OSCE Flashcards
Articulation mechanisms:
- Decrease in pain via descending neural pathways to reduce nociceptive input
- Stretch of joint capsule and connective tissues
- Improve fluid flow and drainage to assist with a reduction in inflammation
Soft Tissue mechanisms:
- Stretch shortened tissues, capsules and connective tissues
- Reduction in pain by activating central inhibitory pathways
- Promoting tissue healing and repair
- Fluid drainage to assist with reducing inflammation
- Reflex muscle action
Inhibition mechanisms:
- Stretch contraction knots
- Reflex muscle action
- Help to promote fluid flow and drainage to assist with reducing inflammation
Counterstrain mechanisms:
- Nociceptor model: decreases nociceptive input and reduce pain
- Neurological model: decreases mechanoreceptor or muscle spindle input, and can assist to reduce muscle guarding and tone
- Fibroblast response: reduces the fibroblast inflammatory response to tissue stress and can assist with decreasing inflammation
MET mechanisms:
- Stretch myofascial tissues
- Inhibition of pain: descending central pain inhibition
- Contraction and relaxation can help reduce inflammation and promote fluid flow
- Improve proprioception and motor control
- Reflex muscle reaction
Framework for presenting to a clinician
- Name, age, occupation
- new/return patient
- presenting complaint (acute/chronic/recurrent SQIRTNAR)
- history of complaint
- red flags
- medical history
- Psychosocial factors
- Differential diagnosis
- Plan for assessment
Transient side effects HVLA:
- increase in pain/discomfort that may radiate/travel
- stiffness
- tiredness/fatigue
- headache
Relative contraindications of HVLA?
- disc herniation/prolapse
- pregnancy
- spondylolisthesis
- osteoporosis
- vertigo
- ligament laxity
- corticosteroid/anticoagulant use
Cervical risks:
- unresolved disc herniation or nerve root compression
- cervical/thoracic muscle strain
- spinal cord compression
- stroke (risk very low)
Thoracic risks:
- strain of the muscles in the rib, thoracic spine or shoulder regions
- fracture of the ribs, or thoracic vertebrae
- spinal cord compression
Lumbar risks:
- strain of the muscles in the shoulder, rib, thoracolumbar and pelvic regions
- unresolved disc herniation or nerve root compression in the mid and lower spine
- vertebral fracture
- spinal cord compression (cauda equina syndrome)
Upper limb neuro components:
Obs
Sensory - pain, light touch, vibration, proprioception
Motor - myotomes, tone
Reflex - biceps (C5,6), BR (C5,6), Triceps (C6,7)
Coord - alt hand on thigh, point to point, finger tap
Peripheral vascular exam
Vitals: HR, RR, BP (both arms), Temp
Obs: size, symmetry, skin changes, cyanosis (palms), capillary, temperature gradiant
Pulses: radial, brachial, carotid, dorsalis pedis, post tibial, femoral
Auscultate for bruits: heart, renal and femoral
Palpate aortic diameter
CV exam:
BENCH AT 30 degrees (RT side)
Obs: distress, breathing difficulty, sweating, overweight
Vitals
Pulses: radial, carotid (ausc for bruits) - grade 0-3+
JVP
Heart: palpate & auscultate
SIJ Ortho tests
Flamingo
Active SLR
Thigh thrust
