week 1 Flashcards
impairment vs diagnosis
Per the Guide to Physical therapy
Disease – The intrinsic pathogen or active pathology (i.e. cancer, IDDM, arthritis)
Impairment – Loss of normal anatomical, physiological, psychological status of an organism. (i.e.- decreased MMT, ROM, sensory changes.
Functional Limitation – limitation of performance of an organism as a whole. (i.e.- inability to ambulate, inability to feed oneself)
Disability – Limitation or disadvantage to perform socially defined roles within a culture, as it relates to age and gender. (i.e. quadriplegic patient)
Upper extremity evaluation- student notes 2024
Examination and evaluation for PT visit
EXAMINATION
The process of obtaining a history,
performing a systems review, and
selecting and administering tests and
measures to gather data about the
patient/client. The initial examination is
a comprehensive screening and specific
testing process that leads to a
diagnostic classification. The
examination process also may identify
possible problems that require
consultation with or referral to another
provider.
Evaluation for PT visit
EVALUATION
A dynamic process in which the
physical therapist makes clinical
judgments based on data gathered
during the examination. This process
also may identify possible problems that
require consultation with or referral to
another provider.
What kind of screen is the upper quadrant screen?
What is another name for it?
It is a neuro screen and it is know as the neuro screen
When is upper quadrant screen performed
When there are any symptoms distal to the acromion. or any suspicion of neurological or unusual involvement
In the upper quadrant screen there in UMN Tests. These consist of what?
Also called upper quarter screen
Also called Neuro screen or neurological screen
UMN tests” refers to tests for Upper Motor Neuron (UMN) lesions. These tests are used to identify signs of damage to the upper motor neurons, which are part of the central nervous system. Examples of UMN tests include:
Babinski Reflex: Stroking the sole of the foot to see if the big toe extends upwards (a positive sign in adults suggests an UMN lesion).
Clonus: Rapidly dorsiflexing the foot and observing for rhythmic contractions (more than three beats are considered abnormal).
Hoffmann’s Reflex: Flicking the nail of the middle or ring finger and observing for thumb flexion (a positive sign suggests an UMN lesion).
Increased Deep Tendon Reflexes (DTRs): Hyperactive reflexes such as exaggerated knee jerk or biceps reflex.
Spasticity: Increased muscle tone that results in stiff and awkward movements.
When do you do over pressure when using Active ROM
When there is no pain in normal ROM
What is end feel
sensation of feel at the end of a joints ROM
PROM measures what?
PROM
. Testing for inert tissue involvement
. Remember this is osteokinematic movement, not accessory
. Overpressure to check end feel
· End feel
. Sensation of PT’s hands’ “feel” at the end of a joint’s ROM
. Gentle overpressure at end range
What does PROM not measure?
Arthrokinematic motions, or acessory motion
What are joint surface levels or accessory motions
These are also known as joint play/ Arthrokinematic Assessment
Joint surface level” or “accessory” refers to accessory joint movements, which are the small movements that occur between the joint surfaces during normal motion. These movements are essential for full, pain-free range of motion and proper joint function. They are not under voluntary control and are necessary for the larger, voluntary movements of the joint. Accessory movements include:
Glide (Slide): One joint surface moves parallel to the plane of the adjoining joint surface.
Roll: One joint surface rolls over another like a tire rolling on a road.
Spin: One joint surface rotates around a stationary axis.
These movements are assessed and sometimes mobilized by physical therapists to improve joint function, reduce pain, and restore normal movement patterns.
Are arthrokinematic assessments done passively or actively
Passively
Passive vs. active rom
PROM vs AROM
Passive vs. active rom
. If active and passive motions are limited/painful in the same direction, the lesion is an inert tissue
. If active and passive motions are limited/painful in the opposite direction, the lesion is in the contractile tissue
Inert tissue
Inert Tissue
Inert tissues are those that do not contract or produce movement. They provide structural support and stability. Examples include:
Ligaments: Connect bone to bone and stabilize joints.
Joint Capsules: Enclose the joint and contain synovial fluid for lubrication.
Cartilage: Provides cushioning and smooth movement at the joints.
Bursae: Small fluid-filled sacs that reduce friction between moving parts.
Inert tissue lesions: If both active and passive motions are limited or painful in the same direction, it suggests that the problem is with inert tissues. For example, pain in both active and passive shoulder flexion might indicate issues with the shoulder joint capsule or ligaments.
Example:
Inert Tissue Lesion: Limited and painful active and passive shoulder abduction could indicate an issue with the shoulder joint capsule or a ligament sprain.
Contractile tissue
Contractile Tissue
Contractile tissues are those that can contract and produce movement. They include:
Muscles: Generate force and movement by contracting.
Tendons: Connect muscles to bones and transmit the force produced by muscles to move the bones.
Contractile tissue lesions: If active and passive motions are limited or painful in opposite directions, it suggests that the problem is with contractile tissues. For instance, pain during active elbow flexion and passive elbow extension may indicate an issue with the muscles or tendons involved in flexion.
Example
Contractile Tissue Lesion: Painful active wrist extension and painful passive wrist flexion might suggest an issue with the extensor muscles or tendons in the forearm.
More examples of short term goals
Short Term Goals:
. By 3 weeks patient will have:
. Patient will have increased Upper Extremity
Functional Scale by 9 points
. Patient will have increased shoulder external
rotation strength as measured by 1/2 MMT
grade
. Patient will have increased shoulder
abduction AROM by 15 degrees
More examples of long term goals
. Long Term Goals:
. By 6 weeks patient will have:
. Increased Upper Extremity Functional Scale by 18 points
. Patient will be able to drive without
compensatory motion
. Patient will be able to engage in all work
activities without compensatory motions
joints of the shoulder
. Glenohumeral Joint
. Acromioclavicular Joint
. Sternoclavicular Joint
. Scapulothoracic Joint
Stage approach for shoulder disorders
1st stage screen for red and yellow flags
2nd stage pathoanatomical diagnosis
3rd stage rehabilitation
Sub acromial impingement syndrome
Also known as SIS
Also known as impingement syndrome
Is a cluster of signs and syndroms
Shld Pain with overhead upper extemity motion
“Painful ark sign”
shoulder pain at night which is usually because of direct compression. (sleeping on affected side
Shoulder pain during repetitive motion, ex: overhead work activities
Signs and Symptoms of impingement syndrome
. AROM may display decreased motion or a painful arc
. PROM may be painfree (contractile lesion)
. Resistive may be painful in the primary motion of the involved structure
. Mobility testing normal unless there are long term capsular changes
Infraspinatus muscle strength test
Also known as infraspinatus muscle test
also known as External rotation resisted test
If all 3 tests are positive it would have ratio of 10.56
two tests would be 5.03
