Principles Of Examination

Front 1

Systemic Screening of Patient (4)

Back 1

General Systemic

Pulmonary

Cardiac

Gastrointestinal

Front 2

Soft Tissue Observation (6)

Back 2

Compare involved to uninvolved

Kinetic Chain (i.e. Standing Posture)

Defromity

Discoloration

Swelling

Atrophy

Front 3

Soft Tissue Principles of Examination:

Systemic Differential Diagnosis

Need to ...

Back 3

1) Rule out all other possibilities

Front 4

Soft Tissue Principles of Examination:

Systemic Differential Diagnosis

Based upon Type of Pain / Pain Pattern (7)

Back 4

1) Referred / Radicular Pain

2) Pain at rest

3) Pain with activity

4) Diffuse pain

5) Chronic Pain

6) Night Pain

7) Pain that doesn't make sense

Front 5

PAIN DESCRIPTIONS

Muscle

Back 5

Cramping, dull, aching

Front 6

PAIN DESCRIPTIONS

Ligament and joint capsule

Back 6

Dull, shooting

Front 7

PAIN DESCRIPTIONS

Nerve

Back 7

Sharp, bright, lightening like

Front 8

PAIN DESCRIPTIONS

Sympathetic Nerve

Back 8

Burning, pressure-like Stinging, aching

Front 9

PAIN DESCRIPTIONS

Bone

Back 9

Deep, nagging, dull

Front 10

PAIN DESCRIPTIONS

Fracture

Back 10

sharp, severe, intolerable

Front 11

PAIN DESCRIPTIONS

Vasculature

Back 11

Throbbing, diffuse

Front 12

Soft Tissue Principles of Examination:

3 parts of the examination - Systemic

Back 12

Obtain Hx

Systems Review

Tests and Measures

Front 13

Soft Tissue Principles of Examination:

Test and Measures includes (8)

Back 13

1) Inspection (structural) / observation

2) AROM (function)

3) PROM (end feel)

4) Isometrics (/ MMT)

5) Reflexes / Sensation

6) Special Tests

7) Palpation (conditions/positions/tenderness)

8) Functional Assessment

Front 14

Soft Tissue Principles of Examination:

Hx taking

Back 14

1) Data from PMH and Present reason for referral

(MOI)

a) Timeline approach

2) Info obtained from

a) Interview

b) Review of pt record

c) Other sources

3) PT identifies health restoration and prevention needs and comorbidity that may have implications for the intervention

Front 15

Soft Tissue Principles of Examination:

Structural Inspection

Back 15

1) Posture

a) Ectomorph

b) Mesomorph

c) Endomorph

2) Deformities

3) Aides (cane, crutches, braces)

4) Edema, Atrophy

Front 16

Soft Tissue Principles of Examination:

Palpation for Condition / Position (6)

Back 16

1) Swelling

a) Soft, Firm, Pitting

2) Elevated / Lowered Temperature

3) Moisture / Dryness

4) Scar / Wounds

5) Mm

6) Jt alignment

Front 17

Soft Tissue Principles of Examination:

Palpation for Condition / Position

Muscles (3)

Back 17

1) Doughy (chemical holding pattern)

2) Guarded

3) Hypertonic

Front 18

Soft Tissue Principles of Examination:

Palpation for Condition / Position

Joint Alignment (4)

Back 18

1) Laterally Tracked Patella

2) Spondylolisthesis (step deformity)

3) Anterior Displaced Humeral Head

4) Protracted Scapula

Front 19

Soft Tissue Principles of Examination:

Palpation for Tenderness (5)

Back 19

1) Subacromial space

a) Bicpes tendon, RTC tendon, Subacromial

bursa

2) Lateral Epicondyle

3) Medial Epicondyle

4) Medial/ Later joint line of the knee

5) Greater Trochanter

6) Achilles Tendon

Front 20

Soft Tissue Principles of Examination:

AROM / Function

First (2)

Back 20

1) Consider the Norms

2) Compare to uninvolved side

Front 21

Soft Tissue Principles of Examination:

AROM / Function

Second - Check

Back 21

1) Functional Ranges not just cardinal planes

2) Muscle/tendon pathology

3) AROM with Pain,

4) Prom: little to no pain

5) Joint Pathology

a) Capsule/ Ligament/ Cartilage

Front 22

Soft Tissue Principles of Examination:

AROM / Function

AROM vs. PROM

Back 22

1) PROM is always > AROM in a healthy joint

2) If PROM is not > AROM then end feel will be abnormal

3) Need to have joint play at end range or there will be no tolerance to outside forces and hence tissue injury will be likely.

Front 23

JOINT END FEEL

NORMAL (3 + examles)

Back 23

1) Bone to Bone - Elbow Extension

2) Soft Tissue Approximation - Knee Flexion

3) Tissue Flex (Ligamentous, Capsular, Ms Stretch

a) Ankle Dorsiflexion

b) Shoulder lateral Rotation

c) Finger Extension

Front 24

JOINT END FEEL

ABNORMAL (8 + examples)

Back 24

1) Early muscle spasm - Protective Spasm following injury

2) Late muscle spasm - From instability and pain

3) “Mushy” tissue stretch - Tight ms

4) Hard capsular - Frozen Shoulder

5) Soft capsular- Synovitis, Soft Tissue Edema

6 Bone to bone - Osteophyte formation

7) Empty - Acute subacromial bursitis

8) Springy block - Meniscus tear

Front 25

Capsular Patterns
(Listed in order of restriction)

Back 25

Glenohumeral joint

Ulno-Humeral

Knee

Hip –

Front 26

Capsular Patterns
(Listed in order of restriction)

2 THEORIES

Back 26

Cyriax – Flexion > ABD > IR > Ext > ER

Kaltenborn – IR> EXT> ABD> Flex> ER

Front 27

Isometric Restricted ROM/Pain

Back 27

Following are signs for a lesion ?????

Strong and Painful *

Strong and Painless*

Weak and Painful *

Weak and Painless *

All Resisted ROM tests are painful

Front 28

Isotonic / MMT + / - values

5+

Back 28

Normal (100%) - Complete ROM against gravity with maximum resistance

Front 29

Isotonic / MMT + / - values

4

Back 29

Good (75%) - Complete ROM against gravity with some (moderate) resistance

Front 30

Isotonic / MMT + / - values

3+

Back 30

Fair + - Complete ROM against gravity with minimal resistance

Front 31

Isotonic / MMT + / - values

3

Back 31

Fair (50%) - Complete ROM against gravity

Front 32

Isotonic / MMT + / - values

3 - (minus)

Back 32

Fair - (minus) - Some but not complete ROM against gravity

Front 33

Isotonic / MMT + / - values

2+

Back 33

Poor+ - Initiates motion against gravity

Front 34

Isotonic / MMT + / - values

2

Back 34

Poor (25%) Complete ROM with gravity eliminated

Front 35

Isotonic / MMT + / - values

2 - (minus)

Back 35

Poor - (minus) - Initiates motion if gravity is eliminated

Front 36

Isotonic / MMT + / - values

1

Back 36

Trace - Evidence of slight contractibility but no joint movement

Front 37

Isotonic / MMT + / - values

0

Back 37

Zero - No contraction Palpated

Front 38

Isometric Measurement can be measured by

Back 38

Dynamometer

Front 39

Isokinetics measured by or type (3)

Back 39

1) Dynamic measurements

2) Graph

3)Endurance assessment

Front 40

Nervous System

Three parts that deal with pain

Back 40

1) Sensation

2)Referred Pain

a) Dermatome

b) Myotome

c) Sclerotome – is an area of bone or fascia

supplied by a single nerve root

3) Reflexes - DTR

Front 41

Nervous System

Classifications of Nerve injuries (3)

Back 41

Neuropraxia – a transient physiological block caused by ischemia from pressure / stretch of the nerve

Neurotmesis – structure of nerve is destroyed by cutting, scarring, or compression

Axonotmesis – damage of axons

Front 42

Special Tests

Back 42

1) Used to assist in diagnosis

2) Used to rule out other pathologies

3) Preformed as a cluster

4) Sensitivity, Specificity, Reliability and Validity

Front 43

Joint Play

Aka ?

Back 43

Aka Accessory motion,

= not under volitional control, occur in response to an outside force.

Necessary in all healthy joint to absorb and relieve outside forces

Front 44

Palpation (3)

Back 44

1) Done Last

2) Locate Lesion

3) Interpretation

Front 45

Functional Assessment (4)

Back 45

1) Functional Assessment

2) Key to reimbursement

3) Preformed sub-acute or later stage

4) Functional Outcome tools

5) Often need holistic approach

Front 46

Diagnosis for Physical Therapy (4)

Back 46

- First-determine the phase of inflammation

- Second-name the tissue and/or condition

- Third-set goals

- Fourth-treatment principles: soft tissue lesions

Front 47

Soft Tissue Principles of Treatment:

3 PARTS OF ACUTE

Back 47

1) First 72 hours / Impairment

2) Protection Phase

3) Precautions and Contraindications

Front 48

ACUTE – First 72 hours

Impairments (5)

Back 48

- Inflammation, pain, edema, muscle spasm

- Impaired movement

- Joint effusion

- Decreased use of associated area

Front 49

ACUTE – Protection Phase

Treatments (5)

Back 49

1. Educate the pt

2. Control pain, edema, spasm

3. Maintain soft tissue and joint integrity and mobility

4. Reduce joint swelling if symptoms are present

5. Maintain integrity and function of associated areas

Front 50

ACUTE: PRECAUTIIONS AND CONTRAINDICATIONS

Back 50

Precautions: proper rest and movement

CI: Stretching and Resistence exert with inflammation

Front 51

Soft Tissue Principles of Treatment:

SUBACUTE - 3 parts

Back 51

1) Impairment

2) Treatment

3) Precautions

Front 52

SUBACUTE – 72 hours to 6 weeks

Impairment

Back 52

Collagen synthesis and fibroblast activity starts in this phase.

1) Pain when end of available ROM is reached

2) ↓ soft tissue edema

3) ↓ joint effusion

4) Developing soft tissue, muscle, and/or joint contractures

5) Developing muscle weakness from reduced usage

6) ↓ functional use of the part and associated areas

Front 53

SUBACUTE - TREATMENT (5)

Back 53

1. Educate the patient

2. Promote healing of injured tissues

3. Restore soft tissue, muscle, and/or joint mobility

4. Develop neuromuscular control, muscle endurance, and strength in involved and related muscles

5. Maintain integrity and function of associated areas

Front 54

SUBACUTE - Precautions (4)

Back 54

1) Pain with rest,

2) fatigue,

3) increased weakness and

4) spasm.

Front 55

Soft Tissue Principles of Treatment:

CHRONIC (2)

Back 55

1) Impairments

2) Treatment

Front 56

Soft Tissue Principles of Treatment:

CHRONIC -

Impairment (4)

Back 56

1) Soft tissue and/or joint contractures and adhesions that limit normal ROM or joint play

2) ↓ muscle performance; weakness, poor endurance, poor neuromuscular control

3) ↓ functional usage of the involved part

4) Inability to function normally in an expected activity

Front 57

Soft Tissue Principles of Treatment:

CHRONIC -

Treatment (6)

Back 57

1) Educate the patient

2) Increase soft tissue, muscle and/or joint mobility

3) Improve neuromuscular control, strength, muscle endurance

4) Improve cardiovascular endurance

5) Instruct in safe body mechanics

6) Progress functional activities

Front 58

Soft Tissue Principles of Treatment

CHRONIC Inflammation (2)

Type of Injury ?

Back 58

1) Impairment

2) Treatment

3) Overuse Injury

Front 59

CHRONIC Inflammation:

Impairment

Back 59

1) Length and strength imbalance

2) Bone malalignment

3) Poor posture

4) Pain of varying degrees

5) Soft tissue, muscle, and or joint contractures or adhesions that limit normal ROM or joint play

6) Muscle weakness and poor muscle endurance

7) ↓ functional use of the region

8) Movement pattern perpetuating the problem

Front 60

CHRONIC Inflammation:

Treatment

Back 60

1) Identify the mechanism of chronic irritation and modify

2) Restrict activity that causes pain

3) Educate pt

4) Promote healing by decreasing pain and inflammation

5) Maintain integrity and mobility of involved tissue

6) Apply modifications and re-assess (taping, arch supports, correct imbalance)

Front 61

Chronic Pain Syndrome

Time Frame

Back 61

> 6 months

Front 62

Chronic Pain Syndrome (3)

Back 62

1) Pain of unknown origin with inflammation

2) Decreased function

3) May have a physical, emotional and psychological component