Objective Exam (1) - Musculoskeletal Flashcards
parts of objective exam
general guidelines
observation
palpation
exam of joint movement
resisted tests
neurological testing
special tests
which side is tested first
unless bilateral movements are required
the good side is tested first
why do we test the good side first
provides baseline data
shows the pt how to perform movement
gives us something to compare to
what movements are done first
active before passive
why do we check active before passive
gives us a baseline on muscle strength, ROM, willingness to move and coordination
helps locate sxs
what movements are done last
painful movements
to prevent overflow of pain to the next movement
why do we do painful movements last
dont want to irritate the pt’s sxs
make the pt feel more comfortable and relaxed
causing pain may affect other motions
what happens if AROM is not full
over pressure is applied
be careful as we must remember normal vlaues
what is AROM is full
over pressure is applied
if AROM is full
evaluate for end feel
if its full there is no need to do PROM
each active, passive or resisted isometric movement is
repeated several times
why are movements repeated several times
repetition may change sxs
ROM may increase
repetition may change sxs
either positively or negatively
how are resisted isometrics done
in neutral position
recommended testing position
place join in mid range
when doing passive or ligament laxity testing
look at the quantity of opening
look at quality of the opening at the joint
what do it feel like
what do we do during passive or ligament laxity testing
evaluating the amount of movement
evaluating the end feel
what point do we go to during ligamentous testing
up to the pint
not beyond
what happens if we go beyond the pain during ligamentous testing
may cause fiber damage
these tests must be passive with no muscle guarding
at completion of the eval
warn the pt that they may experience an exacerbation of their sxs
reassure them that this is normal and sxs will resolve
what should we tell the pt after completion of the eval
instruct them to manage their pain indefinitely
give them instructions or a HEP
observation
begins the minute the pt walks into the clinic or you walk into their room
what should we take note of during the observation
how the pt walks
posture
ease of difficulty in which they move
what does the observation give us
info about what the effects of sxs have on their life
opportunity to look for inconsistencies
ex of inconsistencies
pt may complain of excruciating, constant pain
yet moves with ease
pts are…
innocent until proven guilty
palpation
integ integrity
anthropometric characteristics
what will palpation assist in
identifying the tissue at fault
can determine the extent of the tissue lesaion
how should palpation be done
systematic fashion
start on the unaffected side
what should we follow –> palpation
landmarks that are familiar and easy to location
areas of tenderness –> palpation
may be areas of pathology
what should we distinguish –> palpation
b/w different tissue textures
when tissue is inflamed –> it tends to get thicker
what should we identify –> palpation
tissue types, shapes and structures
to detect abnormalities
difference b/w dermis, fascia, muscles and ligaments
what may help determine the extent of an injury –> palpation
tissue thickness, induration and texture
induration –> palpation
hardening/stiffening
what should we feel for –> palpation
variations in temp
cool temp –> palpation
may indicate nerve or vascular involvement
heat –> palpation
may indicate infection or inflammation
what should we palpate
pulses
muscular tremors
fasiculations
what should we feel for on the skin –> palpation
dryness or moisture
we should discriminate –> palpation
tissue tensions
tissue tensions –> palpation
want to take the tissue to stretch –> then determine what is restricting it
what does it feel like
how may the tissue feel in acute conditions –> palpation
sweaty and warm
how may the tissue feel in a ligament injury –> palpation
exquisitely tender to touch
muscle layers may be swollen or hypertonic
how may the tissue feel in a chronic condition
skin may feel cold and tight or “bound down” to underlying layers
ligs may feel thickened and muscle layers fibroses
