Overview: Orthopedic Manual Therapy & Musculoskeletal Exam

Front 1

manual therapy definition

Back 1

-study of anatomy, mechanics and pathology as well as the application of evaluative and treatment techniques of the neuromusculoskeletal system

Front 2

Cyriax

Back 2

-all pain has anatomical source
-all treatment must reach that source
-identify lesion, treat it, and symptoms will decrease

Front 3

referred pain

Back 3

-pain felt somewhere other than at the site of injury
-can be nerve root injury, spinal cord or dura mater compression

Front 4

where does nerve root injury refer to?

Back 4

-refers segmentally
--dermatomes

Front 5

how does spinal cord or dura mater compression refer?

Back 5

-non segmentally
-

Front 6

evaluation framework of Cyriax

Back 6

-deals w/ soft tissues
-contractile vs non contractile

Front 7

Cyriax evaluation framework components

Back 7

-active movement
-passive movement
-resisted tests

Front 8

active movement

Back 8

-ROM and muscle power
-includes both contractile and non-contractile elements

Front 9

passive movement

Back 9

-includes only non-contractile (IF patient is relaxed)
-assessment of end feel
--apply overpressure @ end of range
--feel what is restricting movement

Front 10

normal end feels

Back 10

-bone-to-bone
-soft tissue approximation
-tissue stretch

Front 11

bone-to-bone end feel

Back 11

-hard end feel
-hard, abrupt stop
-ex: elbow extension

Front 12

soft tissue approximation

Back 12

-soft restriction of movement
-ex: knee flexion

Front 13

tissue stretch

Back 13

-springy end feel
-stretchy restriciton
-ex: shoulder restriction

Front 14

abnormal end feel

Back 14

-muscle spasm
-capsular
-bone-to-bone
-springy block
-empty end feel

Front 15

muscle spasm

Back 15

-involuntary contraction restricts movement
-felt as sudden restriction

Front 16

capsular

Back 16

-tissue stretch but in abnormally shortened range
-feels leathery
-tissue stretch but not at end of normal range

Front 17

bone-to-bone

Back 17

-before normal limits of range
-ex: bone spur, osteophyte

Front 18

springy block

Back 18

-less stretchy than tissue stretch
-in abnormal place in range
-ex: torn meniscus

Front 19

empty end feel

Back 19

-no resistance felt
-movement stopped @ patient's request
-may not be painful, but may be afraid it will be

Front 20

resisted tests

Back 20

-contractile structures only
-(if NO movement is allowed)
-performed midrange
-(to eliminate stress on surrounding tissues)
-identifies pain and/or weakness (cannot assign MMT grade)

Front 21

interpretation of results

Back 21

-identification of specific anatomical structures associated w/ the lesion
-limited ROM

Front 22

limited ROM

Back 22

-capsular pattern
-non-capsular pattern

Front 23

capsular pattern

Back 23

-limitations in ROM occur in predictable proportions
-specific to each joint
-limitations in capsular pattern=arthritis

Front 24

non-capsular pattern

Back 24

-ROM limitations in other proportions
-ligamentous, capsular adhesion, bursitis, internal derangement

Front 25

strong and painful (resisted tests)

Back 25

-minor damage to tendon or muscle
-still generate power/strength but is painful

Front 26

weak and painful (resisted tests)

Back 26

-partial tear
-still able to resist but not as much
-painful

Front 27

strong and painless (resisted tests)

Back 27

-no lesion
-lesion not involving contractile structure
-lesion not involving MS system
-referred pain

Front 28

weak and painless (resisted tests)

Back 28

-complete tear
-entrapment of nerve

Front 29

intervention (Cyriax)

Back 29

-traction
-mobilization
-manipulation
-friction massage
-injection
-patient education

Front 30

philosophical basis of John Mennell

Back 30

-dysfunction is a sign of pathological process or joint disease
-loss of normal joint play can lead to dysfunction
-joint manipulation can restore normal joint play

Front 31

evaluation framework: Mennel

Back 31

-inspection
-palpation
-active movements
-muscle tests
-special tests (diagnostic imaging, etc)
-joint play

Front 32

interpretation: Mennel

Back 32

-based on joint dysfuntion

Front 33

intervention: Mennel

Back 33

-manipulation/mobilizaton (performed by physician)
-PT : exercises, modalities
-patient education

Front 34

philosophical basis of Kaltenborn

Back 34

-biomechanical assessment of joint movement is crucial
-convex/concave rule
-close packed and loosed packed positions
-pain, joint dysfunction, and soft tissue damage found in combination

Front 35

convex/concave rule: convex on concave

Back 35

-bone movement and glide in opposite directions

Front 36

convex/concave rule: concave on convex

Back 36

-bone movement and glide in same direction

Front 37

close packed position

Back 37

-usually @ extremes of movement

Front 38

open packed positions

Back 38

-usually in midrange

Front 39

evaluation framework: Kaltenborn

Back 39

-history
-physical examination

Front 40

history

Back 40

-current
-past
-social background
-medical hx
-family hx

Front 41

physical examination

Back 41

-inspection
-function (AROM, PROM, traction, gliding, compression, resisted tests)
-palpation
-neurological tests
-special tests

Front 42

Kaltenborn interpretation

Back 42

-based on biomechanical assessment and assessment of soft tissues

Front 43

intervention: Kaltenborn

Back 43

-mobilization
-traction/distraction
-soft tissue mobilization
-PNF
-patient education

Front 44

Maitland philosophical basis

Back 44

-understand patient
-apply theoretical thinking
-apply critical thinking
-based on signs/symptoms (comprable sign)
-continual assessment/reassessment
-differential assessment proves/disproves working hypothesis

Front 45

evaluation framework: Maitland

Back 45

-observation
-functional tests
-active movement
-isometric tests
-passive movement (accessory/physiological)
-palpation
-neurological tests
-highlight major findings

Front 46

passive physiological

Back 46

-physiological movements pt is able to control

Front 47

passive accessory movements

Back 47

-part of normal movement; cannot be controlled by patient

Front 48

interpretation: Maitland

Back 48

-behavior of symptoms
-SINS

Front 49

SINS

Back 49

-severity
-irritability
-nature
-stage

Front 50

irritability

Back 50

-how easily provoked
-time to settle

Front 51

nature

Back 51

-need for caution (pathology, injury, easy to exacerbate)
-mechanical vs inflammatory

Front 52

intervention: Maitland

Back 52

-based on continual assessment
-mobilization (grades 1-4)
-manipulation (grade 5: HVLA)
-adverse neural tissue mobilization
-traction
-exercise
-patient education

Front 53

McKenzie Philosophical basis

Back 53

-spinal pain caused by predisposing factors
-extremity pain often caused by postural stress
-patients should be involved in self-treatment

Front 54

evaluation framework: McKenzie

Back 54

-posture
-movement
-repeated movements

Front 55

repeated movements

Back 55

-peripheralization
-centralization

Front 56

peripheralization

Back 56

-increasing symptoms
-radiation

Front 57

centralization

Back 57

-decreasing symptoms

Front 58

McKenzie: interpretation

Back 58

-postural syndrome (static postures)
-dysfunction (loss of joint play)
-derangement (disc involvement)

Front 59

intervention: McKenzie

Back 59

-self-treatment (using repeated movements)
-exercise
-mobilization
-patient education

Front 60

our examination scheme

Back 60

-active/passive movements
-resisted tests
-joint play (kaltenborn/Mennell)
-neurological exam
-posture
-repeated movements
-careful history
-neuro exam
-passive physiological/accessory movements
-SINS

Front 61

history

Back 61

-listen to patient
-what brings you to PT
-current episode
-past history
-medical profile
-diagnostic tests
-demographics, functional profile
-special questions

Front 62

current episode

Back 62

-symptoms
-location
-type (character, severity, irritability)
-behavior
-onset and progression
-aggravating/easing factors

Front 63

past history

Back 63

-similar symptoms
-past treatment

Front 64

medical profile

Back 64

-general health
-meds
-hospitalizations

Front 65

diagnostic tests

Back 65

-radiographs
-MRI
-CT
-must document as "pt reported...." unless you have actual report

Front 66

demographics, functional profile

Back 66

-age
-occupation
-activity level
-prior level of function
-living environment

Front 67

special questions

Back 67

-night pain
-unexplained weight loss/gain
-cough/sneeze
-cord signs
-bowl/bladder control
-dizziness, blurred vision, diplopia, unsteadiness

Front 68

planning the exam

Back 68

-SINS
-structures taht underlie area of symptoms
-structures that can refer to the area
-precautions
-special tests (ligament test; vertebral artery test)

Front 69

examination

Back 69

-observation
-postural assessment
-clear other joints
-AROM
-passive movements
-resisted static contraction
-neurological exam
-passive accessory movements
-palpation
-highlight major findings

Front 70

observation

Back 70

-ADL;s
-willingness to move
-gait
-assistive devices
-skin

Front 71

postural assessment

Back 71

-spinal curves
-skin folds, creases
-alignment
-shape

Front 72

clear other joints

Back 72

-joints that might refer symptoms
-always clear L spine for LE problems
-always clear C spine for UE problems
-joints above and below (active movements w/ overpressure)

Front 73

AROM

Back 73

-active movements w/ over pressure
-repeated movements
-compare sides if able

Front 74

passive movements

Back 74

-PROM w/ overpressure (mvmt throughout range, ability to relax, end feel)
-compare sides (pain free side first)

Front 75

resisted static contraction

Back 75

-static tests
-isometric tests
-looking for reproduction of symptoms
-differentiate contractile form non-contractiles

Front 76

neurological exam

Back 76

-strength (screen vs. MMT)
-sensation
-muscle stretch reflex (MSR)
-Babinski (positive = UMN lesion)
-compare sides

Front 77

passive accessory movements

Back 77

-gliding
-test in loose packed position
-compare slides

Front 78

palpation

Back 78

-temperature
-swelling
-spasm, tension
-relevant tenderness
-structures

Front 79

interpretation: planning the intervention

Back 79

-identify problems
-each problem requires assessment of joint/structure, type of problem, presentation of problem, pathology
-assessment of problem
-development of PT diagnosis
-identify what you will be treating

Front 80

each problem requires assessment of

Back 80

-limitation of motion
-relevant psychosocial factors
-associated factors

Front 81

developing a plan of care

Back 81

-establish prognosis
-formulate goals
-prioritize goals for implementation
-technique selection

Front 82

establish prognosis

Back 82

-prediction of rate and level of recovery
-age & physical condition
-general health
-nature of the pathology
-severity/irritability of the condition
-underlying pathology
-structural integrity
-motivation

Front 83

formulate goals

Back 83

-based on problems
-based on importance to patient

Front 84

goals allow for

Back 84

-correction of the existing problem
-attainment of optimal function
-compensation for problems which can't be fully corrected
-prophylaxis
-identification/control of risk factors which may limit recovery

Front 85

prioritize goals

Back 85

-importance to patient
-relative severity
-relative importance of the problem
-relative ease of anticipated change

Front 86

technique selection

Back 86

-every technique must have a specific intent
-every mobilization technique has parameters