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MSK > Ortho Exam > Flashcards

Ortho Exam Flashcards

1
Q

Ortho Examination

A

-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

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2
Q

Test Selection

A

-help formulate interpretation and determine diagnosis

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3
Q

Reliability

A

-produces accurate, precise and reproducable info

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4
Q

Validity

A

-measures what it;’s supposed to

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5
Q

Significance

A

probability that something happens

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6
Q

Patient Interaction Model

A
  1. Explore disease/diagnosis and it’s effect on life
  2. Whole person
  3. Find common ground reguarding intervention or management
  4. Advocate
  5. Emhance relationship
  6. Realistic expectations
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7
Q

Structural Deformities

A

-don’t change with body position

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8
Q

Functitonal Deformities

A

-change with body position

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9
Q

Observation Questions

A

-prefering to sit, stand or move
-changing position often
-ADL assistance
-visible discomfort
-observations match Hx
-eye contact

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10
Q

When to Scan

A
  1. No obvious MOI
  2. Proximal Cause for Distal S/s
  3. Non-mechanical sounding Sx
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11
Q

LQ Scan

A
  1. Vitals***
  2. Observation: posture, plumb line
  3. Gait: look for gross abnormalities
  4. Functional MMts: squats***
  5. Balance Testing***
  6. Clear the spine**
  7. SI Joint Provocation**
  8. Myotomes: include functional testing (heel and toe walking)
  9. Dermatomes
  10. DTR: patellar, med hamstring, achilles
  11. UMN Testing: Babinski, clonus***
  12. Neurodynamic Testing: SLR, slump test**
  13. LE ROM: FABER, flx, DF/PF, toe flx/ext
  14. Pulses (optional)
  15. Lymph Nodes (optional)
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12
Q

Observations from Behind

A

Even: ears, scapula, ribs, arm gaps, iliac crests, PSIS, booty cheeks, knees, how many toes can you see?
-knee valgum/varum

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13
Q

Observations from Side

A

-spinal curves
-ears even with acromion
-ASIS to PSIS angle
-knee recurvatum

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14
Q

Observations from Front

A

Even: ears, clavicles, niples, arm gaps, iliac crests, ASIS, greater troch, knees, foot arch
-knee valgum/varum

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15
Q

UQ Scan

A
  1. Vitals (HR and BP)
  2. CNs (optional)***
  3. Observation: posture, plumb line, head, face, neck, mouth***
  4. Gait: look for gross abnormalities
  5. Clear the spine
  6. UE ROM (apleys)
  7. Dermatomes (C4-T2)
  8. Myotomes (C5-T1)
  9. DTR: bicep, brachioradialis, tricep
  10. UMN Testing: Hoffman’s ***
  11. Upper Limb Tension Testing**
  12. Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
  13. Thyroid (optional)
  14. Lymph Nodes (neck, and axilla) (optional)
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16
Q

Thoracic/Abdominal Scan

A
  1. Observation: posture, plumb line, sitting, rib hump, rashes
  2. Vitals (HR and, BP)
  3. Respiratory Excursion
  4. Clear the spine (sitting, cue for thoracic only)***
  5. DTR: Upper AND lower***
  6. UMN Testing: Upper AND Lower***
  7. Slump Test***
  8. Dermatomes (T2, T5, T8, T10, L1)
  9. Superficial Abdominal Reflex (T7-T12)

10: Aortic Pulse Palpation

  1. Abdominal Palpation

12: Chest Ascultation (heart and lungs) (optional)***

17
Q

Clinical Decision Making

A

-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

18
Q

Sprains

A

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

19
Q

Strains

A

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

20
Q

Acute Stage of Healing

A

-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

21
Q

Subacute Stage of Healing

A

-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

22
Q

Chronic Stage of Healing

A

-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 ^^

23
Q

Ligament Injuries

A

-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

24
Q

Tendon Injuries

A

-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

25
Q

Muscle Injuries

A

Time:
-Exercise Induced: 0-3days
-Grade 1: 0-14 days
-Grade 2: 4 days to 3 months
-Grade 3: 3 weeks to 6 months

26
Q

Hemostasis and degeneration

A

-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

27
Q

Inflammation phase

A

-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

28
Q

Proliferation/Repair

A

-days to week
-Neovascularization starts making new vascular networks
-Angiogenesis forms, new capillaries
-Granulation tissue forms
-Tissue gaps are filled by proliferation

29
Q

Remodeling and maturation

A

-Scar tissue, reduced in remodeled to increase strength and density
-weeks to months

  1. Tissue contraction.
  2. Tissue regeneration.
  3. Tissue repair.
30
Q

Bone Healing Time

A

5 weeks to 3 months

31
Q

Articular Cartilage Tear

A

2 months to 2 years

32
Q

Principals of Ortho Exam

A
  1. Gather Hx (MOI, description of s/s and pain activity)
  2. To Scan or Not
  3. Test Uninvolved First
  4. AROM>PROM>RROM & Endfeels or Neuro
  5. Joint Play/Assessment (check for pain)
  6. Painful tests lasts
  7. Warn Patient about possible exacerbations
33
Q

Physical Examination Components

A
  1. Pt Hx
  2. Systems Review
  3. Observation
  4. Scanning Exam (if needed)
  5. AROM>PROM>RROM & Flexibility
  6. Muscle
  7. Joint Play
  8. Palpation
  9. Special Tests

MSK (30 decks)

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