Physical Examination Flashcards
aims of physical exam
confirm musculoskeletal dysfunction
prove or disprove diagnostic hypotheses from subjective - articular, muscular, neural combo
- pain and movement responses to physical tests
establish baseline data
overview of physical exam
observation functional testing ROM - active, passive physio, capsular pattern scan adjacent regions muscle tests neurological tests neurodynamic tests palpation accessory movements ligamentous tests special region specific tests
muscle tests
Strength:
Isometric /Conc/Ecc
Muscle Control
Length / Flexibility
neurological tests
function / conduction (2nd year)
neurodynamic tests
nerve sensitivity to movement
ligamentous tests
stability / function
pain
what determines PE inclusions
Pain - severity, irritability stability of condition - improving or worsening clinical reasoning time constraints patient comfort
observations needed to be made
willingness to move/ functional level gait general build posture bony structure and alignment muscle bulk, tone skin - incision, texture, colour presence of oedema
functional testing examples
gait running on treadmill squatting overarm throw reaching overhead
when should we start with functional test
if pain is;
non severe
non irritable
aim of functional testing
observe technique / control / movement dysfunction provoke pain (if not severe/irritable)
capsular pattern
proportional motion restriction that indicates irritation of the entire synovial membrane or joint capsule, as occurs with an active inflammatory or degenerative joint changes
non capsular pattern
motion restrictions in proportions other than the capsular pattern
isometric/resisted muscle testing
Resistance applied in joint rest position
what does isometric/resisted muscle test for
Assess for weakness
Assess for provocation of pain
implies contractile unit lesion
strength muscle testing
Graded isotonic contraction - see Kendall & McCreary (2005)
E.g. Oxford Scale
purpose of strength muscle testing
to see how injured muscles react to pain
how do injured muscles react to pain
spasm -overactivation
inhibition - underactivation
examples of muscle control testing
E.g. During functional tasks
Stepping on and off step
Squatting
purpose of neurological examination
examine state of peripheral and central nervous
neuro tests
Deep Tendon Reflexes (DTRs) E.g. Patellar, Achilles absent 0, depressed +1, normal +2, exaggerated +3 MYOTOMES DERMATOMES Balance Co-ordination
what us palpation useful for
Useful to record also on body chart or palpation chart
palpations note
Temp Skin moisture Oedema / effusion Superficial tissues: mobility, ganglions / cysts Muscle spasm /Trigger points Bony prominence / tenderness
accessory movements assess
Motion abnormality (hyper or hypo) Quality of motion Pain behaviour through range: local & referred Resistance through range Reactivity of muscle
possible findings of ligamentous tests
Lax & painful
Lax & painless
Normal laxity & painless
Normal laxity & painful
examples of region specific tests
Shoulder: Empty Can test
Knee: McMurray’s meniscal tests
Hip: Flexion/Adduction (Scour)test
by the end of the physical exam i should
Identify the dysfunction Confirmed or rejected hypothesis from Subjective examination
Identify treatment options
Identify outcomes to establish goals and monitor treatment
Determine Prognosis
