UNIT 1 Flashcards
how to tell a mechanical from a non mechanical prob
a mechanical prob, the px is modified by movement or rest, non mechanical prob is constant
If we are not able to reproduce the px, we may have to
refer them out
ICF model
health cond to body structure and function to participation rest to activity limitation then personal and env factors
4 main parts to what we do (new pt)
examination -collect data
assessment - interpret data
intervention - develop and implement plan
assessment - reeval
What is 2 compartment thinking
we need to be open to the idea that not everything will fit in to a cookie cutter scenario (brick wall vs permeable wall)
A pos response to your tx indicates that your hypothesis was ___
correct
2 common errors with clinical reasoning
over emphasising findings to help support one hypothosis
ignorning findings that don’t support your hypothesis
SINSS
severity irritability nature stage stability
What is the severity part of SINSS
your assessment of the intensity (min, mod max)
what is the irritability part of the SINSS
amt of activity needed to cause sx
severity of sx
time it takes to subside sx
What is nature
structure that is causing the issue
what is stage
acute, subacute, chronic
what is stability
better or worse (ease of disturbance)
acute is what time frame
less than 30 days (inflammatory phase)
sub acute is what time frame
30 days to 6 mos
chronic is what time frame
after 6 mos
proliferation stage is associated with what phase
sub acute
a physical finding
sign
problem reported by pt
sx
what is clearing a jt
you have to check above and below the joint that is causing the prob, do passive over pressure and testing of all 3, then place a single check mark over the joint on the body chart to indicate cleared
P1
primary complant
C
constant
I
intermittant
/////
numbness or tingling
a sign found on an objective exam that reproduces sx (px)
comparable sign
D vs S
deep vs superficial
our focus in the subjective exam
to find all of the behavior and characteristics of their issue and sx
BTS
back to sleep
HBH
hand behind head
HBB
hand behind back
HF
horizontal flexion
red flags (many children will fall down without loving care NN)
Malaise Chills/fever Wt change Fatigue Dizziness Weakness Lightheadedness Cough N/V Numbness tingling
px that occurs before any resistance is felt, you would do what grades of joint mobs
1 or 2
If px doesn’t increase when resistance is felt, you should be ok doing a grade
3 or 4
what is the closing part of our exam
“is there anything you can think of you need to share that I haven’t asked about”
when should you have 3-4 hypotheses formulated
after your subjective exam
4 catagories to guide you to the extent of your tests/exams
px, ROM, overpressure feel, sustainability
3 stages of intervention
1 - to relieve the primary issue (ex: px)
2 - relieve the movement issue
3 - aid with global issues
when should you test pxfull mvmts
at the very last, or not at all (depends on scenario)
AROM tests what type of tissue
both contractile and inert (focus is on contractile)
PROM tests what type of tissue
inert only
what is PAM
Passive accessory movement (mobs)
PAMs test what kind of motion
arthrokinematics (mvmt within joint articulation)
resisted motion tests, test what type of tissue
contractile
how are resisted motion tests and MMT different
resisted motion tests do not test strength
in order for resisted motion test to really be effective, pt MUST be in ____ position
resting
Scale for resisted motion testing
strong and painless
strong and painfull
weak and painless
weak and painful
if the resisted motion test is strong and painless, this indicates that it is not ____ tissue
contractile (contractile would be painful)
If the resisted motion test is strong and painful, this indicates that it is probably ____ tissue that is effected
contractile (like a strain)
If the resisted motion test is weak and painless, this indicates that the problem is probably
neuro
if the resisted motion test is weak and painful
serious contractile issue or even possible fx
explain how we test dermatomes
light touch sensation
What is DTR
deep tendon reflex (with reflex hammer)
what is the segment for achilles reflex
S1
segment for hamstring reflex
L5
segment for patellar reflex
L4
Scale for reflexes grading
0 nothing 1 hypo 2 normal 3 hyper 4 clonus
hyporeflex would indicate
peripheral issue
hyper reflexive indicates
systemic issue (cortex, spinal cord)
order of your obj eval
OPAPP RMLNF SC observe, palpate, arom, prom, pam resisted testing, mmt, length test, neuro, functional special tests, clear
when does discharge planning start
day 1
what 4 main factors need to be considered when determining a prognosis
demographics
disease factors
bio-behavioral factors
other med conditions
how many nocioceptors are in art cart
none
2 functions of rectus femoris
knee ext, hip flexion
origin of rf
A I I S
actions of adductor longus
adducts hip, IR hip, flexes hip
actions of TFL
FBI
glut min and med actions
FBI
glut max axns
EEEswings (extends hip, extends knee, externally rotates hip, abduction and adduction)
O and I for glut min and med
ilulm to greater trochanter
O and I for glut max
illum, sacrum and coccyx
to the gluteal tuberosity and the IT band
explain muscle length test for gastroc
start with them in seated pos on table
goni measure dorsi
(below lat malleolus, 5th meta, fib head)
the have them extend knee and remeasure, if second measurement is a smaller number they are tight
explain Thomas test
you have pt at end of table (like they were going to sit on it) you guide them back to a supine position as you keep your hand at lumbar spine
as you stabalize tightly as ASIS and PSIS you have them grab behind their opposing knee and have them hold it as you let testing leg drop. if they can reach all the way to table with testing leg, iliopsoas is not tight. if leg reaches table but knee extends then the tight muscle is the RF, If you can abd the leg and get more depth then TFL is the prob
how do we grossly test labrums
compression
before we palpate muscle tissue, what should we have pts do to ensure we are on the correct structure
have them contract the muscle
list inert tissue
bone, capsule, lig, bursa, fascia (anything but muscle)
unwilling to move vs unable to move
unwilling -dt px
unable - dt tissue immobility
AROM tests
contractile tissue and lets you see their response to the movement
list the abnormal end feels
empty, spasm, springy, capsular
what is a capsular pattern
a predictable loss of function that goes along with OA or degneration (look up the specific motions)
px before end feel is usually what stage
acute inflammation
px right at resistnace would correspond with what stage
subacute
if there is no px even after resistance, this would make you think
there is no inflammation
px felt with AROM and PROM with mvmt in agonist direction of muscle would make you think
inert tissue
essentially, contractile tissue should not experience px with _____ROM
PROM
px felt when going opp direction of the muscle (PROM AND AROM) would make you think
contractile tissue - stretch
if you are extending the hip in PROM and there is px in the hip flexors, what tissue is this
contractile
with PROM, if px is felt and you are not stretching the antagonist, then the issue is probably inert tissue
correct
myotomes (8)
L2 - hip flexion L3 - knee ext L4 - dorsi and inversion L5 - toe ext S1 - peroneals S2 toe flexion S1 and S2 together - knee flexion and hip ext
L3 dermatome location
medial lower thigh
L4 dermatome location
medial lower calf
L5 dermatome
top of foot
S1 dermatome
peroneals
S2 dermatome
behind knee
hip flexion corresponds with
L2
knee extension corresponds with
L3
Dorsi flexion corresponds with
L4
toe ext corresponds with
L5
peroneals correspond with
S1
toe flexion corresponds with
S2
L5 dermatome is where
top of foot
S1 dermatome is where
peroneals
S2 dermatome is where
behind the knee
L3 dermatome is where
low medial thigh
L4 dermatome is where
medial calf
pronated posture suggests what muscle is elongated
tib. posterior
supinated posture suggests that what is elongated
peroneals (tib post is shortened)
TF angle should be
170-175
if TF angle is greater than 180
genu varum (bow leg)
if TF angle is less than 170
genu valgus
angle from asis, patella and tibial tuberosity
Q angle
what is super tight in genu recurvatum
quads (and gastroc will be too)
if a person has a flexed knee posture, what is tight
post capsule (quads will be weak)
with ant pelvic tilt, quads are
quads are tight
gluts are weak
with post pelvic tilt what is tight
hams are tight
ant pelvic tilt, ____ are tight
quads and hip flexors
ant pelvic tilt ____ are tight
quads and hip flexors
ant pelvic tilt _____ are tight
quads and hip flexors
decreased lumbar curve indicates tight
hams (post pelvic tilt)
in addition to tight quads, with ant pelvic tilt, what 2 muscle groups are weak
hams and abs
speed of ossilation of mobs
2-3 oscillations per sec or 30 sec)
absolute contraindications for joint mobs
Malignancy – especially bone Tuberculosis – acts like severe OA Osteomyelitis – bone inf Osteoporosis Fracture Ligamentous rupture (eg Alar ligament) Disc prolapse with nerve root compression
the assessment of joint mobility we do (scale 0-6), what findings would we not want to do joint mobs and why
4, 5, 6 we typically don’t do mobs on unless they have px (these are hyper mobile)
difference btwn grade 1 and grade 2 mob
both are before resistance
There is only one difference between a Grade 2 oscillation and a Grade I: Grade 2 amplitude is large and a Grade I amplitude is small.
so grades 1 and ___ are small ossilations and grade 2 and ____ are large ones
1 and 4 = small
2 and 3 = large
why might you want to do a grade V
to “snap” adhesions or alter/move structures in the joint
small, slowly adapting mechanoreceptors, found in the superficial joint capsule. They provide information concerning the static position of the joint, and contribute to regulation of postural muscle tone; kinesthetic sense; direction and speed of movement, and regulation of muscle tone (describes what type of mechanoreceptor)
type 1
medium sized, rapidly adapting mechanoreceptors, found in the deeper layers of the joint capsule. They fire only on quick changes in movement (i.e. are dynamic), providing information about acceleration and deceleration of joint movement (i.e. the change in speed of movement) (describes what type of mechanoreceptor)
type 2
dynamic/inhibitive mechanoreceptors are type
3
non adapting px receptors are type
4
we want to stimulate these receptor types with standard joint mobs
1 and 2
in the stress/strain curve, grade 1 and 2 joint mobs are where on the graph
elastic
in the stress/strain curve, grade 3 and 4 joint mobs are where on graph
plastic
the only time you might do joint mobs on a hypermobile joint is to tx
px
after a grade III or IV joint mob, _____ should be done to optimize mobility in the joint
exercise
What is post pred value
High PPV: indicates a (+) test is a strong predictor of the disorder“True positives (likely hood they actually have the pathology)
you want sensitivity closest to
1.0
sensitivity tests
Test’s ability to detect patients who actually have the disorder as indicated by a reference standard
specificity tests
Test’s ability to detect patients who actually do not have the disorder as indicated by a reference standard
spin snout
if specificity is high (rule in) and the test you do is pos, the likely hood that they have it is
very high
spin snout
if specificity is low and the test you do is pos, the likleyhood they have it is
unclear
most widely used imaging
xray
explain grading scale for PAM assessment
0/6 = there is no motion between the two articulating surfaces. Mobilization/manipulation is not indicated because the joint is ankylosed. 1/6 = there is considerable limitation in the excursion between the two joint surfaces. 2/6 = there is slight limitation in the excursion between the two joint surfaces. 3/6 = the amount of movement between the joint surfaces is normal. 4/6 = there is a slight increase in the excursion between the two joint surfaces. The patient should be treated with stabilization and postural re-education. Taping and bracing may also be used. 5/6 = there is a considerable increase in the excursion between the two joint surfaces. Treatment is similar to that listed in 4/6. 6/6 = The joint is unstable.
