Patient History Flashcards
____ is often our most valuable resource
the patient
what type of questions are ideal when taking pt history?
open-ended
what are red flags?
symptoms that may require immediate attention and supersede PT
what do red flags typically indicate?
- non-neuromusculoskeletal condition
- pathology of visceral origin
what are yellow flags?
- confounding variables which may be cautionary warnings regarding the pt’s condition
- require further investigation
- you need to proceed with caution
what are some red flags that can point to neoplasm?
- constant severe pain, esp at night
- unexplained weight loss
- loss of appetite
- unusual fatigue
- blurred or loss of vision
- frequent or severe HA
- persistent nerve root pain
- radicular pain with coughing
- paralysis
- trunk and limb paresthesia
- BL nerve root signs and symptoms
- difficulty with balance and coordination
what is a red flag that can point to thyroid dysfunction?
unusual fatigue
what are some red flags that can point to neuro dysfunction?
- blurred or loss of vision
- frequent or severe HA
- persistent nerve root pain
- radicular pain with coughing
- paralysis
- trunk and limb paresthesia
- BL nerve root signs and symptoms
- difficulty with balance and coordination
what are some red flags that can point to CV dysfunction?
- increased arm pain with increased CV demand
- shortness of breath
- dizziness
what is a red flag that can point to systemic infection or disease?
fever or night sweats
what is a red flag that can point to upper cervical impairment or CNS involvement?
dizziness
what is a red flag that can point to SC compression?
quadrilateral paresthesia
common components of an eval
- review pt chart
- pt history
- systems review
- observation/postural assessment
- upper quarter screen
- ROM/MMT
- joint mobility
- palpation
- special tests
why should a systems review be done on every pt?
to ensure they are safe to exercise
what are the components of a systems review?
- CV
- Cognition
- Neuro
- MSK
- Integ
why should a screening exam be done early on?
to ensure that the pt is safe for PT and that their condition is treatable by PT
by performing a screening exam, we are looking to either ____ or ____ the pt’s symptoms
reproduce or reduce
what are the goals of a screening?
- direct focus of clinical exam
- determine true location and nature of pt’s complaints
- may need to refer to another health professional
- determine if issue is an inert vs contractile tissue problem (could be both)
what do we analyze during an upper quarter screen?
- symmetry
- quality of movement
- willingness to move
- pain
- end feel
- scapulohumeral rhythm w/ arm elevation
what motions should happen at the scapula during arm elevation, and what does this prevent?
- ER, upward rotation, posterior tilt
- prevents subacromial impingement
what type of exam should we perform if we suspect possible cervical involvement and/or the pt reports feelings of numbness/tingling?
neuro exam
what might we test in a neuro exam?
- dermatomes
- myotomes
- reflexes
- pathological reflexes
what must you do if an area of your upper quarter screen reproduces the pt’s symptoms?
you must perform a complete evaluation in that area
observation begins when?
when the pt enters the clinic
should we observe the pt’s resting posture, corrected posture, or both?
both!
what are some causes of low shoulder?
- adaptive laxity of the shoulder
- leg length discrepancy
- scoliosis
- increased muscle tone
- hand dominance
what could a “balled up” muscle indicate?
possible muscle rupture
what could atrophy of the deltoid indicate?
axillary nerve injury
what could atrophy of the posterior deltoid indicate?
multidirectional instability
what could atrophy of the infraspinatus and supraspinatus indicate?
- RC tear
- suprascapular nerve injury
what could atrophy of the upper trap indicate, and what other muscle would likely be impacted?
- spinal accessory nerve inury
- SCM would likely be impacted as well
what could the scapula do to make you suspicious of serratus anterior atrophy without even looking at the serratus anterior?
winging
about how many cm and how many finger widths away from the thoracic spine is the medial border of the scapula?
- 5-8 cm
- 2 finger widths
what is the vertebral level of the scapula’s superior angle?
T2
what is the vertebral level of the spine of the scapula?
T4
what is the vertebral level of the scapula’s inferior angle?
T7
abnormal position of scapula at rest is common in shoulder ____ injuries
overuse
what are some signs of abnormal static scapular position?
- winging
- elevation/depression
- ABD/ADD
- rotation
- tipping
what should we observe when looking at someone’s posture?
- head on neck
- neck on trunk
- arm and scapula position
in normal posture, how much of the humeral head should be anterior to the acromion?
1/3
if less than 1/3 of the humeral head is anterior to the acromion, what could this indicate? Greater than 1/3?
- less than 1/3: tight posterior capsule
- greater than 1/3: anterior joint laxity
what is normal hand/arm position?
thumbs facing anteriorly or slightly medially
if posterior aspect of hand is showing, arms are ____
internally rotated
forward head + rounded shoulders often causes scapula to be ____, ____, and ____.
ABD, elevated, internally rotated
forward head + rounded shoulders often causes shoulders to be ____
protracted
what is the main result of forward head + rounded shoulders, and why do we care?
- decreased subacromial space
- can lead to subacromial impingement
