UE Examination Sequence

Question 1

What is the Filtered Approach?

Answer 1

• hypothetical deductive reasoning
• develop a hypothesis
• try to rule-in/out hypothesis
• refine the hypothesis
• facts & logical rules

Question 2

What is the difference between the clinical reasoning of Hypothetical Deductive and Gestalt?

Answer 2

Hypothetical Deductive - filtered approach, starts with overview, standardized, based on probability, early in career
Gestalt - pattern recognition, starts small, not standardized, used later in career

Question 3

When having your patient perform AROM during your regional examination what are you looking for?

Answer 3

• if movement is functional (normal length)
• if movement is dysfunctional (short)
• painful or non-painful

Question 4

When having your patient perform AROM during your regional examination when do you know or its indicated to perform PROM?

Answer 4

• if AROM is dysfunctional (short)

Question 5

During your regional examination you are performing PROM on your patient, when do you know if your suppose to apply overpressure?

Answer 5

• if PROM is dysfunctional (short)

Question 6

Why would you want to apply overpressure to a joint?

Answer 6

• to determine the end-feel
• • firm/hard = joint
• • elastic = soft tissue
• • empty = pain

Question 7

During your regional examination how are you going to determine what joints you need to check the accessory motion and why?

Answer 7

• if it’s PROM is dysfunctional (short)
• to determine if hypo- or hyper- compared bilaterally
• does accessory motions reproduce symptoms

Question 8

During your regional examination what is your indication that you need to check muscle length of a joint?

Answer 8

• if the joint has an elastic end-feel

Question 9

During your regional examination how the heck do you know when or when not to check manual muscle test?

Answer 9

• not appropriate with moderate to high levels of pain
• weak & pain-free = neurological lesion or full thickness tear (not sure but I am not MMT this dude)
• weak & painful = major muscle tear (probably not this guy either, maybe flip a quarter heads for MMT and tails no MMT)

Question 10

Using the Staged Rehabilitation System what is the appropriate treatment order?

Answer 10

1st - Pain/Inflammation
2nd - Mobility Dysfunction (jt mobility then TED)
3rd - Stability/Motor Control Dysfunctions

Question 11

What are the four major categories in the Staged Rehabilitation System?

Answer 11

• Pain/Inflammation
• Mobility
• Stability/Muscle Performance
• Neuromuscular/Functional Training

Question 12

What region specific information is critical to your examination with your patient who has a acute cervical injury?

Answer 12

High Risk factors
- pt older than 65
- dangerous mechanism of injury
- paresthesia in extremities (pins & needles)
Low Risk factors
- simple rear-end motor vehicle collision
- sitting position in the emergency department
- ambulatory at any time
- delayed (not immediate) onset of neck pain
- absence of midline cervical-spine tenderness
Can pt rotate 45° left and right

Question 13

If a patient demonstrate ataxia walking back to the exam room what should you do?

Answer 13

• refer the patient

Question 14

What resisted muscle test is there for testing a patient with a stays in a forward head posture for an extended period time?

Answer 14

• deep neck flexor endurance
• 30 sec is normal
• want 60 sec if pt has headache

Question 15

What region specific information is critical to your examination with your patient who has a shoulder injury and why?

Answer 15

• TUBS “torn loose” or AMBRI “born loose”
• a traumatic causation of injury means you refer the patient
• a minor trauma, multi directional instability, bilateral means you treat the patient

Question 16

What region specific information is critical to your examination with your patient who has a elbow injury and why?

Answer 16

• observe to see if the patient is extending his arm fully, if not perform elbow extension test, refer if test is positive.
• if patient can’t extend arm fully he/she may have a structural deformity that needs to be determined via x-ray

Question 17

What region specific observation is critical to your examination with your patient who has a hand/wrist injury and why?

Answer 17

• atrophy of the thenar (median n.) and/or hypothenar (ulnar n.) muscles of the hand can indicate nerve involvement.