MSK-1: Week 1 : Introduction, Physical Examination & Pain (online notes)

What are the 3 pieces of data or findings we must get from PROM CLASSICAL and PROM ACCESSORY? Differentiate amongst these components.

There will ALWAYS be three (3) pieces of data or findings we MUST get from PROM Classical and three (3) from PROM Accessory. Those are the quantity, quality, and patient response. Quantity is the amount of movement present. Is it limited, normal or excessive? Quality is what we as a PT will feel. Meaning, what is preventing us from moving any further. Is that feeling normal or abnormal? This is called the END-FEEL. Patient response. What the patient expresses verbally at the point of no further movement, if not before. Typically this is PAIN OR NO PAIN, but it may also be tightness, apprehension or fear of further movement, increased symptoms, or even decreased symptoms.

Define Step #13: Special Tests

Used to confirm/refute a hypothesis A special test is only as good as the tester. The problem with special tests as a diagnostic tool is not all special tests are sensitive or specific or valid or reliable. Note: Some special tests are mobility tests or length tests. Since the mobility testing (PROM) and muscle length testing steps come before the special test step, there is no need to repeat these tests. (e.g., Ober, anterior drawer, Thomas Test). Refer to the Dutton Text as a reference for special tests.

What are the potential findings of MSTT?

#1: Resistance: can hold, Pain: no, Tissue impairment: normal. Question:What tests are needed to confirm this dysfunction? None #2: Resistance: can hold, Pain: yes, Tissue impairment: tendonitis/osis. Question:What tests are needed to confirm this dysfunction? Palpation for tenderness, MLT/PROM classical, Palpation for condition (if an itis) #3: Resistance: cannot hold, Pain: yes, Tissue impairment: partial tear. Question:What tests are needed to confirm this dysfunction? Palpation for tenderness and palpation for condition #4: Resistance: cannot hold, Pain: no, Tissue impairment: complete tear. Question:What tests are needed to confirm this dysfunction? MMT, palpation for condition

List the new 18 steps

18 Steps of the Extremity Examination per Patla and Paris 1.Intake Forms Assessment 2. initial Observation 3. History 4. Systems Review/Review of Systems 5. Screening (ROM/overpressure/dermatome/myotome/reflexes/quadrant tests) 6. Structural Inspection - position 7. Palpation for Condition 8. Joint Active Range of Motion 9. Joint Passive Range of Motion (quantity and quality) 10. Muscle Selective Tissue Tension 11. Muscle Length Testing (including myofascial) 12. Manual Muscle Testing 13. Special Tests 14. Neurovascular (also referred to as neuromuscular and neural tensioning) 15. Palpation for Tenderness 16. Movement Analysis 17. Diagnostic imaging 18. Evaluation/Diagnosis/Prognosis

What is a CAPSULAR PATTERN?

A capsular pattern is a restriction in the capsule. The whole, entire capsule is tight in ALL directions. We will discuss the capsular pattern of each joint in the various units. Each joint will have a specific pattern or sequence in which the range of motion is limited. For example, at the shoulder joint external rotation is the most limited with abduction the 2nd most limited and internal rotation the least limited. Both active and passive ranges of motion are limited in those directions and are typically painful towards the end of the available range of motion.

What is the difference between a patient and a client?

A patient represents the person who comes to you individually with a potential musculoskeletal condition. This is someone you will treat. A client represents an individual or group of people, who are receiving consultation from a PT.

Define Pain

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage -Pain is an individual and subjective experience Pain is multidimensional experience -CNS activity (pain is a central nervous system sensation) -Involves emotions, thoughts, and beliefs SIMULTANEOUSLY

How do we know if a patient needs a specific intervention?

Based on the data from the tests and measures and the list of tissue specific impairments

In regard to END FEEL, for HARD, what tissues will give that feeling?

Bone is probably what you are thinking, however in a normal situation do we ever have bone on bone contact? No, so the better choice of words is cartilage

In regard to END FEEL, for FIRM, what tissues will give that feeling?

Capsule, ligament and muscle stretch

Differentiate acute pain from chronic pain

Chronic pain -anything that has occurred greater than 3 months -not well understood at this point -not necessarily a trigger that causes pain -in the brain, but no necessary cause and effect -warning and protective function is lost -not felt in one place -strong link between physical and psychological changes that are occuring in the brain -has an impact on clinical outcomes and quality of life -The PT may need to be a lot more understanding and have more patience Acute pain -a cause (trigger) and effect (e.g. you hit your thumb with a hammer and it hurts) -tends to be localized and understood where it is coming from -most pt. who have had surgery, contusions, etc. -easier to progress them along

Differentiate btw QUANTITY and QUALITY for PROM Classical v Accessory

Classical/Osteokinematic: Goniometric measurement [DETERMINED BY USING GONI] (quantity) End-feel (quality) Accessory/Arthrokinematic: Hyper/Hypomobility [DETERMINED USING OUR HAND] (quantity) End-feel (quality)

Define Step #14: Neuromuscular & Neurovascular

Confirming the involvement of a peripheral nerve This step encompasses sensory and motor testing related to peripheral nerves, neural tension testing, and pulses. Neurovascular/Neuromuscular in Ortho is specific to sensation related to a peripheral nerve, the vascular supply of a specific artery, and the strength of specific muscles. Note that we have already performed dermatome, myotome and reflex testing earlier on in our examination to rule out (or rule in) a nerve root condition. In this examination step we are examining to confirm the involvement of a peripheral nerve. NOTE: MMT also is specific to the strength of muscle. So how is this step different than MMT? Truth be told, MMT would have been done before this step and would have identified weakness, but MMT only tells us a muscle is weak it does not confirm the weakness could be related to the nerve that innervates that muscle. In this case, we would need to find weakness in all the muscles innervated by the nerve beyond the nerves location of damage.

Describe some structure v positional examination findings

Consideration of structure versus positional examination findings: The appearance is not typical but is normal for the patient's body type. Example - A cultural consideration with African Americans whereas the sacral angle is increased producing an increased lordosis (this may apply to the second bullet as well) The appearance is abnormal but is of the acquired type. Example - pregnancy (this may apply to the bullet above and below depending on how it is reasoned) The appearance is abnormal but is of a compensatory type (positional). Example - post-polio patients whereas compensations developed compensatory positional faults that may become structural faults due to osseous changes.

Define Step #6: Structural Inspection & Position

Don't forget when we examine posture we want to look at the person as a whole, not just the body part we are examining. This was very briefly conducted during step #2 (Initial Observation) but was not nearly as specific, valuable, or reliable. During this step, we become more specific to the patient's complete structure regarding not only their overall body but the joint and extremity alone. What does the spine look like? What do the feet look like? How are those two connected? Do you notice any assistive devices (crutches, braces, corsets)? Observing: body as a whole general posture (e.g. forward head, etc.) spine

What are the same 5 FINDINGS that will allow the therapist to make the determination that there is a capsular pattern present.

Decreased AROM - in the pattern of the specific joint Decreased Classical PROM quantity - in the pattern of the specific joint Decreased Classical PROM quality - tight/hypomobile capsule end-feel with classical PROM Decreased Accessory PROM quantity - in the pattern of the specific joint Decreased Accessory PROM quality - tight/hypomobile capsule end-feel with accessory PROM

What are some characteristics of DYSFUNCTIONAL AROM?

Dysfunctional Active Movement is anything that is not normal: limited range unwillingness to move painful arc (pain in the middle of ROM, typically used about the GH joint flexion and abduction) compensatory movement presence of crepitus (noises) pain at the end of range

What is the tissue-specific impairments that can be determined solely by palpation for condition?

Edema only. You may be tempted to include effusion. However, effusion is found with palpation for condition but is not yet confirmed until PROM Accessory has been performed. Effusion will be felt once we move the joint. If we do not feel effusion during PROM accessory this rules it out and the finding of swelling during palpation for condition will naturally be edema.

What are the six basic components of patient/client management

Examination → Evaluation → Diagnosis → Prognosis → Intervention → Outcomes

Define Step #9: Joint Passive Range & End-Feel

For now, all you need to know is that PROM is ALWAYS differentiated as either Classical (Osteokinematic) or Accessory (Arthrokinematic) movement.

How does the clinician make the differentiation between a structural and positional scoliosis?

Have the patient forward bend. With forward bending of the trunk, a rib hump will remain if the scoliosis is structural; whereas the rib hump will be alleviated with a forward bent position if the scoliosis is functional. This is because with structural scoliosis the bones have changed to give the shape of the curve, whereas, with positional scoliosis, something else (soft tissue) was causing the curve. Forward bending allows the soft tissue to change and therefore the curve of scoliosis will change. Realize this is a screening tool for scoliosis and not an absolute determination of a scoliosis dysfunction.

Define Step #8: Joint Active Range of Motion

Helps us differentiate btw normal and dysfunctional AROM Observations that can be made with Active ROM: The quality of motion An indication of some strength Symptom reproduction Painful Arcs Note: Active range of motion findings by themselves can NEVER tell us what is wrong with the patient or tissue. It alone will NEVER lead the clinician to the tissue-specific impairment and therefore cannot be considered the best examination finding EVER. It cannot determine a tissue-specific impairment. It only provides us information as to if the patient can or cannot move in the presence of their pathology.

Define Step #3: History and Interview

Here is a possible list of things to gather from history: General Demographics Social history Employment / work history Growth and development Living environment Social / Health habits Family history Medical and surgical history Current conditions /chief complaints Functional Status and activity level Medications General health Status Other clinical tests Salter also lists different components of the history. He includes the following: Pain Decrease in function Relevant history Functional inquiry Social, economic and work history Family history Sample questions to ask: Tell me in your own words what your problem is? When did the pain start? Where did it start? Where did it spread to? What do you think caused it?

Note the following PRINCIPLE: We always perform Mobility testing of a joint before testing the length of any soft tissue. We cannot evaluate length if joint ROM is limited. Why is this principle significant? How does it relate to the sequence of the 18 steps?

If there is tightness in the joint due to capsule tightness, the joint cannot go through full ROM, as a result we cannot assess the length of the muscles that cross that joint. If muscle length testing is performed it will result in a false positive resulting in incorrect interventions being applied. The sequence of the 18 steps allows for the mobility of the joint to be examined prior to muscle length testing.

Describe the BIOPSYCHOSOCIAL MODEL of PAIN

Illustrates that you need to understand the biological factors, psychological factors, and social factors that go on with people. Biological factors: -Pain itself -We might avoid certain things to provoke the pain Psychological factors: -Lack of sleep -Appetite depression -Anxiety -Anger -Loss of self confidence -Withdrawn from social groups -Feel like a burden to others Social factors: -Difficult things they can no longer participate in -Work -School -Social functions (e.g. dinner) -Impact on financial status -Overall impact quality of life

What is the difference between a diagnosis by an MD and diagnosis by a PT?

MDs diagnose disease and pathology Diagnosis by a PT is to diagnose tissue and movement impairments

What do you think of when you hear "patient/client management"? Is the management of a patient/client the same as our treatment? Alternatively, is there a difference?

Management includes all of our 18 steps. But it doesn't stop at discharge. Like a dentist, we should call and check in with patient to make sure they are keeping up with their exercise/wellness. So to summarize, patient/client management is the overall care that the patient receives from initial evaluation, through discharge and even after discharge.

Give some examples of Step 1: Intake Forms Assessment

McGill Pain Questionnaire Body Chart Diagram Lower Extremity Functional Index (LEFS) Upper Extremity Functional Index (UEFI) Shoulder Pain and Disability Index (SPADI) Quick Disabilities Arm, Shoulder and Hand (Quick DASH) Neck Disability Index (NDI) Oswestry Low Back Pain Disability Questionnaire Can use these charts to write short term goals. We want to get pt. from 20/80 to 40/80.

What are the 9 ABNORMAL END FEELS? Which conditions/actions may produce these?

Nine (9) Abnormal End Feels Capsule tightness Harsh resistance with reduced or absent creep e.g. abnormal in ROM, characteristic capsular pattern Joint adhesions Sudden sharp arrest in one direction e.g. intracapsular Bony block Sudden hard/rigid stop e.g. callus formation, periarticular ossification (myositis ossificans) Abnormal cartilage Rough, grating e.g. chondromalacia, osteoarthrosis Displaced meniscus Springy rebound, bouncing back e.g. luxated meniscus, joint mouse (free floating cartilage) Pannus Soft with crunchy e.g. elbow extension Capsule/ligament laxity Increased movement without firm arrest e.g. capsule torn with hypermobility, grade 2 ligament laxity Swelling Boggy, soft e.g. effusion (synovitis, hemarthrosis), edema Abnormal muscle Abnormal contractile resistance e.g. muscle contracture, adaptive muscle shortening, voluntary /in voluntary muscle guarding, adhesed

Is pain an end feel?

No, the therapist can not feel the pain, the patient feels the pain. The end-feel can provoke pain, but the pain is not considered an end feel in the Paris/Patla system. Pain is the PATIENT RESPONSE

Is every swollen state inflamed?

No. Inflammation is the buildup of leukocytes and everything else. It is an active process of tear down and builds up. Inflammation IS swelling, BUT not every type swelling is inflammation because fluid can be present without an active process of healing.

Can PTs make the diagnosis of osteoarthritis (OA) and Degenerative Joint Disease (DJD)?

No. The validation for such diagnoses requires tests and measures that are beyond the scope of the PTs tests and measures. The PT can diagnose and discuss the impairments associated with or correlated with degenerative changes.

What are the 5 Normal End Feels? Give an example of what the resistance feels like and which actions may produce this end feel?

Normal muscle/soft tissue approximation Soft & spongy e.g. elbow flexion, knee flexion with hip flexion Normal muscle Elastic, slow e.g. straight leg raise, hip abduction Normal ligament Firm arrest, no creep e.g. ankle inversion Normal cartilage/bone Hard/rigid, sudden stop e.g. elbow extension Normal capsule Firm arrest, creep (with time) e.g. knee extension with hip extension p. 35 E1 manual

Using what you know about MSTT and FINDINGS, consider the following scenario: In the video clip, the shoulder was used as the example. Let's say that abduction and external rotation were both painful and could not hold resistance. What is the tissue impairement?

Partial tear

Define Step #11: Muscle Length Testing (MLT) Presentation

Principle: Mobility test before length test Cannot evaluate full length if ROM is limited

Define Step #12: Manual Muscle Testing (MMT) Presentation

Principle: Mobility test before strength test Cannot evaluate full strength if ROM is limited

What types of findings would require caution with the rest of the examination?

Significant redness, warmth and swelling

In regard to END FEEL, for SOFT, what tissues will give that feeling?

Soft tissue approximation

In the following example from an MSTT: the shoulder was used as the example. Let's say that abduction and external rotation were both painful and could not hold resistance. We found from this example that the tissue impairement is a partial tear. However you still don't know what muscle is involved. To do this, you must think of all the muscles that do shoulder abduction and all the muscles that do an external rotation. What is the common muscle(s)?

Supraspinatus. So you can reason that there is a partial tear of the supraspinatus. This then becomes more TISSUE SPECIFIC!

According to Dr. Paris what is "Suffering"

The act of not knowing why you're in pain.

Why do we as physical therapists need to perform an examination and evaluation? Why can't we just take what the referral says and treat based on that? Why can't we just take the patient's word and treat where their pain is?

The answer is multifaceted but boils down to the fact that we as independent healthcare practitioners need to know what we are treating and why we are treating it. Although the patient's referral may reference "Shoulder pain: Eval and treat" or the patient will report complaints of shoulder pain, it is not the shoulder pain we directly treat. Instead, it is the specific tissue causing the pain and the pathology of the painful tissue that we as physical therapists treat. The physical examination and evaluation allows us to determine these components. Again, we need to determine the TSI, the MD diagnosis does not tell us, so we must identify the TSI diagnosis through our exam and eval.

Define DIAGNOSIS

The diagnosis is two-fold. It is both the process of the evaluation and the result of evaluating information obtained from the examination, which the physical therapist then organizes into defined clusters, syndromes, or categories to help determine the most appropriate intervention strategies. This may appear confusing. How can the diagnosis be the same as the process of evaluation? Well, as you evaluate/analyze the data you may very well consider several potential diagnosis/conditions. This is normal, but a thorough examination and accurate an accurate evaluation should always lead you to confirm one diagnosis.

Define EXAMINATION.

The examination is the process of obtaining a history, performing relevant systems reviews, and selecting and administering specific tests and measures to obtain data. [1] So, basically this is everything involved in collecting the data. We will further break this part down into individual steps a little later.

Define INTERVENTION (Plan of Care)

The intervention(s) is frequently referred to as the "Plan of Care." This is the purposeful and skilled interaction of the physical therapist with the patient/client and, if appropriate, with other individuals involved in the care of the patient/client, using various physical therapy methods and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis.

Define OUTCOMES

The outcomes are the results of our patient/client management. It is how much improvement, or lack thereof, the patient gained. At times, the outcomes may not be as expected. This is because outcomes are challenged by the extent of the pathology and impairments present. Outcomes hold the physical therapist accountable to the interventions that are provided to the specific impairments.

Define PROGNOSIS

The prognosis is the determined level of optimal improvement that might be attained through our intervention and the amount of time required to reach that level. Prognosis is how much improvement the patient is going to achieve. Will they get back to 100% or only 80%? What is realistic for that patient? Maybe 60% is realistic. There are several factors that need to be taken into consideration when determining a patient's prognosis. One of the biggest factors is the amount of experience the therapist has. This does not necessarily mean the amount of experience in years of treating. It is most related to the amount of experience the therapist has with that given diagnosis. Not because more experience makes you a better therapist, but because you have a better idea of what to expect based on past experiences. You also must take into consideration what is wrong with the patient, the prior level of function and co-morbidities. All of these will impact the patient's capabilities at improvement. Lastly, the prognosis is our way of informing the patient if we can help them, what we believe we can do for them, and how long it will take.

Define Step #10: Muscle Selective Tissue Tension

The purpose of performing MSTT is to determine the dysfunction that is present within the musculotendinous unit. We will use our deductive reasoning to figure out the muscle involved as well as the dysfunction that is present. We need two pieces of information from this test The subjective response - is there pain or no pain? The ability to match/meet resistance - is it strong or weak? Having these two pieces of information, we then combine them to figure out the dysfunction that is present.

What is the purpose of the physical examination by the physical therapist?

The purpose of the physical examination by the physical therapist is to perform a series of tests and measures to collect data. Once the data is collected, it can then be analyzed. Following analysis, only then should intervention be applied.

If there is pain with MSTT, why is MMT deferred?

The rationale being if a sub-max muscle contraction is painful a maximal contraction will be painful. Pain with MMT will invalidate the results of the MMT, and if there is a partial tear present, there is a risk of causing more damage to the tissue when doing an MMT after the painful MSTT. MLT can be performed after pain with MSTT in certain situations. If there is pain with MSTT but the patient can meet the resistance, meaning they are strong but painful, then MLT can be attempted. However, if there is pain and the patient is unable to match the resistances, meaning they are weak and painful, then do not do an MLT. In the latter, there is a suspected partial tear and performing an MLT on a partial tear could cause more damage to the muscle.

Define Step #5: Screening

The screen is performed to rule out (or rule in) pain referral from a different anatomical location. The screen includes the following elements: AROM of joints above and below the location of symptoms AROM and quadrant tests of the spine (cervical or lumbar) if there are neurological symptoms present regardless of the location of symptoms Overpressure after the AROM movements Dermatome/Myotome/Reflex testing for neurological complaints to rule out/in a cervical or lumbar nerve root condition A positive finding from any of the elements in the screen would result in the need for further more detailed examination of that anatomical location. In summary, the screening either confirms the problem is in a specific area and rules out areas around it. Or it may rule them in if the pain is found elsewhere.

Define Step #4: Systems Review/Review of Systems

The systems review is the part of the physical exam where the physical therapist will do a screen of the major systems in the body (cardiovascular, pulmonary, urogenital, gastrointestinal, endocrine, integumentary, neurovascular, musculoskeletal, etc) to determine if there are any other health conditions that require referral to another health care professional. Vital signs will be taken at this point in the exam. Vitals signs include temperature, blood pressure, heart rate and respiration rate.

Aside from pain, why do people come into the clinic?

Their inability to do something!

What are the 6 characteristics of NORMAL ACTIVE MOVEMENT?

There are six characteristics of normal Active Movement: takes place smoothly-regardless of speed adequate relaxation of antagonists range is full-according to body type pain free muscles are of normal strength since they have to move through the range against gravity Will be less than passive ROM

Define Step #15: Palpation for Tenderness (PFT)

This examination step is useful to confirm a structure is involved. It is useful when you may not have been able to provoke the patient's pain with any of the previous steps. It is also useful to confirm the structure that is involved. Palpation for Tenderness requires a thorough knowledge of anatomy and great palpation skills. We perform this test with only 1 finger palpating only 1 tissue. As compared to palpation for condition that was conducted with a broad hand contact. Note: A few things to be cautious of though is that we are relying on the patient to tell us where it is painful and if there is any pain at all, which makes this step very subjective. The other caution is referred pain. Think of patients who have shoulder problems - where do all of them complain of pain? Lateral brachial region. Is that where their actual problem is? Not usually. We want to reproduce the patient's pain just once. This will show the patient that we can find their pain which means that we can treat it. PFT is: Performed toward the end of the examinations as to not prematurely aggravate the patient Narrow the point of palpation by use of 1 finger Gradually palpate into the tissue with greater depth

Define Step #7 Palpation for Condition

This is to help us determine what stage of condition the patient is in. Meaning, where is there tissue at in its phase of healing. This provides some information to help determine if the patient is in an Acute, Sub-acute, Settled or Chronic stage of the condition. Most specifically, though, Palpation for Condition determines the presence of swelling and warmth. These findings are typically related to either an Acute or Sub-acute stage of condition. Lack of these findings may indicate the patient's tissue has begun to heal and may be in more of a Settled of Chronic stage of condition. Note that the presence of swelling and warmth are common to what is considered the Cardinal Signs of Inflammation, but these are not the only signs. During a PT examination, we need to determine the cardinal signs of inflammation early on. The complete list includes: Color - redness Temperature - heat Swelling - fluid Pain Loss of function When performing palpation for condition you should be looking for the following: What is noticed about the muscles - are there any gaps or atrophy or change in contour? What is noticed about the skin - is there warmth, redness, moisture, scars? What is noticed about the subcutaneous tissue - does if feel soft or firm?

Define Step #16: Movement Analysis

This step is to look at how well the patient can or cannot perform certain functional activities. It may be useful to have the patient show you what they do that causes their pain, such as: Gait or particular movement patterns Ergonomics of the workplace Sports needs and daily living requirements Functional movement patterns The movement analysis is useful in creating a functional goal for your patient.

Why do physical therapists do an examination?

We do it as a screen to determine if the patient requires physical therapy. If we cannot find a problem, we should not be working with the patient. They are screened for physical therapy needs. We may also examine to see if the patient may need a referral for additional intervention or to see if the problem is not musculoskeletal and therefore beyond the scope of our practice. It provides a starting point for intervention and a way to measure progress.

Define Step #17: Diagnostic Imaging

You will learn much more in the imaging course. For now, understand a radiologist primarily looks for: Disease Fracture Displacement While a physical therapist may look for: Joint space and alignment Bone density adjacent to joint space Calcification of soft tissues and soft tissue integrity Range & sequence or motion

According to Dr. Paris, who is in control over pain.

You, if you do the same things to make it worse, you are responsible.

Define Step #2: Initial Observations

Your examination of the patient begins the first moment you see them. At this time you are doing a very brief inspection of them. You want to see how they sit in the waiting room, what their posture is, how they rise to standing, how they shake your hand, etc. All of this can start to give you some valuable information about the patient and possibly what may go on. It will not tell you exactly what is wrong, but it will give you a place to start. Observe for: Guarded motions Freedom and ease Pain and dependency behaviors trick movements Note: Sitting posture Rising from chair gait Handshake Getting into Chair Getting onto table

Define EVALUATION

a DYNAMIC process in which the physical therapist makes CLINICAL JUDGMENTS based on the data gathered during the examination. Note: the eval is dynamic, or always changing, and ongoing. The evaluation is always changing and always ongoing. You gather the data in the examination, and the evaluation is where you start to put it all together. You begin to come up with impairments and the diagnosis. The evaluation is the critical thinking aspect of patient/client management. It is the component where the PT comes up with a problem list and a list of tissue-specific impairments. Understand, the process of examination and evaluation are different.

The physical examination and evaluation are set up to facilitate the __________________ as well as to avoid ________________.

decision-making process; bias

What is a general rule of thumb to differentiate between a STRUCTURAL v FUNCTIONAL impairement?

o use ROM (AROM or PROM) to see if the dysfunction changes. If it is structural it will not change, if functional it should change with either AROM or PROM.

What are some examples of interventions?

modalities, stretching, manipulation, strengthening, ADL retraining, etc; many more can be included on this list

The 18 steps progressive from ____________________ to ______________________

the steps progress from least aggressive to the most aggressive. We start off gentle and talking to the patient and gradually progress our examination to be provocative and perhaps more painful to tissue. Also recognize that the exams are grouped by "system." Meaning all joint tests (AROM, PROM) are done in order before going on to muscle tests (MSTT, MLT, MMT).

What is the purpose of the evaluation and the diagnosis?

to make a clinical judgment based on the data from the tests and measures that results in a diagnostic label for the patient.

What types of examination findings do you get from performing palpation for condition?

warmth, swelling, scar, atrophy, scar, moisture, gap in muscle