Wk 1 MSK Flashcards
what is the physiotherapy process?
- subjective examination (SE) = PC, history, goals, contraindications
- objective examination (OE)= Physical assessment to confirm/refine hypothesis
- intervention= treatment and re assessment
what are the aims of physiotherapy process?
- establish a therapeutic relationship with the client
- create a clinical diagnosis from the likely hypothesis
- understand the patients goals and expectations
- establish the patients baseline capacities
- identify contraindication and precautions for treatment
- identify possible intervention strategies based on the information gathered
what is the aim and the structure of the SE?
- Gather sufficient information to clinically reason and plan a safe, person-specific physical examination, which identifies the likely hypotheses for the patient’s symptoms and underlying pathophysiology.
- The SE follow the Structure
1. Develop a Therapeutic relationship
2. Form a Clinical diagnosis: identify likely hypothesis for symptoms and pathophysiology, gather information to facilitate object examination
3. uncover the Patient’s goals and
understanding
4. uncover the patients Baseline capacities
5. uncover any Contraindications and
precautions (medical history)
6. Identify a possible Intervention strategies
what are the components of the SE?
- present complaint (PC)
- body chart (BC)
- history of presenting complain (HPC)
- Symptoms Behaviour (Sx Beh)
- Social history (SHx)
- Clients expectations, goals and understanding
- Past Medical History (PMHx)
- Outcome Measures (OM)
What is information is gathered in the presenting compliant section of SE and what is its purpose?
- The patients pc (condition or injury) and their main concern associated with this injury or condition
- the purpose is to establish the body part that is causing them trouble and their main concern with that (e.g pain)
What is the purpose of the Body chart and what information is gathered?
- The purpose of a body chart is to provide a visual representation of the symptoms to assist in forming a hypothesis
- This include information such as:
- location: where+ if the pain is local or referred pains
- quality: the type of pain/stage (ache, sharp, burning, throbbing, shooting, tingling, numb, acute or chronic
- depth: superficial or deep
- intensity: (0-10
- frequency: intermittent, constant or constant variable
- relationship to other symptoms: the correlation between pain and referral pain
- associated symptoms: swelling, bruising, clicking, instability, giving way, weakness, stiffness
What is the purpose of history of presenting complaint and what information is gathered?
- the purpose is to gain information about how the condition started and how it has changed since then to assist in forming a hypothesis
- The information includes:
- details about the onset of the injury: acute injury, overload injury or systemic issues?, how were symptoms managed by patient after the onset of pain
- details about the progression of symptoms: how have the changed overtime
- details about current management strategies: what is helping with the pain, have they seen another health professional
- details about previous episodes: has the patient had these symptoms before?
What is the purpose of the symptom behaviour and what information is gathered?
- the purpose is to uncover dominant pain types and recognise clinical patterns to form a hypotheses and plan for the OE
- the information gathered includes;
- symptoms severity and behaviour (across 24 hours how does the pain differ?)
- severity and irritability (mild, moderate or high pain)
What is the purpose of the Social history and what information is gathered?
The purpose of social history is to identify the impact of the symptoms on the patients life, identify contributing factors and understand the patients goals. These help to build a therapeutic relationship with the patient, and suggest possible treatment for OE .
- the information gathered includes:
- details about home, work/school and family life + exercise and hobbies
What is the purpose of the client expectations and contributing factors and what information is gathered?
-The purpose is to inform goal setting and treatment planning. Which in the process builds a therapeutic relationship
- The information gathered includes:
- client goals and expectations
- their understanding of what is going on/causing them pain
What is the purpose of the Past medical history and what information is gathered?
- the purpose of past medical history is to identify any precautions, contraindications and any contributing factors
- the information include:
- previous injuires
- general health (recent cold, fatigue, smoking, stress, anxiety ect
- medication
- diseases/red flags: THREADSCO
What is the purpose of the Outcome measure and what information is gathered?
- the purpose of outcome measures are to establish the patients baseline and asses the impact of that treatment through standardised test. This will inform goal setting and OE planning by suggesting possible treatments
- the information gathered includes:
- data from standardised test and questionnaires to establish the patients baseline and how it changes throughout treatment (positive or negative)
What is the purpose of the a Flag System and what information is gathered?
- the purpose is to inform the hypothesis, possible treatment strategies and the prognosis (the outcome e.g their prognosis is good, with recovery in a few week, their prognosis is worse, needing further medical assistance)
- the information gathered includes:
- Red flags: indicate serious pathologies (e.g., cancer, infections).
- Yellow flags: highlight psychosocial factors that may affect recover
what is the structure and aim of an OE?
- The aim and the structure of the OE is to:
1. develop a therapeutic relationship
2. clinically diagnose: determine if the hypothesis likely or unlikely, refine pathophysiology
3. uncover patients goals and understanding, determine contributing factors
4. establish the patients baseline capacities.
5. confirm and identify any red flags (contraindication and precautions)
6. provide management ideas (intervention strategies)
What are the component of OE ?
- Informed Consent
- Observation – Posture, deformity, muscle bulk, skin changes
- Functional Tests – Assessing movement quality, strength, endurance
- AROM/PROM/PAM – Active, passive, and accessory movements
- Muscle Testing – Strength, endurance, motor control (coordination)
- Special Tests – Ligament, joint stability, neurological tests
- Palpation – Tissue quality, swelling, tenderness, bony abnormalities, temperature
what information is gained from Informed consent and its purpose?
- asking patient for consent is required at almost every stage; avoiding any leading questions e.g is it ok if we go ahead ? instead use Are you happy to continue?
- its purpose is to ensure we do no harm to patient, they know exactly what is happening and because its a legal requirement of our jobs
what information is gained from Informed consent and its purpose?
- the purpose is to assist in the diagnosis and identifying any contributing factors
- the information gained from observation includes:
- deformity: joint or bone
- posture: asymmetry, adaptive or maladaptive (does posture support movement)
- skin changes: bruising, redness, swelling, scars
- muscle form: muscle bulk, atrophy
- Pain behaviours guarding, bracing, grimacing, rubbing
- gait
what information is gained from functional tests and what is it purpose?
- the purpose of functional tests are to see how well the patient can participate in life and activities, through the use of assessments and re assessments. This helps to inform interventions
- The information gathered includes:
- the patients relative functions: aggravating activities, functional requirements, goals
- the movement ability of multiple MSK functions: Pain, strength, Rom, muscle endurance, balance, dexterity, CV fitness flexibility
- the movement ability of multiple MSK structures: muscles, joints, ligaments, nerves
what information is gained from AROM and what is it purpose?
- The purpose is to:
- Assess Quality, Range, and Pain Response: Determines the functional capacity of joints and tissues, and identifies any discomfort associated with movement.
- Reproduce Symptoms: Helps in pinpointing specific structures or tissues that may be causing pain or dysfunction by replicating symptoms during movement.
- Bias Towards Contractile Structures: Focuses on muscles and tendons, as active movements primarily engage these tissues, aiding in identifying issues like muscle weakness or tendon injuries.
- Identify Contributing Factors: Recognizes elements such as joint stiffness, muscle tightness, or neural impairments that may limit movement.
- Set a Baseline: Establishes initial measurements to monitor progress and effectiveness of interventions over time.
- the information gathered includes:
- Joint Range and Integrity: Evaluates the extent of movement possible at a joint, helping to identify any limitations or abnormalities.
- Quality and Pattern of Movement: Observes the smoothness, coordination, and control during motion, which can indicate neuromuscular function.
- Muscle and Neural Function: Assesses the strength and activation of muscles, as well as the efficiency of neural pathways involved in movement.
- Patient’s Willingness to Move: Identifies any apprehension or fear of movement, which may be related to pain or psychological factors.
What is overpressure? (not required knowledge)
Definition: After a patient completes active range of motion (AROM), the therapist gently applies passive pressure to the joint at the end of its movement to assess the full extent of its capacity.
what is end feel? and what is considered normal?(assumed knowledge)
Definition: The sensation or quality of resistance the therapist perceives when applying overpressure at the end of a joint’s passive range of motion.
Types of Normal End Feels:
- Soft: Movement is restricted by soft tissue compression, such as in knee flexion.
- Firm: Movement is limited by taut ligaments or joint capsules, exemplified by wrist flexion.
- Hard (Bony): Movement is halted by bone-to-bone contact, as seen in elbow extension.
what information is gained from over pressure and end feel and what is it purpose?
- the purpose of over pressure is to determine if there are any limitations or pain beyond the active movement range, ensuring a comprehensive evaluation of the joint’s functionality.
- the purpose of end feel is to identify if specific structures are limiting movement. End feel also detects any abnormalities that may indicate underlying pathologies
- Information Gained:
- Joint Integrity and Range: Determines the completeness of joint movement and identifies any restrictions.
- Pain Assessment: Detects pain or discomfort at the end range, which can signal potential issues within the joint or surrounding tissues.
- Tissue Characteristics: Assesses the nature of the limiting tissue, whether it’s soft tissue, ligamentous, or bony, providing clues to the source of movement restriction.
- Muscle Response: Observes for muscle spasms or guarding, which may indicate protective mechanisms due to pain or instability.
what information is gained from PROM and what is it purpose?
- Passive Range of Motion (PROM) refers to the movement of a joint performed entirely by an external force—typically a therapist—without the patient’s active involvement. This assessment is crucial in evaluating the functional status of joints and surrounding tissues.
The information gathered from PROM includes;
- Joint Range and Integrity: PROM helps determine the full extent of movement possible at a joint, identifying any limitations or abnormalities.
- Quality of Movement: By observing the smoothness and resistance during passive movement, therapists can assess the condition of joint structures and surrounding tissues.
- Patient’s Willingness to Move: Although the patient is passive during PROM, their comfort level and reactions can provide insights into their willingness or apprehension towards movement, which may be influenced by pain or psychological factors.
Purpose of PROM Assessment:
- Assess Quality, Range, and Pain Response: Evaluates the functional capacity of joints and identifies any discomfort associated with passive movement.
- Clinical Reasoning: Assists in determining whether limitations are due to non-contractile structures (e.g., ligaments, joint capsules) since muscles are not actively engaged during PROM.
- Comparison with AROM: By comparing PROM with Active Range of Motion (AROM), therapists can differentiate between issues related to muscle function and those related to joint or connective tissue restrictions.
- Identify Contributing Factors: Recognizes elements such as joint stiffness, capsular tightness, or neural impairments that may limit movement.
- Establish a Baseline: Provides initial measurements to monitor progress and effectiveness of interventions over time.
- Guide Treatment Strategies: Informs the development of appropriate therapeutic interventions, such as stretching or mobilization techniques, based on the specific limitations identified.
what are the 4 types of muscles tests (name and describe) ? (assumed knowledge)
- functional muscle test: are assessments designed to evaluate the performance of muscles (Strength) and their coordination during specific movements or tasks
- manual muscle test
- muscles length test
- motor control test
what information is gained from functional muscles tests and what is it purpose?
purpose
- Diagnostic Clues: They help in identifying potential muscle imbalances, weaknesses, or dysfunctions, offering preliminary information that can guide further diagnostic evaluations.
- contributing factors: By evaluating multiple muscles and their coordination during functional tasks, these tests identify overall impairments in movement patterns and functional performance.
- Establish Baselines: Functional muscle tests provide a baseline measurement of an individual’s capabilities, facilitating the monitoring of progress and effectiveness of interventions over time
Information gained:
- Muscle Strength: Evaluates the ability of muscles to generate force during concentric (muscle shortening), isometric (muscle length remains constant), and eccentric (muscle lengthening) contractions.
- Endurance and Power: Assesses the muscles’ capacity to sustain activity over time and their ability to produce force quickly, which are crucial for daily activities and athletic performance.
- Motor Patterning: Observes the coordination between different muscle groups, determining the efficiency and effectiveness of movement patterns.
- Stability: Evaluates both global (overall body) and local (specific joint or region) stability, essential for maintaining posture and preventing injuries.
what information is gained from manual muscles tests and what is it purpose?
- Manual Muscle Testing (MMT) is applying a resistance to a muscle and observing the muscle’s response to asses it strength and function
Purpose of Manual Muscle Testing:
- Diagnosis: MMT aids in identifying specific muscles or muscle groups that may be weakened or impaired, assisting in diagnosing conditions such as nerve injuries, muscle disorders, or other neuromuscular pathologies.
- Establishing a Baseline: By determining the current strength levels of muscles, MMT provides a baseline for tracking progress over time, which is essential for evaluating the effectiveness of therapeutic interventions.
- Identifying Contributing Factors: MMT helps in recognizing specific structural impairments, such as muscle weakness or imbalance, that may contribute to functional limitations or pain.
Information Gained from Manual Muscle Testing:
- Isometric Contraction Force: Evaluates the muscle’s ability to generate force without changing its length, providing insight into its strength and endurance.
- Willingness to Contract: Observes the patient’s readiness and ability to activate the muscle, which can reflect both physical and psychological factors affecting muscle performance.
- Symptom Response: Monitors any pain or discomfort during muscle contraction, helping to identify potential sources of musculoskeletal issues.
what information is gained from muscle length tests and what is it purpose?
Purpose of Muscle Length Tests:
- Diagnosis: MLTs help identify muscles that may be contributing to a patient’s symptoms, such as tightness or strain. For example, assessing hamstring flexibility can reveal tightness that might be causing lower back pain.
- Identifying Contributing Factors: By determining the length and flexibility of specific muscles, clinicians can identify impairments that may affect posture, movement patterns, or joint mechanics. For instance, tight hip flexors could limit hip extension during gait.
- Establishing a Baseline: MLTs provide objective measurements of muscle extensibility, serving as a reference point to monitor progress and the effectiveness of interventions over time.
Information Gained from Muscle Length Tests:
- Range of Movement: MLTs measure how far a muscle can be passively stretched, indicating its flexibility. This is typically quantified using instruments like goniometers to ensure accuracy.
- Quality of Movement: During the test, clinicians observe the smoothness and ease of muscle elongation, noting any irregularities or compensatory movements that may suggest dysfunction.
- Onset and Quality of Resistance: The point at which resistance is first felt during passive stretching, along with the nature of that resistance (e.g., soft, firm), provides insights into muscle tightness or shortening.
- Symptom Reproduction: MLTs can provoke symptoms, helping to identify muscles or soft tissues that may be sources of pain or discomfort.
what information is gained from motor control tests and what is it purpose?
Purpose of Motor Control Tests:
- Identifying Contributing Factors: By analyzing movement patterns, clinicians can detect impairments in specific muscles or muscle groups. For example, early activation of the upper trapezius (UT) during shoulder movements may indicate compensatory strategies or dysfunctions that could lead to pain or injury.
- Establishing a Baseline: Assessing current motor control patterns allows practitioners to document a patient’s initial functional status. This baseline is crucial for monitoring progress, evaluating the effectiveness of interventions, and setting realistic rehabilitation goals.
Information Gained from Motor Control Tests:
- Recruitment Pattern: Observing the sequence in which muscles are activated during a movement helps identify normal or abnormal patterns. Deviations from typical recruitment sequences can suggest neuromuscular inefficiencies or compensations.
- Movement Quality: Evaluating the smoothness, precision, and coordination of movements provides insights into the integrity of motor control. Poor movement quality may reflect underlying neuromuscular issues or maladaptive movement strategies.
- Muscle Activity: Monitoring the intensity and timing of muscle contractions during tasks helps determine if muscles are overactive, underactive, or appropriately engaged, informing targeted therapeutic interventions.
what information is gained from special tests and what is it purpose?
Purpose of Special Tests:
- Diagnosis: Special tests help identify the specific structures causing symptoms, facilitating accurate diagnosis. For example, the Lachman test assesses anterior cruciate ligament (ACL) integrity in the knee.
- Identifying Contributing Factors: By pinpointing structural impairments, these tests inform treatment strategies. For instance, detecting patellofemoral joint (PFJ) instability can guide rehabilitation efforts.
- Establishing Baselines: Special tests provide reference points for a patient’s current functional status, allowing for the monitoring of progress and the effectiveness of interventions over time.
- Determining Precautions or Contraindications: Identifying specific pathologies through these tests helps establish activity limitations or contraindications to prevent exacerbation of the condition.
Information Gained from Special Tests:
- Structural Integrity: Assessing the stability and function of ligaments, tendons, and joints.
- Neurological Function: Evaluating the condition of neural structures and their impact on movement.
- Symptom Provocation: Determining which movements or positions reproduce symptoms, aiding in localization of the pathology.
- Functional Capacity: Understanding the impact of impairments on daily activities and overall mobility
what information is gained from palpation and what is it purpose?
Purpose of Palpation:
- Diagnosis: Palpation helps identify the specific structure causing symptoms (e.g., Achilles tendon pain). It is often a crucial diagnostic tool for understanding underlying conditions.
- Contributing Factors: It aids in detecting impairments in specific structures, such as hypotonic muscles (e.g., small, hypotonic gastrocnemius) or abnormal muscle tone.
- Establishing Baselines: Palpation helps establish the current state or capacity of specific structures (e.g., assessing muscle tone in the gastrocnemius).
- Precautions or Contraindications: Through palpation, clinicians can identify severe conditions (e.g., fractures, deep vein thrombosis) that may require certain treatments or restrict specific movements.
Information Gained from Palpation:
- Temperature Changes: Detecting abnormal temperature in tissues can indicate inflammation or infection.
- Sweating: Excessive sweating may suggest autonomic dysfunction or localized irritation.
- Swelling/Oedema: Helps identify fluid accumulation in tissues, indicative of inflammation or injury.
- Mobility and Quality of Soft Tissue: Examining the mobility of soft tissue (muscles, tendons) can indicate stiffness, tightness, or abnormal tissue quality.
- Muscle Tone: Evaluating muscle tone provides insight into whether muscles are hypotonic (low tone), hypertonic (high tone), or in spasm, which can affect function and pain.
- Muscle Bulk: Assessing muscle bulk helps detect atrophy or hypertrophy.
- Bony Abnormalities: Palpating for any bony irregularities can help identify fractures, misalignments, or bony growths.
- Symptom Reproduction: By palpating structures, it is possible to reproduce symptoms, which helps in confirming the diagnosis and locating the source of the issue.
what are red flags and what is its purpose in identifying ?
Red flags are warning signs that suggest the presence of serious pathology requiring immediate attention.
Purpose of Identifying Red Flags:
- Diagnosis: To identify serious underlying conditions that require immediate intervention.
- Treatment Planning: To guide appropriate referrals and tailor treatment strategies.
- Prognosis: To assess the severity of the condition and predict potential outcomes.
what are the ref flag pathologies to be aware of when treating?
- cancer
- fracture
- infection
- systemic inflammatory disease
Identify and describe the red flag pathology cancer and it typical clinical features
- Typical Clinical Features:
- Severe, constant pain without a logical pattern.
- Unrelenting night pain.
- Unexplained weight loss (>5-10% of body weight in 3-6 months).
- Risk Factors:
- Personal history of cancer.
- Unexplained weight loss.
- Age >50 years.
- Night pain.
Identify and describe the red flag pathology fracture and it typical clinical features
- Typical Clinical Features:
- Severe, constant, localized pain.
- Sudden onset of symptoms, often linked to trauma.
- Significant functional impairment.
- Risk Factors:
- Recent trauma.
- Age (>50 or >70 years).
- Female gender.
- Prolonged corticosteroid use.
- Osteoporosis diagnosis.
Identify and describe the red flag pathology infection and it typical clinical features
Definition: Infections can be viral, bacterial, fungal, or parasitic and may affect musculoskeletal structures.
- Typical Clinical Features:
- Non-mechanical pain (not influenced by movement or position).
- Neurological symptoms.
- Fever, chills, sweats, fatigue, and weight loss.
- Risk Factors:
- Immunosuppression (e.g., chemotherapy).
- Recent surgery.
- Intravenous drug use.
- History of recent infection.
Identify and describe the red flag pathology systemic inflammatory disease and it typical clinical features
- Examples: Rheumatoid arthritis (RA), ankylosing spondylitis (AS), gout, psoriatic arthritis.
- Typical Clinical Features:
- Non-mechanical pain.
- Morning stiffness >30 minutes.
- Night pain that does not easily settle.
- Gentle activity eases pain.
- Possible joint swelling, redness, or rashes.
- Risk Factors:
- Family history of inflammatory disease.
- History of inflammatory bowel disease.
- Endocrine disorders (e.g., hypothyroidism, hyperparathyroidism).
what are some common questions to ask patients if you suspect a red flag?
- “Have you had any unexplained weight loss?”
- “Have you had any recent infections or surgeries?”
- “Do you have a history of cancer or inflammatory conditions?”
- “How did your symptoms start?” (to identify trauma-related fractures).
what actions are required if you suspect a red flag?
- Assess the significance – Consider the overall clinical picture and the likelihood of serious pathology.
- Communicate with the patient – Explain concerns and possible next steps.
- Refer appropriately – Refer to a GP or specialist if necessary.
- Follow up – Check in with the patient to ensure appropriate care has been provided.
what are accessory movements and give some examples?
are involuntary joint movements that can’t be directly performed by an individual. Accessory movements include: glides, rolls, and spins.
how do accessory movements compare to physiological movements?
physiological movements are voluntary and can be performed by an individual such as flexion, extension, abduction, adduction, rotation. Whilst accessory movement are not voluntary and are needed to facilitate functional movement.
What are PAMS and what types of movement occur in accessory movements?
- PAMS is an external force applied by the physio to glide, roll, spin or rotate a joint, in order to assess or improve mobility.
- Glides (e.g., anterior-posterior, medial-lateral)
- Rolls (e.g., posterior-anterior roll)
- Spins (e.g., medial or lateral spin)
What do PAMs assess and how does this information help us?
- Joint mobility (whether the joint is too stiff or hypermobile)
- Pain response (if the movement reproduces symptoms, indicating an issue with the joint or surrounding tissues)
- Quality of movement (e.g., presence of crepitus (popping, crackaling), smoothness of movement)
- This information helps diagnose joint dysfunctions, identify contributing factors to movement limitations, and guide treatment decisions.
How are PAMs quantified and graded?
PAMs are graded based on the amount of force applied and the resistance encountered:
- Grade I: Small amplitude at the beginning of range (used for pain assessment)
- Grade II: Large amplitude within a resistance-free range
- Grade III: Large amplitude into resistance (further sub-divided into III-, III, III+, III++)
- Grade IV: Small amplitude into resistance (further sub-divided into IV-, IV, IV+, IV++)
- Grade V: High velocity, small amplitude thrust (manipulation)\
What symbols are used to document PAMs?
- Joint tested (e.g., TCJ – talocrural joint)
- Direction of movement (e.g., AP for anterior-posterior glide, PA for posterior-anterior roll)
- Grade of movement (I to IV)
- Quality of movement (e.g., crepitus, early/late R1)
- Symptom response (pain, stiffness, onset timing, severity using VAS scale)
How do the concepts physiological movement, accessory movement and grade of movement work together?
- Assess Physiological Movement – Check active ROM (e.g., patient tries to lift arm).
- Assess Accessory Movements (Joint Play) – Use PAMs (e.g., therapist glides humeral head in the shoulder).
- Identify Restrictions – If joint glide is restricted, physiological movement will also be limited.
- Apply Graded Mobilization – Use appropriate grade to restore joint mobility and reduce pain.
- Reassess Physiological Movement – Check if active ROM has improved after joint mobilization
