Week 7 Flashcards
Abdominal Screen: name the 4 parts (Part 3- what should be percussed?; Part 4-name 2 areas and 1 test)
1.) Inspection
2.) Auscultation
3.) Percussion (liver)
4.) Auscultation (rebound tenderness, liver, spleen)
Splenic dullness (rational, +sign, how to perform)
-help assess for enlarged spleen upon palpation (upper L abdominal quadrant)
-dull sound with percussion when pt breathes in deep; splenomegaly
-pt supine with bolster under knees, expose abdominal region, rib 8-9 along mid-axillary line, percussion this region at rest & do it again when pt breaths in deep; should not hear a noise difference
Shifting dullness (rational, +sign, how to perform)
-looks for ascites (excess fluid in abdominal region); sometimes for psoriasis of liver
-change in noise while pt is sidelined
-pt supine and PT at the side of pt, start just lat to umbilicus and percussion this region and go laterally until you reach side of body; do same thing with pt sideline; should be no difference in sound
Murphy’s percussion (rational, +sign, how to perform)
-differentiate b/w back pain and kidney pain
-pain, kidney involvement
-pt seated or prone; bottom of 12th rib and put hand flat down and take other hand in a fist and thud the pt over your flat hand
Heel jar(percussion) (rational, +sign, how to perform)
-search for peritonitis, appendicitis
-test causes pain in lower quadrant(s)
-pt supine, feet are exposed, hold pt heel (cup it in 1 hand) and then other hand pounds on the heel you’re cupping
Heel drop (rational, +sign, how to perform)
-assesses if vibratory sensation causes pain in lower abs; peritonitis, appendicitis
-test causes pain
-pt standing, feet exposed, pt hands onto PT’s hands and goes on their toes and then drops to their heels
Iliopsoas Palpation (rational, +sign, how to perform)
-assess for iliopsoas abscess from peritonitis/appendicitis
-pressure produces pain; iliopsoas abscess
-pt supine in 90-90 knees/hips position, find ASIS and umbilicus, go 1/3rd way from ASIS and apply pressure (have pt flex hip to feel the muscle activation
Obturator muscle (rational, +sign, how to perform)
-looks for vertebral/osteomyelitis
-pain reproduced
-pt supine, PT on same side of leg being tested, pt goes into 90-90 knees/hips position and PT IRs the hip passively
McBurney’s point, Blumberg’s sign, Pinch an Inch (rational, +sign, how to perform)
-McBurney’s point: halfway b/w ASIS and umbilicus
-Blumberg’s sign:
-looks for peritonitis or appendicitis
-pain with rebound test- R side (appendicitis) & L side (peritonitis)
-pt supine and do rebound test at McBerney’s point (hold 3-5 sec.)
-Pinch an Inch:
- looks for peritonitis or appendicitis
-pain provoked
-pinch McBurney’s point and pull up and let go
Iliopsoas muscle (rational, +sign, how to perform)
-assess the muscle
-motion provokes pain
-active: resist hip flexion motion & passive: pt sideline and extend the leg that’s on top (hip flexor stretch)
Fracture screening auscultation with percussion techniques (rational, +sign, how to perform)
-use this when you’ve already ruled out soft-tissue involvement; high specificity/sensitivity; cautious of edema areas that can give a false positive
-dull/diffuse sound
-pt supine with pillow under knees for comfort, stethoscope on pubic symphysis (pt can hold it), grab patella with thumb/index finger and then percuss with other hand onto the kneecap your stabilizing (use 2 fingers); start with uninvolved then involved side
-key points: stethoscope on bony element, percussion on bone, use finger tips and snap down to get better transmission of energy through the bone
Fracture screening Tuning fork for pain provocation (rational, +sign, how to perform)
-when you’re looking at superficial bones (foot, ankle, wrist, clavicle, mandible); assesses for fractures/stress fractures
-ache/sharp soreness from the tuning fork
-256 frequency is best to use; if fork goes proximal to injury and pain occurs distally, you can assume a fracture; use pisiform or hard surface to vibrate the fork, hold from bottom of the stem, and hold next to injured area
Tuning fork: bowing or bending test (rational, +sign, how to perform)
-when you suspect a bony lesion or fracture; more for mid shaft injuries; high sensitivity; use this if percussion test isn’t working
-pt is apprehensive
-start slow and progressively more pressure; femur: 1 arm under thigh with pt seated and then apply pressure with other hand onto top of thigh near patella to create a bending moment; ribs: pt seated, PT has 1 hand on back and other on abs over ribs and squeeze hands together
Temporal Arteritis screen (rational, +sign, how to perform)
-pain with jaw/headache, pain with palpation over temporal area (muscles of mastication)
-pain over TMJ/temporal area with palpation
-ask pt about any visual disturbances; palpate artery bilaterally into the temporal/TMJ area with pt seated
Abdominal screen for AAA; observation, percussion, auscultation (rational, +sign, how to perform)
-mid/low back pain and worsens with activity; smoker/high cholesterol pts
-greater than 3 cm detection upon palpation
-pt supine (may be hooklying), Observe: belly wall and look for pulse, Palpate: 4 quadrants, aorta is on the L side and middle of the abs; push down slightly and observe if pressure is normal or not; make your way to the common iliacus (ASIS and umbilicus) and feel medial/inf to umbilicus and see the distance it takes to feel the pulse of the abdominal aorta
Anterior, posterior, lateral compartment screen (rational, +sign, how to perform)
-Anterior:
-ex: pain with shin splints; local blunt trauma
-more Ps noticed leads to anterior compartment syndrome
-6 Ps: Pain, Palpation pain, Pulse (dorsalis pedis), Palor (decreased arterial flow), Perioneal nerve (numbness, DF in weight bearing position)
-Posterior:
-ex: calf pain; local blunt trauma posteriorly
-don’t need all Ps to be present to be positive; just a few
-Ps: Pain, Palpation (posterior compartment pain), Pulse (tibial artery b/w med malleolus and Achilles), Palor, Paresthesias, Plantar flexion (MMT in weight-bearing)
Lateral:
-local lateral leg pain
-Ps: Pain location, Palpation (pain/tension along lateral leg), Superficial Peroneal nerve (dorsum of foot except webspace), Eversion (MMT)
Spinal percussion (rational, +sign, how to perform)
-use when pt has severe back pain, night sweats, potential spinal infection
-deep, dull, nausea ache, sharp pain with percussion
-pt seated in a forward flexed posture over the table with pillows under; start in non painful area first then progress to painful area; put finger over vertebra and tap on finger with the tuning fork
Lymph node screen
- criteria for normal vs abnormal findings- 4 topics
-Locations (cervical & shoulder)
-Diameter
-norm: 1-1.5cm
-abnormal: >1-1.5 cm
-Consistency
-norm: squishy
-abnormal: firm/hard
-Tenderness/pain
-norm: none
-abnormal: present even without palpation
-Mobility
-norm: should move easily
-abnormal: fixed to adjacent tissue
-Cervical: Supra/infra clavicular, front/behind ears, submandibular, along SCM/upper traps, suboccipital
-Shoulder: axillary (upper/lateral humerus, lats, thoracic rib cage), medial elbow
-Other: femoral triangle (anterior hip)
What 3 pt scenarios suggest a fracture may be present?
Major trauma
Minor trauma (compromised bone density, bony tumor, osteoporosis)
Repetitive or unusual activity (stress reaction injuries)
Name the criteria for plain films with the Ottawa Foot and Ankle Rules following trauma to ankle
Pain in malleolus region &
Palpation tenderness at distal fibula or tip of lateral malleolus
Palpation tenderness at distal tibia or tip of medial malleolus
Inability to WB 4 or more steps
Name the criteria for plain films with the Ottawa Foot and Ankle Rules following trauma to the foot
Pain in mid foot zone &
-Foot: Palpation tenderness at base of 5th met, navicular
Inability to WB 4 or more steps
-ankle: tenderness at tip of lateral or medial malleolus; inability to bear weight
Ottawa Foot and Ankle Rules: highly specific or sensitive?
Highly sensitive; there will be few false negatives but the low specificity shows there will be a high # of false positives
When would you do tuning fork pain provocation vs auscultation with bony percussion?
Tuning fork: useful for bony structures close to the surface such as the carpals and tarsals
Auscultation with percussion: better for deeper bony areas such as proximal femur and humerus
What’s a Jone’s fracture?
Fracture at base of 5th met that’s comminuted
