A

PROM

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52
Q

what do you want to look for with PROM

A
  • weakness, active insufficiency
  • Pain
  • Joint or muscle contractures
  • Muscle spasticity
  • compare uninvolved side. norm
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53
Q

What do you want to asses for in PROM

A
  • Crepitus
  • Joint motion/ muscle length
  • Pain/pattern of pain to resistance
  • End Feel
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54
Q

What are you looking at for joint motion for PROM

A

Excessive, normal, limited

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55
Q

What are some causes for Excessive joint motion for PROM

A

trauma/disease, repetitive exposure (pitcher), genetic predisposition

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56
Q

what are some causes for limited joint motion for PROM

A

Muscle length/spasm, pain, adhesions,

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57
Q

Pattern of restriction can be ?

A

capsular pattern or non capsular pattern

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58
Q

Motion restriction in a proportional pattern

A

capsular pattern (cyriax)

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59
Q

what indicates total joint irritation, capsular contraction, arthritis, arthrosis

A

capsular pattern (cyriax)

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60
Q

motion restriction doesn’t follow capsular pattern?

A

non capsular pattern

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61
Q

what indicates local restriction, ligamentous adhesions, internal derangement, extra-articular lesion ?

A

non capsular pattern

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62
Q

what is the stage of injury when there is pain before tissue resistance

A

acute

63
Q

what is the stage of injury when there is pain at tissue resistance

A

sub acute

64
Q

what is the stage of injury when there is pain with overpressure (if painfree at tissue resistance) tissue resistance

A

chronic

65
Q

what is the stage of injury when there no pain with overpressure?

A

No injury

66
Q

Normal End feels for PROM

A

soft
firm
hard

67
Q

soft end feel

A

soft tissue approximation

68
Q

Firm end feel

A

Tissue stretch (muscle or capsule)

69
Q

Hard end feel

A

bone to bone (elbow)

70
Q

Abnormal end feels

A 
muscle spasm 
empty 
hard/bony
springy block
capsular
71
Q

Empty end feel

A

restricted by pain

72
Q

hard bony end feel

A

occurs early in ROM (ostephyte)

73
Q

Springy block end feel

A

Typical of meniscal tear

74
Q

Capsular end feel

A

Occurs with restricted ROM

75
Q

What is a MIDRANGE examination

A

resisted isometrics

76
Q

Resisted Isometrics asses for

A

contractile tissue and peripheral n

77
Q

Is resisted Isometric a break test?

A

NO

78
Q

Strong and painfree

A

uninvolved contractile tissue or supplying nerve

79
Q

Strong and painful

A

Mild lesion of contractile tissue, 1st or 2nd degree strain, tendinopathy

80
Q

weak and painfree

A

Rupture of tendon or neurological involvement

81
Q

Weak and painful

A

Severe lesion around joint, fracture causes reflex inhibition

82
Q

What does MMT interpret

A

Muscle STRENTH grade

83
Q

what does resisted isometric interpret

A

Assessing contractile tissue and peripheral nerve INTEGRITY

84
Q

Examples of examination of task analysis for LE

A
  • sit/stand
  • stair ascent/descent
  • squat/lift
85
Q

Examples of examination of task analysis for UE

A
  • Lift/ reach
  • Grooming/feeding
  • Writing/ turning pages
  • opening jars
86
Q

Special test are selected by

A

specific to a joint or structure

87
Q

Special tests are what in nature

A

provocative

88
Q

What do special test confirms

A

suspected diagnosis

89
Q

Special test assists with what?

A

differential diagnosis

90
Q

Grade 1 sprain for ligamentous testing

A

increased pain, no increased joint laxity, end feel softer than unaffected side

91
Q

Grade 2 sprain for ligamentous testing

A

increased pain, increased joint laxity, end feel softer than unaffected side

92
Q

Grade 3 sprain for ligamentous testing

A

no pain/ minimal pain, increased joint laxity, hard or soft end feel

93
Q

What are findings for deep tendon reflexes

A

hyporeflexia (LMNL, aging)
Areflexia (LMNL)
Hyperreflexia (UMNL)

94
Q

what must be relaxed to perform DTR

A

patient

95
Q

what must be on stretch to perform DTR

A

tendon

96
Q

grading of 0 for DTR

A

Absent

97
Q

grading of 1 for DTR

A

diminished

98
Q

grading of 2 for DTR

A

Normal

99
Q

grading of 3 for DTR

A

Increased/ exaggerated

100
Q

grading of 4 for DTR

A

clonus

101
Q

When screening for sensation what do you do

A

Light touch, side-to-side difference, dermatomal distribution

102
Q

What do you look for when examining sensation

A

pain, pressure, temp

103
Q

accessory motions

A

movement between joint surface

104
Q

Osteokinematic motion

A

cardinal planes of motion

105
Q

Normal accessory movement is necessary for what?

A

full pain free ROM

106
Q

Accessory motion is also referred as?

A

joint play

107
Q

When looking at accessory motions, how must one assess the joint?

A

resting, open, loose packed position

108
Q

When performing accessory motion what do you have to do to the segments?

A

stabilize one and mobilize the other

109
Q

during traction/distraction the movement is in what direction from the concave joint surface

A

perpendicular and away

110
Q

movement for traction/distraction is through what

A

up to and slightly through tissue resistance

111
Q

During glide movement is what to the concave joint surface

A

parallel

112
Q

movement for glide is through what

A

up to and slightly through tissue resistance

113
Q

What are you examine for accessory motions?

A

mobility and pain

114
Q

what is mobility for accessory motions

A

based on how much excursion is present from the beginning position to tissue resistance

115
Q

How is mobility measured for accessory motions

A

7 grades

116
Q

Grade 0 for accessory motions

A

fused

117
Q

Grade 1 for accessory motions

A

considerably hypo mobile

118
Q

Grade2 for accessory motions

A

slightly hypo mobile

119
Q

Grade 3 for accessory motions

A

normal

120
Q

Grade 4 for accessory motions

A

slightly hyper mobile

121
Q

Grade 5 for accessory motions

A

considerably hyper mobile

122
Q

Grade 6 for accessory motions

A

unstable

123
Q

interpretation of hypomobility, no pain

A

chronic joint contracture/adhesion

124
Q

interpretation of hypomobility, pain

A

acute joint contracture/ adhesion. muscle guarding

125
Q

interpretation of normal excursion, pain

A

minor sprain

126
Q

interpretation of normal excursion, no pain

A

normal

127
Q

interpretation of hypermobility, no pain

A

chronic joint laxity or partial ligament tear, acute/chronic complete ligament tear

128
Q

interpretation of hypermobility, pain

A

acute joint laxity or partial ligament tear

129
Q

pain with distraction means what?

A

joint capsule

130
Q

Pain with compression means what ?

A

joint surface , shortening the capsule

131
Q

why do you palpate ?

A

alignment, tissue tension/texture/thickness, warmth, tenderness, pulses

132
Q

Palpation grading of 1

A

compliant of pain

133
Q

Palpation grading of 2

A

compliant of pain & winces

134
Q

Palpation grading of 3

A

Winces & withdraws

135
Q

Palpation grading of 4

A

No palpation allowed

136
Q

Why do we exam diagnostic imaging?

A

confirm vs establish diagnosis

137
Q

Radiography

A

Bone integrity, cartilage thickness (joint space)

138
Q

Arthography? CT Arthrography

A

Peripheral joints

139
Q

MRI

A

Joint pathology, spinal/ neural structures

140
Q

CT scan

A

disc/ facet, complex fractures

141
Q

Diagnostic US

A

Soft tissue injuries/ masses

142
Q

what four things do you want for goals

A

structure (ABCDE), measurable, meaningful/functional, timely

143
Q

what does A mean for goals

A

Actor: who will accomplish the goal

144
Q

what does B mean for goals

A

Behavior: the action, task, or function that the individual will be able to perform

145
Q

what does C mean for goals

A

Circumstances: The context, circumstances, and support needed to perform the behavior

146
Q

what does D mean for goals

A

Degree: a quantitative specification of performance

147
Q

what does E mean for goals

A

Expected time: the time period within which the goal will be achieved

148
Q

Short term goals are

A

time frame within therapy episode of care

149
Q

Long term goals are expected to met what?

A

as a result of PT interventions

150
Q

Each STG should have what?

A

appropriate intervention

151
Q

Plan of care should include?

A 
Frequency and duration 
patient input 
STG and its interventions
direct intervention
patient education 
discharge planning
152
Q

Patient input should be based on what?

A

their expectations and previous experience with PT

153
Q

Direct interventions include?

A 
TE
Neuromuscular re-education 
manual techniques
functional training
physical agents
154
Q

Patient education includes?

A

HEP
posture/ergonomics/body mechanics
activity modification

exam and Intervention II (6 decks)

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