Ortho Exam Flashcards
Ortho Examination
-gather info
-evaluate pathology, impairment, activity, participation
-combining clinical experience with best evidence
Strength: relies on accuracy and quality of test
Tips: screening 1st, diagnostic at end, minimize pain
Test Selection
-help formulate interpretation and determine diagnosis
Reliability
-produces accurate, precise and reproducable info
Validity
-measures what it;’s supposed to
Significance
probability that something happens
Patient Interaction Model
- Explore disease/diagnosis and it’s effect on life
- Whole person
- Find common ground reguarding intervention or management
- Advocate
- Emhance relationship
- Realistic expectations
Structural Deformities
-don’t change with body position
Functitonal Deformities
-change with body position
Observation Questions
-prefering to sit, stand or move
-changing position often
-ADL assistance
-visible discomfort
-observations match Hx
-eye contact
When to Scan
- No obvious MOI
- Proximal Cause for Distal S/s
- Non-mechanical sounding Sx
LQ Scan
- Vitals***
- Observation: posture, plumb line
- Gait: look for gross abnormalities
- Functional MMts: squats***
- Balance Testing***
- Clear the spine**
- SI Joint Provocation**
- Myotomes: include functional testing (heel and toe walking)
- Dermatomes
- DTR: patellar, med hamstring, achilles
- UMN Testing: Babinski, clonus***
- Neurodynamic Testing: SLR, slump test**
- LE ROM: FABER, flx, DF/PF, toe flx/ext
- Pulses (optional)
- Lymph Nodes (optional)
Observations from Behind
Even: ears, scapula, ribs, arm gaps, iliac crests, PSIS, booty cheeks, knees, how many toes can you see?
-knee valgum/varum
Observations from Side
-spinal curves
-ears even with acromion
-ASIS to PSIS angle
-knee recurvatum
Observations from Front
Even: ears, clavicles, niples, arm gaps, iliac crests, ASIS, greater troch, knees, foot arch
-knee valgum/varum
UQ Scan
- Vitals (HR and BP)
- CNs (optional)***
- Observation: posture, plumb line, head, face, neck, mouth***
- Gait: look for gross abnormalities
- Clear the spine
- UE ROM (apleys)
- Dermatomes (C4-T2)
- Myotomes (C5-T1)
- DTR: bicep, brachioradialis, tricep
- UMN Testing: Hoffman’s ***
- Upper Limb Tension Testing**
- Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
- Thyroid (optional)
- Lymph Nodes (neck, and axilla) (optional)
Thoracic/Abdominal Scan
- Observation: posture, plumb line, sitting, rib hump, rashes
- Vitals (HR and, BP)
- Respiratory Excursion
- Clear the spine (sitting, cue for thoracic only)***
- DTR: Upper AND lower***
- UMN Testing: Upper AND Lower***
- Slump Test***
- Dermatomes (T2, T5, T8, T10, L1)
- Superficial Abdominal Reflex (T7-T12)
10: Aortic Pulse Palpation
- Abdominal Palpation
12: Chest Ascultation (heart and lungs) (optional)***
Clinical Decision Making
-foundation for pt care
-Dx made when all potential causes for s/s are ruled out
-pattern recognition
-catergorical reasoning
-narrative reasoning
-collaborative reasoning
-diagnostic reasoning
Sprains
Grade 1: ligament stetched
Grade 2: incomplete or partial tear, most pain, most common, reduced strength
Grade 3: complete tear, no pain, loss of function
Strains
Grade 1: Microtearing of muscle, mild pain and swelling
Grade 2: partially torn muscle, moderate pain, affecting activity
Grade 3: complete or avulsion, severe pain initially, defect, loss of function
Acute Stage of Healing
-inflammatory
-pain early in ROM
-0-10 (or 3) days
-chemicals irritate nerve endings
PT:
-prevent negative effects of rest
-reduce inflammation, edema, pain
-protect area
Teqniques:
-soft tissue, estim, cryo, US
-joint mobilizations (I-II)
-Muscle Energy Techniques
Subacute Stage of Healing
-proliferation and repair
-pain at endfeel
-2-22 days
-growth of capillaries, collagen formation, wound is covered, granulation tissue
PT:
-mobilize scar
-promote healing and function (PROM>AAROM>AROM)
-develop neurmuscular control
-pt education about 6w healing
Teqniques:
-soft tissue, estim, heat, stretching, isometrics, AROM
-joint mobilizations (II-III)
-HVLAT
-MET
Chronic Stage of Healing
-maturation and remodeling
-pain at overpressure
-12 days -1+ yr
-new collagen (type 2) to align with stress
-scar formation
PT:
-return to function
-increase tensile quality of scar
- develop functional independence
-mobilize scar
-improve neurmuscular control
Teqniques:
-soft tissue, stim, heat, stretching, strength training
-joint mobilizations (III-IV)
-HVLAT
-MET to prepare for ^^
Ligament Injuries
-trauma, mechanical stress, gender differences
-3-6weeks
-85% type I collagen, turn into type III
-30-50% weaker
Laxity:
-3 weeks= mild tension
-6 weeks= resume normal activities
-12 weeks= almost max tensile strength
Time:
-Grade 1: 0-3 days
-Grade 2: 3w to 6months
-Grade 3: 5w to 1 yr
-Graft: 3m to 2 yrs
Tendon Injuries
-singular incident or cummulative
-patial tear or rupture @ junction
-surgical repair essential for full return if >50% diameter
Healing:
-limited blood supply, 7.5x lower than muscle
-type III collagen aligned randomly (proliferative)
-increase in type 1 lonngitudianlly (remodeling)
Timelines:
-Tendinopathy/itis: 3-7 weeks
-Tendinosis: 2-6 months
-Laceration: 5w to 6 months
Muscle Injuries
Time:
-Exercise Induced: 0-3days
-Grade 1: 0-14 days
-Grade 2: 4 days to 3 months
-Grade 3: 3 weeks to 6 months
Hemostasis and degeneration
-Seconds to hour
-Stops bleeding through coagulation and growth factors to summon anti-inflammatory cells
-Brings fluid to the area to dilute substances and bring white blood cells
-Formation of a hematoma, necrosis of dead cells, beginning of inflammatory phase
Inflammation phase
-hours to days
-Goal is to inactivate injuries, agent, breakdown, dead cells, and promote healing
-Vasodilation, capillary, permeability, and increased white blood cells
-Key components are: blood vessels, blood cells, connective, tissue, chemical, mediators, collagen, basement membrane
Proliferation/Repair
-days to week
-Neovascularization starts making new vascular networks
-Angiogenesis forms, new capillaries
-Granulation tissue forms
-Tissue gaps are filled by proliferation
Remodeling and maturation
-Scar tissue, reduced in remodeled to increase strength and density
-weeks to months
- Tissue contraction.
- Tissue regeneration.
- Tissue repair.
Bone Healing Time
5 weeks to 3 months
Articular Cartilage Tear
2 months to 2 years
Principals of Ortho Exam
- Gather Hx (MOI, description of s/s and pain activity)
- To Scan or Not
- Test Uninvolved First
- AROM>PROM>RROM & Endfeels or Neuro
- Joint Play/Assessment (check for pain)
- Painful tests lasts
- Warn Patient about possible exacerbations
Physical Examination Components
- Pt Hx
- Systems Review
- Observation
- Scanning Exam (if needed)
- AROM>PROM>RROM & Flexibility
- Muscle
- Joint Play
- Palpation
- Special Tests
