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Peripheral Musculoskeletal Science > The examination: subjective, physical and clinical reasoning > Flashcards

The examination: subjective, physical and clinical reasoning Flashcards

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1
Q

What are the 5 main aims of the subjective examination?

A
  1. collect and interpret info about problems from pt’s perspective
  2. develop therapeutic alliance
  3. understand pt’s beliefs, understandings, goals, preferences, insights
  4. identify any flags
  5. provide a basis and direction to p/e
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2
Q

What are red flags an indication of?

A

recent major trauma, severe pain with minor trauma, pain worse at night, pain that doesn’t improve with physio, history of cancer, IV drug use, immune suppression, neuro S+S, bowel or bladder disturbances

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3
Q

What are constitutional symptoms?

A

loss of appetite, unexplained WL, fever, chills, night sweats, fatigue, general malaise –> systemic illness

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4
Q

What are the 4 types of yellow flags?

A

Cognitive, affective, unhelpful/maladaptive behaviours, social

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5
Q

Why are yellow flags important to address?

A
  • influences behaviour
  • influences compliance
  • acts as a barrier to recovery
  • transition from acute to chronic
  • strong predictor of outcome
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6
Q

Yellow flag: cognitive

A

thoughts and beliefs -ve/unhelpful atitudes and beliefs, inappropriate expectations, poor self-efficacy, low expectations of recovery

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7
Q

Yellow flag: affective

A

emotional: depression, anxiety, fear, stress, worry

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8
Q

Yellow flag: unhelpful/maladaptive behaviour

A

slow rigid movements, inappropriate protection, inconsistent movement behaviours linked to attention, passive coping strategies, feat avoidance, withdrawal from interactions

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9
Q

What are blue flags?

A

employee and workplace factors that are barriers to recovery

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10
Q

What are black flags?

A

compensation and system factors

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11
Q

Yellow flag: social

A

low SES, low education, poor health literacy, poor family support

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12
Q

Examples of lifestyle factors

A
  • poor sleep - increased pain sensitivity
  • smoking - poor healing
  • chronic stress
  • sedentary lifestyle
  • adipose tissue
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13
Q

Examples of whole person considerations

A
  • poor self reported general health
  • widespread pain
  • diabetes
  • genetics
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14
Q

What is symptom severity?

A

how firm therapist needs to be to reproduce symptoms

-high SS = pain at rest, 7/10 pain, significant referred pain, sleep disruption

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15
Q

What is disorder irritability?

A

how easily (or not) the symptoms get worse, symptom severity when exacerbated, how quickly symptoms ease back to baseline level

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16
Q

What are the key components which point towards non-mechanical pain?

A
  • constant/widespread pain
  • stimulus-response decoupled
  • disproportionate pain in response to mechanical stimulus
  • inconsistent/unpredictable
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17
Q

What is the difference between a risk-screening tool and an outcome measure?

A

risk screening tool: identifies pts at risk of a poor outcome
outcome measure: used to evaluate change from one point to another

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18
Q

Why is it important to gain social history early?

A

To determine the effect of the pt’s problem on their function

19
Q

What should be included in the body diagram?

A

area of symptoms (in pt’s words), areas of parathesia, constancy of pain, nature of symptoms, 24h behaviour, depth, severity, relationship

20
Q

What is the significance of superficial vs deep pain?

A

Superficial: from localised tissue, precise location of perceived pain
Deep: referred or from deep structures, may have vague boundaries

21
Q

What is the significance of night pain?

A

spontaneously waking up/moving in bed causes pain = mechanical
preventing sleep = acute inflammation

22
Q

What is the significance of morning pain + lengthy stiffness?

A

inflammatory condition/state

23
Q

What is the significance of pain that increases through the day?

A

related to sustained or repeated loading

24
Q

What are asterisk signs?

A

signs that can be compared/reassessed between treatment sessions

25
Q

What are the key aims of the p/e?

A
  • confirm source of symptoms and nature of pathology
  • confirm/negate mechanical nature of injury
  • identify impairments and correlate with symptoms
  • establish involvement of neuro
  • exclude red flags
26
Q

What are the general components of the p/e?

A

Observation –> functional testing –> screening tests (AROM, PROM, passive over-pressure) –> combined movements –> passive accessory movements –> resisted isometric muscle tests –> manual muscle testing –> muscle length test –> motor control examination

27
Q

When would you test PROM?

A

when AROM is impaired

28
Q

What is the purpose of passive over-pressure?

A
  • pick up subtle ROM losses
  • get joint EF
  • gain comparable signs
29
Q

What are three normal end feels?

A

soft (soft tissue), form (capsular), hard (bony)

30
Q

What are three pathological end feels?

A

different on each side, springy, empty

31
Q

What are passive accessory movements?

A

normal subtle passive movements that occur between joints

32
Q

What is the purpse of resisted isometric muscle tests?

A

determines whether or not contractile muscle tissue is a source of symptoms

33
Q

What position should the joint be in when assessing resisted isometric muscle tests?

A

loose packed/mid position to minimize joint compressive forces

34
Q

What is the difference between open and closed packed positions?

A

Open packed: position with the least amount of joint congruency, capsule and ligaments are lax, joint play is maximised
Close packed: position with the most amount of joint congruency, capsule and ligaments are tight, accessory motion is minimised

35
Q

What is the definition of a diagnosis?

A

a patho-anatomical source of symptoms and underlying pathology

36
Q

What is the difference between a specific and non-specific diagnosis?

A

specific: specific patho-anatomical S+S, underlying pathology and MOI established
non-specific: patho-anatomical S+S not established with certainty

37
Q

What are the classifications>

A

Acute, sub-acute, chronic/persistant

38
Q

Acute classification

A
  • response to trauma/noxious events
  • traumatic onset - inflammatory response
  • non traumatic onset - tissue sensititsation
  • adaptive responses to facilitate natural recovery and prevent further damage
  • Mx: pain control, prevent further damage, explanation, reassurance, active Mx
39
Q

Sub-acute classification

A
  • traumatic - normal expected healing
  • non-traumatic - symptoms subside as part of disorder’s natural history
  • adaptive responses gradually extinguished
  • Mx: gradual restoration of function, address impairments, pain control
40
Q

Chronic/persistent classification

A
  • symptoms extend beyond expected period of healing
  • pain behaviours become mal-adaptive
  • Mx: ensure no red flags are missed, identify and address symptoms contributing to chronic symptoms
41
Q

What are the two classifications of peripheral MSK pain disorders?

A
  • movement impairment disorders: articular hypomobility, tight/hypertonic contractile tissue
  • motor control impairment (muscle imabalance
42
Q

Signs of articular hypomobility

A
  • pain/stiffness at EROM
  • decreased AROM and PROM
  • RI muscle tests pain free
  • firmer end feel earlier in range
  • decreased PAM
  • secondary impingements in muscle length, strength, endurance
43
Q

Signs of tightness/hypertonic contractile tissue

A
  • AROM and PROM decrease in direction that lengthens tissue
  • firm end feel
  • pain on palpation
  • normal PAM
  • pain free resisted iso
  • pain/pull at end of ROM
44
Q

Signs of motor control impairments (muscle imbalance)

A
  • pain provoked by movement
  • may be associated with joint laxity/instability
  • normal ROM
  • normal/increased PAM

Peripheral Musculoskeletal Science (2 decks)

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