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MSK I > Neuromuscular Assessment > Flashcards

Neuromuscular Assessment Flashcards

1
Q

What are the 3 main goals of a subjective examination?

A
  1. Determine SIN
  2. Make a hypothesis
  3. Plan a safe objective exam to prove/disprove hypothesis
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2
Q

What 5 general questions do you want to ask about their problem?

A
  1. What is the problem?
  2. Why is there a problem?
  3. How did it come about?
  4. What impact is the problem having?
  5. What factors may influence recovery?
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3
Q

What 5 things should you consider when communicating with patients?

A
  1. Body Language
  2. Tone of voice
  3. Motivational attitude
  4. Questioning style
  5. LISTEN
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4
Q

What 3 ways are symptoms classified on a body chart?

A

Site
Type
Behaviour

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5
Q

BODY CHART:

What are 3 categories you should ask about in behaviour of symptoms? (3)

A
  1. Frequency (constant, occasional)
  2. Aggravating / easing factors. Time taken to resolve
  3. Time of day of symptoms (morning, afternoon evening, night)
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6
Q

For nocturnal pain, what are 3 general questions you can ask?

A

• Difficulty getting to sleep?
• Wakes because of pain or something else?
• How long to get back to sleep?
• Mattress? Pillows? Different if changes bed?
Is it because of turning?

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7
Q

What are severity and irritability with respect to symptoms?

A

Severity – The degree to which the symptoms affect function / pain intensity – usually VAS score /10
Irritability - The degree to which the symptoms increase with provocation and how quickly they ease.

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8
Q

Give an overview of the categories of questions you need to ask (ex. present condition) (5)

A
  1. Present Condition (PC)
  2. History of Present condition (HPC)
  3. Past Medical/Surgical history (PMSH)
  4. Drug history (DH)
  5. Social history (SH)
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9
Q

For pain in the morning or during the day, what 3 questions can you ask?

A

Is your pain on waking? On rising?
Do you have early morning stiffness?
Is it activity dependent? Do you have more pain at the end of day?

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10
Q

What questions should you ask for history of present condition? (HPC)

A 
Time of onset?
Mechanism of trauma?
Pain immediately? Swelling?
Possible causes?
Investigations so far/ results known?
Development of symptoms?
Previous episodes/treatments?
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11
Q

What are questions in their past medical history you should ask?

A

Does the patient have any history of previous major
illnesses, previous operations, accidents? Fractures? History of joint disease? Heart/Respiratory/BP? How is the patient’s
general health - any weight loss?

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12
Q

What are RED FLAG questions you should cover?

A 
Specific:
MJ THREADS
Myocardial infarction
Jaundice
Tuberculosis
Hypertension
Rheumatoid Arthritis 
Epilepsy 
Asthma
Diabetes
Stroke
General questions: 
CNS involvement
Malignancy
Serious systemic illness
Active inflammatory joint disease
Drug history/ abuse
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13
Q

What are yellow flag factors that are associated with poor outcomes?

b) What’s a handy mnemonic for remembering these categories?

A 
Catastrophic beliefs?
Fear avoidance behaviour?
Low mood/ social withdrawal?
Expectation of passive solution?
External locus of control (ie I need someone or something to "fix" me) 
b) ABCDEFW
Attitude about pain
Behaviours
Compensation Issues
Diagnosis and Treatment
Emotions
Family 
Work
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14
Q

What are some questions you can ask for past medical history?

A 
Major ops/accidents/illnesses?
General health / weight loss?
Epilepsy/Diabetes/Asthma/Malignancy, thyroid problems?
Heart/BP/respiratory?
Fractures?
History of joint disease?
X-rays/MRI's/other investigations?
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15
Q

What should you ask for their drug history (DH)?

A

All current medications
Steroids
Anticoagulants
Pain relief - adequate?

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16
Q

What should you cover in family history?

A

Hereditary diseases?
Genetic predisposition to pathologies?
Previous experience and health beliefs?

17
Q

What questions should you ask for their social history?

A

Occupation

  • Were they injured at work?
  • The physical nature of their work
  • Can they take breaks?

Leisure

  • Sedentary or active?
  • Hobbies - risky or safe?

Home responsibilities

  • ADLs
  • Childcare or caring for elderly
  • Sources of physical / mental stress
18
Q

Special Questions that are relevant to area?

A 
Parasthesia/Anaesthesia?
Bowel/Bladder control 
Unsteadiness/headache/nausea/disorientation
Locking/giving way/swelling/crepitus?
Unexplained weight loss?
19
Q

Special questions for spinal cord compression? (3)

A

Gait disturbances?
Bilateral parasthesia?
Bilateral limb weakness?

20
Q

What are 5 mechanisms of spinal cord compression?

A

Disc protrusion/herniation

  1. Tumor
  2. Infection (pus)
  3. Haematoma
  4. Fractures
21
Q

What are the main symptoms of cauda equina syndrome?

Why is this a medical emergency?

A

Saddle anaesthesia
Bowel/bladder incontinence
Bilateral sciatica
Sexual dysfunction

Cauda equina syndrome is compression in the spinal cord, which has very little protection or capacity for natural recovery. Can result in permanent paralysis if untreateed

22
Q

List risk factors for serious spinal pathology?

A 
Age >50, <20
History of cancer
Unexplained weight loss
Recent bacterial infection (e.g. UTI)
Immune suppression (medication or underlying condition)
Major trauma
Minor trauma in osteoporotic patient
Constant, progressive, non mechanical pain
Thoracic pain
Severe restriction lumbar flexion
Pain worse supine, severe night time pain
Structural deformity
Widespread neurology
23
Q

What are 6 risk factors for TB?

A

1) Past history
2) Family history/exposure
3) Travel to high risk areas
4) Night sweats, fever, cough
5) Persistent pain
6) Weight loss

24
Q

What are 7 warning signs of cancer?

A 
• Persistent pain at night
• Constant pain
• Unexplained weight loss (4.5-6.8kg
in 2 weeks or less)
• Loss of appetite
• Unusual lumps or growths
• Unwarranted fatigue
• Past history of cancer.
25
Q

Risk factors for inflammatory conditions of the spine

A
  • Gradual onset before age 40
  • Marked EMS
  • Iritis, psoriasis, colitis
  • Urethral discharge
  • Peripheral joint involvement
  • Reduced spinal movements in all directions
  • Family history
  • Night pain – waking in latter half of night
  • WORSE WITH REST, BETTER WITH EXERCISE
26
Q

What are the 4 stages of forming a diagnostic hypothesis?

A
  1. The structures involved in producing symptoms
  2. Stage of disease/healing process
  3. Prognosis
  4. . Severity / irritability of the problem
27
Q

What are the aims of an objective examination?

A
  1. Confirm/disprove hypothesis
  2. Establish baseline data for re-assessment and evaluation
  3. Contraindications/precautions
  4. Make clinical diagnosis
  5. Identify problems and goals for management
28
Q

What is the relevance of SIN to the objective examination?

A
  • Effect of pain on patient
  • The kind of examination required
  • Testing to onset of pain
  • Testing into pain
  • Testing to limit of available range
29
Q

What are the 8 stages of an objective examination?

A

Owen Finds Assless Pants Are Making Penelope Smile

  • Observation
  • Functional demo
  • Active movements
  • Passive movements
  • Accessory movements
  • Muscle tests
  • Palpation
  • Special tests
30
Q

During observation, what 5 things can you be watching for?

A
  • Formal and informal
  • Functional deficits
  • Abnormalities
  • Asymmetries
  • Gait
  • Muscle wasting
  • Swelling
  • Scars
  • Skin changes
  • Bony alignment
  • Positional deformities
31
Q

For active/passive movements, what are your main objectives? (4)

A

Look to reproduce symptoms.

  1. Consider structures stretched/compressed
  2. Willingness to move
  3. Pain at rest and SIN
32
Q

What are 10 factors to consider when looking at active/passive movements?

A
  • Range of movement
  • Pain
  • Behaviour
  • Limiting factor
  • Quality of movement
  • End-feel -normal/abnormal
  • Over-pressure
  • Combined movements
  • Sustained
  • Rapid movements
  • Move under compression
33
Q

What are 6 things to look for on palpation?

A
  • Temperature
  • Hyperhydrosis (sweating)
  • Swelling/deformity
  • Tenderness (hyperalgesia)
  • Crepitus- soft tissues or joints
  • Fibrotic changes
34
Q

If there is neurological involvement, what 3 types of tests do you want to look at?

A

Dermatomes
Myotomes
Reflex testing

35
Q

What are deep tendon tests measuring? What are some factors that can diminish or exaggerate the response?

A 
• Muscle stretch reflexes -test integrity
of spinal reflex
• Tested with reflex hammer
• Abnormality of nerve conduction →
diminution or loss
• Ageing also causes decreased
response
• Abnormalities relevant if found with
sensory and motor changes
• Exaggerated responses may indicate
CNS (UMN) problem
36
Q

What do neural provocation tests measure?
What are the main nerves tested?
What are 2 examples of neural provocation tests?

A 
• Ability of nervous system
to be subjected to tensile
loading
• Tests nerves, connective
tissues, associated blood
vessels

Main nerves tested:
• Sciatic, femoral, median, radial, ulnar

1) Straight leg raise
2) Upper limb tension test

37
Q

What are 5 common errors in assessment a physiotherapist can make?

A
  1. Representativeness shortcuts (assumptions based on
    triggers)
  2. Availability shortcuts (that which comes easily to mind)
  3. Overconfidence (in yourself, in your techniques: don’t be
    a physio evangelist)
  4. Confirmatory Bias (if you look for something you might
    just find it!)
  5. Illusory Correlation (In your diagnosis and treatment)
    “Post hoc, ergo propter hoc.

MSK I (3 decks)

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