Planning the Objective exam Flashcards
Think
Plan
Prove
framework for hypothesizing your hypotheses. THinking of predisposing, precipitating factors and perpetuating factors
Planning the physical exam to test
Proving your hypothesis and rule out others as needed
Check list to reduce errors
WHat is in front of me?
What else could this be?
IS it more than one thing?
WHat is the worst possible thing this could be?
Comparable sign-
The test or movement that reproduces the symptoms for which the patient is seeking tx
Planning the objective exam
WHat, how and how much?
WHen to progress forces
-condition not severe or irritable
-nature warrants no caution
-condition chronic and stable
-Aggravating factors suggest that comparable sign may be difficult to reproduce
-Symptoms not produced with standard testing
Way to progress AROM forces
Overpressures,
Sustained OP
Repeated motions
combined motions
increase speed
movement under load
Response to forces
Red light
Green light
Amber light
red- produced or increased and remains worst
Green-
-derangement pain decreased or abolished or better
-dysfunction- produced at end range and then reduced
Amber-
dereangement- pain produced but not worsened/improved
how to plan for OE
Area under symptoms, visceral, structures immediately above or below
-any clinical syndromes
-Think of primary and secondary hypotheses
-Any contraindications
Stenosis cluster
Age over 48
Better with sitting
Worse with standing and walking
Bilateral leg pain
Leg pain>back pain
Cervical myelopathy cluster
Age over 45
+hoffman
+inverted supinator sign
+babinski
Gait deviations
1/5= rule out myelopathy
3-4/5- 94-100%
P1 in OE
Where patient just starts to experience pain
Higher irritability- go to just here and then wait to see jow long they take to disappear
L in OE
FOr patients who are not severe or irritable
Goes to the limit of the range
When to not reproduce symptoms and what to do instead
-high severity and high irritability with latency
Perhaps go to P1 or just shy of P1
WHat to do when distal symptoms difficult to produce ex- lateral shin pain that occurs only after hours
Examine above and local
How to progress neurodynamics
Seated knee extension to SLR to Slump
If patient has red flags how should exam be adjusted
perform the exam clearing or assessing red flags first
ex clear canadian c spine rules, VBI or upper cervical instability in trauma cases before moving to neuro testing
lower cross syndrome
increased lumbar lordosis, TL hypomobility, midlumbar hypomobility, low lumbar hypomobility and tight hip flexors
Treating lower cross syndrome
facilitate abs and glutes
-inhibit and stretch erector spinae, iliopsoas and hamstrings
Upper cross syndrome
tight SO muscles, weak DNF, tight pecs and weak posterior periscapular musculature
