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intro lecture 1
ortho foundations exam 1 info
| Question | Answer |
|---|---|
| evaluation and treatment model based on specific impairment, functional loss, and attainable quality of life rather than a medical diagnosis | disablement model |
| loss of abnormality or anatomical, physiological, mental or psychological structure or function (ex: loss of ROM) | impairment |
| restriction of the ability to perform at the level of the whole person, a physical action, task or activity, in an efficient, typically expected or competent manner | functional limitation |
| functional limitation is commonly quantified by | self-report scoring forms |
| the inability to perform actions, tasks, and activities usually expected in specific social roles that are customary for the individual or expected for the person's status or rule in a specific socio-cultural context and physical environment | disability |
| 6 elements of patient management | examination, evaluation, diagnosis, prognosis, intervention, outcomes |
| examination includes | history, systems review, testing, determining if they are right for PT (have primary musculoskeletal problem) |
| evaluation description | PT makes clinical judgements based on data gathered from the examination |
| diagnosis description | end result of evaluating examination data |
| expected level of improvement to be attained with intervention and the amount of time required to reach that level | prognosis |
| ______ details interventions to be used as well as expected frequency and duration of care | plan of care |
| purposeful and skilled interaction of the PT with the patient using various methods and techniques to produce a change in condition | intervention |
| results of management of the case | outcomes |
| common reasons for error | assumptions, too few hypothesis, not sampling enough info, assuming only one association between regions |
| in what part is clinical alliance gained | subjective exam |
| traumatic onset | defining moment |
| insidious onset | doesn't have specific moment/ can't recall when it started |
| referred pain | when you feel pain in a location but it's not coming from that location |
| dermatome | pattern of sensation from a specific nerve root |
| myotome | motor, pattern of weakness associated with a specific nerve root |
| conditions favoring referred pain | strength of stimulus (the more inflamed, the greater the stimulus), position of structure (proximal refer more than distal), depth (deeper structures are more difficult to localize), nature of structure |
| features of referred pain | usually segmental, doesn't cross mid-line, reference occurs distal, lesion not necessarily in painful area, pain can be felt anywhere in dermatome |
| suspect referred pain when patient complains of | deep burning / aching along limb , pain from posterior to anterior trunk , deep pain with large, poorly defined boundaries, if painful area has no physical signs |
| screening for medical disease cardiovascular system | heart trouble, sweating associated with pain, palpitations, smoker, HBP, high cholesterol, SOB, orthopnea, swelling, rheumatic fever, family history, do your symptoms change when going up a flight of stairs |
| screening for medical disease GI system | difficulty swallowing, nausea, heartburn, vomiting, specific food intolerance, constipation, stool color change, do your symptoms change when you've eaten food/hungry |
| SINSS | severity, irritability, nature, stability, stage |
| severity | helps to determine how vigorous exam will be. how bad is the pain. what is the impact on function |
| irritability | how much to provoke the pain, how long to ease |
| nature | pathology- musculoskeletal, nociceptive, psychosocial |
| stage | acute, sub-acute, chronic |
| stability | present state- worsening, static, or improving |
| yellow flags are factors that increase risk of | developing long term disability and work loss, higher likelihood of chronic pain |
| yellow flags | high fear levels, catastrophizing pain, central sensitization |
| 5 x 5 scheme of Frisch inspection / observation | ADL, posture, shape, skin, aids |
| 5 x 5 scheme of Frisch functional exam | active, passive, resisted, traction/compression, gliding |
| 5 x 5 scheme of Frisch palpation | skin and subcutaneous tissue, muscle and tendon, tendon sheaths and bursae, joints, nerves and blood vessels |
| 5 x 5 scheme of Frisch neurological tests | nerve trunk, reflexes and key muscles, sensory, motor (central and peripheral paralysis), coordination |
| 5 x 5 scheme of Frisch additional tests | radiology, lab tests, electro diagnosis, punctures, other (referral to other specialists) |
| contractile | muscle, tendon junction, tendon |
| non contractile | bone, nerve, blood vessels, bursae, CT |
| active motion stresses | contractile AND non contractile |
| info gained from active motion | ability and willingness to move, absence of a painful arc |
| passive motion stresses | non contractile (sometimes antagonist contractile tissue) |
| info gained from passive motion | sequence of pain to resistance, end feel |
| types of ROM | limited, full, excessive |
| capsular ROM | progressive pattern of loss of motion, in synovial joints, typically arthritis is involved |
| things that limit movement | weakness, tightness, pain, joint restriction |
| early stage of capsular ROM limited by | muscle guard / spasm |
| later stage of scapular ROM limited by | connective tissue |
| capsular pattern for knee | loss of knee FLEXION before knee extension |
| if pain before resistance | acute |
| if pain synchronous with resistance | sub-acute |
| if pain after resistance | late stage inflammation |
| sensation imparted to examiner's hand when the extreme of possible range is reached | end feel |
| 6 types of end feel | bone to bone, soft tissue approximation, capsular, muscular, springly, |
| bone to bond | hard end feel, elbow extension is an example |
| soft tissue approximation example | elbow flexion |
| capsular end feel | leathery, little give but not much |
| 3 variations of muscular end feel | muscular insufficiency, slow guard, fast guard |
| muscular insufficiency | hitting a tight muscle |
| slow guard | resistance secondary to a muscle contraction, patient is protecting muscle |
| fast guard | even more abrupt stop of motion, very acute, muscle is highly aggravated |
| 2 abnormal end feels | springy and empty |
| springy | bounce (ex: meniscus torn) |
| empty | don't get an end feel, either bc joint itself is too acute or patient is highly afraid |
| resisted tests are designed to | selectively place tension on contractile tissues |
| isometric contraction happens in | midrange |
| if resisted test finding is strong and painless | contractile and nerve are okay |
| if resisted test finding is strong and painful, | contractile INVOLVED, nerve okay |
| if resisted test finding is weak and painless | contractile possibly involved, nerve is LIKELY involved |
| if resisted test finding is weak and painful | contractile LIKELY involved, nerve possibly involved |
| if if resisted test finding is all painful | acute or psychogenic |
| separation of joint surfaces | traction |
| approximation of joint surfaces | compression |
| both traction and compression are _____ to treatment plane | perpendicular |
| limited range in traction means | contracture |
| excessive range in traction means | hyper mobility |
| increase pain in traction means | possible tear of CT |
| decreased pain in traction means | possible joint surface damage (patients w/OA like traction bc it relieves pressure ) |
| if increase in pain in compression, means | possible joint surface damage |
| if decrease pain in compression, | means it eases connective tissue tension |
| for gliding, passive movements are _____ to treatment plane | parallel |
| limited range in gliding means | CT contracture |
| excessive range in gliding means | damaged CT |
| hypomobility- okay to mobilize? | yes |
| hypermobility- okay to mobilize? | contraindication |
| common sources of error with mobilization | condition is too acute, minor, more than 1 lesion present, psychogenic component of pain, human error |
Created by:
thomask9
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