CAP; SIGNS AND SYMPTOMS AND CASE STUDIES

A 23 year old woman presents with a single "c" curve scoliosis to the right having its apex at T9. She complains of fatigue type of pain in her back muscles and describes a general overall feeling of stiffness and a lack of flexibility in her torso. Complicating factor - she has burped at least ten times during the interview, despite the disruptiveness of the burping, she is embarrassed and apologetic and explains that for some unknown reason she has been constantly belching for days and has no idea why.

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Parents bring their 5-year-old son in to see you. They state that he was running around the recreation room chasing a friend when he tripped over a stool and landed on his shoulder. He refuses to move his arm and is crying, because the accident occurred only 2 hours earlier. Describe your assessment plan for this patient.

AC JOINT ISSUES; STEP DEFORMITY; NON CONTRACTILE Postural; STEP DEFORMITY; ACROMION DOWN, CLAVICLE UP Palpation; TENDER SHOULDER; AROM; HORIZONTAL ADDUCTION LIMITED PROM; PAIN FULL WITH ADDUCTION & ABDUCTION AR ROM; FINE 1. JOINT PLAY ON CLAVICLE; IN INFERIOR POSITION ORTHO TEST; 2. AC SHEAR TEST; POSITIVE; PAIN 3. NEAR IMPINGEMENT; POSITIVE

• Axial skeleton • Bamboo spine • Pain worse at night or extended periods of inactivity • Pain improves during activity • Severe flare ups may result in constant pain • Spontaneous flare ups & remissions • Slow progression • Inflammatory flare ups typically cease around age 40 • Younger client = secondary joint swelling • SI & lower L spine affected first • Redness • Eye pain • Light sensitivity • Areas of body in both early & later stages Early • Dull, achy low back & glutes Later • Severe ROM loss d/t joint fusion • Muscle shortening d/t lack of mobility, muscle contractures, atrophy • Laboured, shallow breathing

ANKLYOSING SPONDYLITIS

An 18-year-old male football player comes to you complaining of a "dead arm" after a tackle he made 2 days ago. Although he can now move the left arm, it still does not feel right. Describe your assessment plan.

BRACHIAL PLEXUS VS. ACROMIOCLAVICULAR SPRAIN CONTRACTILE; Nerve root compression Brachial plexus Functional assessment AROM; CERVICAL; ELVATON ON LEFT SIDE. (LIMITED), DEPRESSION, RETRATION PROTRACTION OF GH SHOULDER. PROM; relieve of discomfort with arm raised. AR ROM; weakness LENGTH; SCALENES; NORMAL STRENGTH; UPPERTRAPS WEAK DERMATOME; C8; all sensation MYOTOME; C8; THUMB EXTENSION/ ULNAR DEVIATION, PEC MAJOR. Ortho tests; EDENS TEST + SPURLINGS; ; nerve root compression NEGATIVE.

A 26-year-old male football player is referred to you after surgery for a ruptured (third-degree strain) left biceps tendon at its insertion. His cast has been removed, and you have been asked to restore the patient to normal function. Describe your assessment plan for this patient.

Biceps sprain POSTURAL; possibly short left are Length of biceps; short and tight Strength of tricep AROM; extension limited, supination limited. Flexion and pronation fine Prom; everything good; because this is contractile AR ROM; pain supination and flexion Ortho tests; speeds ; resist pronation and supination; long head of biceps. Will be negative Yergasons; resist as they ext rotate; transverse humeral ligment; will be negative

• Change in pigmentation • Change in size or shape • Lack of distinguishable palpable borders • Fatigue • Weight loss • Increased illness frequency • Sudden & unexplained headaches • Fever • Unexplained edema

CANCER

• Unilateral or bilateral • Numbness & tingling • Nocturnal dysthesia • Local pain which progresses proximally • Limited ROM (extension) • Possible swelling • Fascial restrictions, TrPs, H+, f/a flexors • Adhesions, scar tissue flexor retinaculum or tendons • Atrophy thenar muscles

CARPAL TUNNEL

A 48-year-old man comes to you complaining of neck and shoulder pain. He states that he has difficulty abducting his right arm. There is no history of trauma, but he remembers being in a car accident 10 years earlier. Describe your assessment plan for this patient.

CERVICAL SPONDYLOSIS VS. ADHESIVE CAPSULITIS Non contractile AROM; GH JOINT; LIMITATION IN ABDUCTION ONLY PROM limitation and pain in abduction AR ROM; ok FUNCTIONAL ASSESMENT; REACH UP FOR COMFORT. PN AT BACK OF SHOULDER. ASSUME SUPRASPINATUS; LENGTH; PEC MAJOR; WILL BE FINE. STRENGTH; SUPRASPINATUS; TEST END RANGE; WEAK Supraspinatus ("Empty Can" or Jobe) POSITIVE HAWKINS KENNDY; TEST; POSITIVE

A 31-year-old woman complains of pain in the right hand with a duration of 3 months. The pain awakens her at night and is relieved only by vigorous rubbing of her hand and motion of the fingers and wrist. There is some tingling in the index and middle fingers. Describe your assessment for this patient. Complicating factor - pregnant (third trimester) with edema of the right wrist and hand.

CLINICAL IMPRESSION; CARPAL TUNNEL PALPATION; HYPERTONICITY IN FLEXORS POSTURAL; RIGHT SHOULDER ELEVATED DUE TO COMPENSATION. CONTRACTILE; FOREARM FLEXORS TIGHT. LENGTH TEST ON FLEXORS; SHORT AND TIGHT. STRENGHT TEST ON EXTENSORS ; NEGATIVE/NORMAL TEST; ALLENS FOR VASULAR; NEGATIVE PHALENS TEST FOR CONTRACTILE; POSITIVE FOR PAIN; EXP NUMBNESS AND TINGLING INTO THUMB INDEX, MIDDLE AND LATERAL HALF OF RING FINGER.

A 72-year-old woman comes to you with a left Colles fracture. Describe your assessment of this patient.

COLLES ; BROKEN RADIUS DISTALLY Functional assessment ; turning key; door knob. Contractile Weak supination testing supinator ; okay pronation Postural; everything fine; left arm atrophy and hypotonicity Hypertonicity in left gh joint.; hold arm in guarded position. AROM; no full supination PROM; Fine AROM; resist supination ; pain Length on pronators Strength: poor on supinator Myotome; C6; wrist extension, elbow flexion & serratus. Negative. Ortho test; phalens test ; negative

A 52 year-old man is referred to Massage Therapy for his left elbow pain. He complains of tenderness over the lateral epicondyle with occasional numbness and tingling shooting done his arm. He states that he has not done any repetitive forearm activity and does not play tennis. When asked he divulges that he drives a taxi for a living and often rests his arm on the armrest of the taxi door. After further case history questioning it is discovered that he in on heart & blood pressure medications and finds his job extremely stressful dealing with people.

CONTRACTILE CLINICAL IMPRESSION; LATERAL EPICONDYLE PLUS COMPRESSION OF ULNAR NERVE. PALPATION; EXTENSORS ARE TIGHT POSTURAL;.LEFT GH JT. RAISED FUNCTIONAL TEST; LEAN ON TABLE; RAISE /FLEX WRIST. AROM; FLEXION LIMITED PROM; FINE AR ROM; EXTENSORS ARE LIMTED. LENGTH TEST ON EXTENSORS; TIGHT STRENGHT TEST ; FLEXORS; NORMAL TEST; ULNAR TAP TEST: POSITIVE ON Med side Cozens for lat epicondyle Pronate and resist extension

A 52 year-old man is referred to Massage Therapy for his left elbow pain. He complains of tenderness over the lateral epicondyle with occasional numbness and tingling shooting done his arm. He states that he has not done any repetitive forearm activity and does not play tennis. When asked he divulges that he drives a taxi for a living and often rests his arm on the armrest of the taxi door. After further case history questioning it is discovered that he in on heart & blood pressure medications and finds his job extremely stressful dealing with people.

CONTRACTILE CLINICAL IMPRESSION; LATERAL EPICONDYLE PLUS COMPRESSION OF ULNAR NERVE. PALPATION; EXTENSORS ARE TIGHT POSTURAL;.LEFT GH JT. RAISED FUNCTIONAL TEST; LEAN ON TABLE; RAISE /FLEX WRIST. AROM; FLEXION LIMITED PROM; FINE AR ROM; EXTENSORS ARE LIMTED. LENGTH TEST ON EXTENSORS; TIGHT STRENGHT TEST ; FLEXORS; NORMAL TEST; ULNAR TAP TEST: POSITIVE ON Med side Cozens for lat epicondyle Pronate and resist extension

A 23 year-old woman comes in after a motor vehicle accident. Her car was hit from behind while stopped for a red light. She could tell the accident was going to occur because she could see in the rear view mirror that the car behind her was not going to be able to stop. The car that hit her was going 50 km/h, and skid marks were visible for only 5 meters from the location of her car. She states that her neck feels unstable, she is fearful and does not want to remove her neck brace although she has medical clearance to.

Clinical impression; muscular; cervical strain vs cervical facet syndrome CONTRACTILE; MUSCLE STRAIN Grade 2 (2nd Degree)25-75% • viable tear from several to a majority of fibers • may be audible snap or snapping sensation at time of injury • may be palpable gap in the tissue • client has difficulty with daily activities from pain and weakness • moderate loss of ROM • support bandages or crutches may be needed WOW/surprise; ALAR Ligament test; we need ligament tugging at 20/30 degrees. POSTURAL; Anterior head carriage; left lat flexion; right rotation PALPATION; ht on left side in the case of whiplash, scalenes, levator scapula, all posterior cervical muscles including longus colli FUNCTIONAL ASSESSMENT; look over blind spot to right. AROM; Moderate loss of ROM; PROM; more range than AROM; AR ROM; left lateral flexion and right rot. Length; scalenes left; positive short Strength; flexors ; weak; grade 4 joint play; all cervical facets moving ok ortho test; ALAR & SPURLINGS.

A 20-year-old male tennis player comes to you complaining that when he serves the ball, his arm "goes dead." He has had this problem for 3 weeks but never before. He has increased his training during the past month. Describe your assessment plan for this patient

Clinical impression; neurological; non contractile Functional assessment; AROM; flexion limited PROM; limited and pain AR ROM; fine Length; 1. Strength; resist flexors; anterior deltoid; bring to end range; positive ; decreased with pain 2. Joint play; decreased posterior direction 3. Ortho tests; neer impingement; positive; impingement; need to move joint posteriorly. 4. Posteriorly drawer test; negative

• Weight loss • Polydipsia, polyphagia, polyuria • Peripheral neuropathies, vasculopathies • Fatigue & irritability • Seizures • Fainting &/or coma • Compromised healing • Decubitus ulcers & gangrene • Hypertension • Edema • Ketoacidosis • Confusion &/or lack of focus • Nausea & vomiting • Uncontrollable shaking • Excessive sweating & clamminess

DIABETES

• Palmar fascia tender, thick & nodular • Palmar fascia contraction flexes digits • May stop at any stage of progression • Decreased local circulation • More tone of wrist flexors • TrPs referring to palm • Active free ROM not possible

DUPUYTRENS

• Widespread pain • Heightened sensitivity to tactile pressure • Hypersensitivity to vibrations • Reduced tolerance to cold • Anxiety & depression • Memory loss, memory retention, trouble with concentration • IBS • Restless legs syndrome • Muscle twitches &/or spasms • Chronic fatigue

FIBRO

Acute infection • 2-4 weeks • Flu like symptoms Clinical latency • Months to years (8 on average) • Generally asymptomatic • Increase in flu like symptoms • Weight loss or GI distress Chronic • Months to years • Opportunistic infections • Chronic signs of illness

HIV AIDS

• Functional or structural • Difficulty breathing • Pain similar to hyperlordosis • Hypertonic pecs • Short/tight - pec major & minor, subclavius, serratus anterior, anterior intercostals, subscapularis, latissimus dorsi, levator scapula, upper trapezius, suboccipitals • Stretched/weak - rhomboids, mid trapezius, platysma, longus coli, supra & infra hyoids

HYPERKYPHOSIS

All forms • Abdominal pain (cramping/spasm) • Vomiting • Diarrhea • Rectal bleeding • Weight loss • Stunted growth • Ulcers UC • Continuous, superficial inflammation • Diarrhea mixed with blood & mucus CD • Patches of inflammation • Slower initial presentation • Deeper inflammation • Aphthous ulcers

IBD

Loose or liquid bowel movements • Decreased urination • Loss of skin elasticity • Changes in skin colouring • Difficulty with focus & decision making

IBS

• Hot, swollen joint • Bilateral • ROM loss in affected joints • Pain & swelling • Repeated flare ups cause incongruent joint surfaces • Granular feeling (pannus) • Visible deformities - swan neck, boutonniere's, ulnar drift • Deformation rarely seen d/t entering remission • Eye diseases - uveitis, glaucoma, cataract

JRA

• Connective tissue • Butterfly facial rash • Hair loss • Photophobia • Chronic joint pain • Classic arthritis presentation • Variety of symptoms depending on organ dysfunction

LUPUS

• Begins as dull, ache gradually worsening • Severe pulsating pain • Unilateral in 60% of cases • Begins abruptly in one area spreading to larger area • Severe enough to require hospitalization • Common early morning onset • Muscle soreness • Sensitive to light & sound • Nausea, vomiting, diarrhea • Pain can be disabling

MIGRAINES

A 26 year old male ice hockey player comes in complaining of back pain that is referred around the chest. He explains that he was "boarded" (hit between another player and the boards). He did not notice the pain and stiffness until the next day. He has had the problem for two weeks and finds the pain intensifies to a burning pain on the right when he is breathing.

NON CONTRACTILE ISSUE FACET PROBLEM ON RIGHT; POSTURAL; SEE RIGHT LAT FLEX AND LEFT ROT IN THORACIC; EVERTTHING ELS FINE PALPATION; HT ON RIGHT SIDE; NO CHANGE IN ANYTHING ELSE. CLIENE FEELS DISCOMFORT. INFERIOR BORDER OF SCAPULA IS T7 USE THAT. COUPLING ACTION; LATERAL FLEXION RIGHTS SO ROTATION TO LEFT. SLUMPS; NEGATIVE KEMPS; POSITIVE IN RIGHT LATERAL FLEX, ROTATON AND EXTEND

• Unilateral or bilateral • Early stage is painless • Alleviated by rest • Achy pain local to joint • Morning stiffness • Decreased ROM lasting 30 minutes or less • Later stages pain with minimal activity • Nocturnal pain may be present • Decreased ROM • Crepitus with movement • Contracture formation in joint capsule • Contracture formation in surrounding soft tissue • Joint misalignment • Periods of acute inflammation • Muscle spasms & edema

OSTEOARTHRITIS

Regenerating nerve lesions • Edema • Altered tissue health • Flaccid paralysis & muscle wasting • Holding patterns • Contractures • Pain • Scar tissue Permanent lesions • Edema • Trophic changes & muscle wasting • Holding patterns • Contractures • Scar tissue • pain • Compensatory changes • Permanent functional & sensory loss

PERIPHERAL NERVE LESIONS

• Gradual onset • Pain local to compression • Achiness in the f/a flexors • Numbness in thumb & index fingers • Weakness in thenar muscles • No nocturnal symptoms

PRONATOR TERES SYNDROME

An 18-year-old man comes to you after suffering a right scaphoid fracture. He has been in a cast for 12 weeks, and clinical union has been achieved. Describe your assessment for this patient. A

Postural; right arm shorter Palpaton; hypotonicity on right arm arom ; pain with radial deviate prom; no pain; hard end feel with deviation Ar ROM; ok joint play; radio/carpal radial/ulnar dev; stuck in extenstion need to fix strength for flexion and extension; weak length test flexors myotome c7; negative Froments paper sign negative.

• Hot, swollen joint • Bilateral • ROM loss in affected joints • Pain & swelling • Repeated flare ups cause incongruent joint surfaces • Granular feeling (pannus) • Visible deformities - swan neck, boutonniere's, ulnar drift

RA

• Progressive in onset • With or without acute inflammation • Initial discomfort after activity • Eventually discomfort during activity • Chronic stage discomfort after activity ends • Pain & loss of function • Weakness • Compensation of surrounding unaffected tissue

REPETIVE STRAIN/OVERUSE INJURIES

• Hardened/thickened skin • Ulcers or sores • Raynaud's phenomenon • ROM loss in affected area • Limited facial muscle control • Difficulty swallowing • Dilated skin capillaries, expanded or ruptured

SCLERODERMA

A 14-year-old boy comes to you complaining of wrist pain with swelling on the dorsum of the hand. He says he tripped and fell on the outstretched hand. He states the wrist hurt, the pain decreased, and then the swelling came on over 2 or 3 days. Describe your assessment of this patient.

SPRAIN AT WRIST; 3RD DEGREE Non contractile; POSTURAL l No visible abnormalites; guarding wrist PALPATION; swelling in tissue; tight extensors FUNCTIONAL; difficulty with toothbrusch AROM; flex limited PROM; pain with extension AR ROM; fine 1. JT play; assess wrist; limited in flexion: concave joint; flexion limited we take joint anteriorly find joint limited anteriorly. 2. ORTHO; murphys sign to rule out carpal bone. 3. Muscle length; extensors are short 4. Strength test; fine

Grade 1 • Minor stretch & tear • No instability with passive relaxed testing • Mild discomfort with activity Grade 2 • Tearing of several or majority • Snapping sound when injured • Joint hypermobile but stable • Pain makes activity difficult • New collagen fibers 1-2 weeks after injury • Slow healing, scar tissue Grade 3 • Complete rupture or avulsion fracture • Snapping sound • Very instable • Pain intense in acute, chronic may be painless • Surgical repair or casting

SPRAINS

• Hot, swollen joint • Bilateral • ROM loss in affected joints • Pain & swelling • Repeated flare ups cause incongruent joint surfaces • Granular feeling (pannus) • Visible deformities - swan neck, boutonniere's, ulnar drift • Deformation rarely seen d/t entering remission • Eye diseases - uveitis, glaucoma, cataract • Much worse • High intermittent fever • Swollen lymph nodes • Salmon coloured rash • Swelling in abdomen - liver & spleen • Jaundice • Fatigue • Weight loss • Chronic infections • Liver referral = right upper trap area • Spleen referral = left shoulder

STILLS

Grade 1 • 0-25% • Mild, minor stretch & tear • Minimal strength loss or ROM • Can continue with ADL • Local edema, minimal bruising • On site tenderness Grade 2 • 25-75% • Viable tear of several to most fibers • Audible snap • Palpable gap in tissue • Difficulty with ADL from pain & weakness • Moderate loss of ROM • Support bandages or crutches Grade 3 • 75-100% • Complete rupture • Avulsion facture • Snapping sound or sensation • Palpable gap sometimes visible • Muscle often bunches up • Pain makes it difficult with ADL • Bruising at site, hematoma possible • Protective muscle spasm, limited ROM • Bandages/crutches • Surgical repair usual

STRAINS

• Thickening of tendon • Point tenderness • Redness, swelling in acute flare up • May feel granular or hard at adhesion site • May feel crepitus on movement of tendon in sheath • Hypertonicity • TrPs • Very granular onset

TENDONITIS

• Pain bilateral or following referral pattern • Associated shoulder pain • Begins in adolescence or early adulthood • Can last a few minutes, hours, days or weeks • After TrPs activated • Later in an average work day • Nausea, dizziness or tinnitus

TENSION HEADACHE

• Unilateral or bilateral Neuronal • Numbness & tingling in C8-T1 distribution • Diffuse, achy, throbbing pain shoulder, f/a & hand • TrPs in scalenes, pec minor & subclavius refer down arm • Mimicking TrPs in lats, serratus ant & post superior • Pain relieved lying down • Progressive motor weakness/grip • Clumsiness • Atrophy in hypothenar eminence & Interossei Vascular • PaiN • Whitening • Cyanosis • Cold feeling in extremities • Edema in hands

THORACIC OUTLET

• TMJ dysfunction, increased tone in muscles of mastication • TrPs • Adhesions • Limited ROM • Cool feeling d/t ischemia • Decreased strength, possible atrophy • May lead to DDD or osteoarthritis

TMJ

Acute • Sudden onset • Pain on movement • Respiration rate increased • Painful expression • TrP in SCM • Tinnitus, nausea, referral pattern • Pain b/t scapula Congenital • Thickening & shortening of SCM • Days or weeks after birth • No pain • Associated conditions: TMJ, cervical DD, osteoarthritis, hemihypoplasia Spasmodic • Adult onsET • Typical position • Jerk or twitch • Ipsilateral shoulder shrugs • Temporary or permanent

TORTICOLLILS

A 26-year-old man comes to you complaining of pain in his neck. The pain was evident yesterday when he got up and has not decreased significantly since then. He thinks that he may have "slept wrong." There is no previous history of trauma. Describe your assessment plan for this patient.

TORTICOLLIS; CONTRACTILE POSTURAL; head is tilted to lEFT LAT FLEX & RIGHT ROTATION PALPATIONS; short and tight in left side of neck FUNCTIONAL; look to blind spot on right AROM; limited right lateral flexion PROM; normal; tightness to right AR ROM; PAIN ON LAT LEFT FLEXION; PAIN ON RIGHT ROTATION=SCM 1. JOINT MOB; C3/4 nothing abnormal 2. MUSCLE LENGTH; SCALENES LEFT 3. MUSCLE STRENGHT ON RIGHT SCALENES; 4. ORTHO; SPURLINGS TO LEFT SIDE. DERMATOME; MYOTOME

A 14-year-old girl comes to you complaining of neck pain. She has long hair. She states that when she "whipped" her hair out of her eyes, which she has done many times before, she felt a sudden pain in her neck. Although the pain intensity has decreased, it is still there, and she cannot fully move her neck. Describe your assessment plan for this patient. Complicating factor - felt dizzy immediately following, for a few seconds but has dizziness has subsided. However, she presents as excessively moody and with an uncooperative attitude..

TORTICOLLIS; CONTRACTILE POSTURAL; Left lateral flexion and right rotation. PALPATIONS; short and tight neck muscles. FUNCTIONAL; LOOK over right blind spot AROM; limited right and left lat flex PROM; normal AR ROM; pain on left lat flexion; PAIN ON RIGHT ROTATION=SCM 1. JOINT MOB; C3/4 2. MUSCLE LENGTH; scalenes on left tight 3. MUSCLE STRENGHT ON RIGHT SCALENES; weak 4. ORTHO; SPURLINGS TO LEFT SIDE. 5. with complicating factor make sure to do vertebral artery test to rule out VA insufficiency

Radial • Wrist drop d/t flaccid extensors • Muscle wasting • Swelling on dorsum of hand • Proximal elbow affects motor & sensory • Distal to elbow one or the other • Sensory loss over extensor surface Ulnar • Claw hand presentation • Muscle wasting in hypothenar muscles • Weakened grip b/t thumb & index finger • Altered sensation on palmar/dorsal of hypothenar eminence Median • Ape hand • Oath hand • Flaccidity in opponens pollicis • Edema in hand • Trophic changes d/t vasomotor loss • Atrophy of f/a flexors & thenar muscles • Altered sensation to palmar surface

ULNAR, MED, RAD LESIONS

Acute • Spasms, strain & contusions in SCM, scalene, lev scap, hyoids, longus coli • Facet joint irritation, lig sprains, hematomas • Possible rupture of long lig, cervical disc lesion, vagus nerve tractioning... • Loss of consciousness or post concussion h/a • Apprehension of active/passive movements • Heat, edema • Spams in SCM & multifidi • Local tenderness Subacute • Decreased heat & inflammation • Decreased pain • Developing adhesions • Decreased spasms • TrPs • Decreased ROM • Swelling around facet joints • Neurological signs • Sharp pain becomes achy Chronic • Deep achy pain referral to arms & scapula • h/a worsens with activity • c spine muscles fibrosed • spasms in longus coli decreased cervical lordosis

WHIPLASH

A 14-year-old female gymnast comes to you complaining of elbow pain. She explains she was doing a vault and bent her elbow backward, at which time she heard a snap. The injury occurred 1 hour earlier, and there is some swelling; she does not want to move the elbow. Describe your assessment plan for this patient.

biceps tendon rupture or epipheseal fracture

A 37-year-old woman comes to you complaining of pain and grating on the radial side of the wrist. Describe your assessment of this patient.

cartilaginous disc vs. schaphoid fracture non contractile; Clinical impression; schapoid fracture Functional assessment; trouble turning key to left; flicking on light AROM; pain with limited mob radial deviation; pain with ext. PROM; lim mob with rad deviation and pain AR ROM; pain with redial deviation; no pain with ulnar Length; flexors normal Strength: radial deviation weak; Abductor Pollicis Longus Flexor Carpi Radialis Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis jt mob; hypermobility with schapoid Ortho tests; finklesteins test; +pain clinical impression; schaphoid fracture

A 16-year-old boy comes to you with a complaint of having hurt his neck. While "fooling" with some friends at the lake, he ran away from them and dove into the water to get away. The top of his head hit the bottom, and he felt a burning pain. The pain decreased as he came out of the water, but he still has a residual ache. Describe your plan for this patient.

cervical fracture or sprain NON CONTRACTILE; POSTURAL; ANTERIOR ROLL OF GH, anterior head carriage; possible concussion palpation; hypertoniciy of upper traps, and tenderness in post neck and shoulder. AROM; PAIN AND TENDERNESS WITH EXTENSION. PROM; PAIN WITH LIMITED EXTENSION AR ROM; OK JOINT PLAY; C 6 AND 7; STUCK IN EXTENSION; ROTATION. (NERVE IMPINGEMENT C1/2 & 3 DERMATOME C3, 4, MYOTOME ALAR LIGAMENT; TO RULE OUT; ARE OK DISTRACTION; RELIEVES PAIN POSITIVE

A 47-year-old man comes to you complaining of elbow and neck pain. There is no recent history of trauma, but he remembers being in a motor vehicle accident 19 years ago. He now works at a desk all day. Describe your assessment for this patient.

cervical spondylosis (osteoarthritis of spine)vs. tennis elbow, vs double crush injury Cervical spondylosis is a 'wear and tear' of the vertebrae and discs in the neck. It is a normal part of ageing and does not cause symptoms in many people. However, it is sometimes a cause of neck pain. Symptoms tend to come and go. In severe cases, the degeneration may cause irritation or pressure on the spinal nerve roots or spinal cord. This can cause arm or leg symptoms (detailed below) CERVICAL spondylOSIS--non contractile arom; rom limitation with lateral flexion. prom; pain with flexion and extension ar rom; normal ; no pain length test for scalenes normal strength test for scalene weak myotome of c6; elbow flexion, wrist extension Positive joint play; stiffness in lateral flexion ORTHO TESTS; cozens test to RULE OUT LATAERAL EPICONDYLITIS Max compression test; positive

A 54-year-old man comes to you complaining of neck stiffness, especially on rising; sometimes he has numbness into his left arm. Describe your assessment plan.

cervical spondylosis vs. subacromial bursa NON CONTRACTILE LISA PICKS SUBACROMIAL BURSA Symptoms of subacromial bursitis can be similar to those of supraspinatus inflammation or injury in the shoulder. There will be pain and weakness in the arm, particularly when it is lifted sideways through a 60 degree arc. AROM; Pain with abuduction (left arm) limited PROM; Pain & limitation with abduction over 60 deg. AR ROM; no pain myotome test; c4; resist shoulder abduction c5; resist abduction at 90 deg. and ext rot. myotome testing is done for 3 times for 10 sec. ORTHO TESTS; PAINFUL ARC; positive NEER TEST; Patient seated or standing Passively fully elevate in scapular plane (30 degrees) Abduct with arm medially rotated by examiner; (HAND THUMB POINTING DOWN +Pain in acromion/tendon area= Subacromial impingement 1.

A 47-year-old man comes to you complaining of pain in the left shoulder. There is no history of overuse activity. The pain that occurs when he elevates his shoulder is referred to his neck and sometimes down the arm to his wrist. Describe your assessment plan for this patient.

cervical spondylosis vs. subacromial bursitis

A 2 year old is brought to you by a concerned parent. The child does not move the head properly, and the sternocleidomastoid muscle on the left side is prominent. Describe your assessment plan before beginning treatment.

congenital torticollis contractile palpation; hypertonicity in left scm, scalenes upper traps. postural; depressed right shoulder arom; limited in lateral flex and rotation prom; restricted but not painful ar rom; restricted but not painful length; lenght of SCM & scalenes restricted. strength; scalenes fine ortho tests; vertebral artery test to rule out s,purling test for facet irritation; scalene cramp test.

A 14-year-old boy presents complaining of a severe aching pain in the middorsal spine of several weeks' duration. He is neurologically normal. X-rays reveal a narrowing and anterior wedging at T5 with a Schmorl nodule into T4. Describe your assessment plan for this patient.

kyphosis or scheurmanns disease....wtf?

A 46-year-old man comes to you complaining of diffuse left elbow pain. When he carries a briefcase for three or four blocks, his elbow becomes stiff and sore. When he picks up things with his left hand, the pain increases dramatically. Describe your assessment plan for this patient.

lateral epicondylitis vs. osteoarthritis

A 35-year-old woman comes to you complaining of persistent headaches that last for days at a time. She has recently lost her job. She complains that she sometimes sees flashing lights and cannot stand having anyone around her when the pain is very bad. Describe your assessment plan for this patient.

migraine or tension headace; migraine headache; POSTURAL; head forward posture, hyperkyphosis, PALPATION; Hypertonicity with nodule in occipitals; referring pain like a band around head. AROM; Limited flex. all other normal PROM; limited in motion of atlas and axis LENGHT test, upper traps short and tight STRENGTH test of anterior neck muscles; for flexion weak ORTHO TESTS; vertebral artery test + Spurlings -

A 16-year-old girl comes to you complaining of thumb pain. She was skiing during the weekend and fell, landing on her ski pole. She hurt her thumb when she fell. Describe your assessment for this patient.

non contractile ulnar collateral ligament sprain postural; arms in valgus presentation; strength of abductor pollicus; weak myotome C8; negative Tinel tap test: positive valgus stress test; positive

A 31-year-old man comes to you complaining of posterior elbow pain. He says he banged his elbow on the table 10 days earlier, and he has had posterior swelling for 8 or 9 days. Describe your assessment plan for this patient.

olecranon bursitis or joint synovitis

A 68-year-old woman comes to you complaining of pain and restricted ROM in the right shoulder. She tells you that 3 months earlier she slipped on a rug on a tile floor and landed on her elbow. Both her elbow and shoulder hurt at that time. Describe your assessment plan for this patient.

olecranon bursitis vs. adhesive capsulitis FROZEN SHOULDER non contractile Rule out the cervical spine, elbow, and TMJ issues - other pathologies of the shoulder such as tendonitis, bursitis, R.A., acromio-clavicular joint sprain. AROM; restriction with external rotation severely limited, abduction,moderatly restricted (slight restric with internal rot and flexion) PROM; slightly more movement but flexion and internal rotation have leathery endfeel. Pain with abuction AR ROM; pain with ext rot and abduction LENGTH; BICEPS FOR ELBOW; NORMAL STRENGTH; DELTOID (PUT IN CLOSED PACK) ORTHO TESTS Apley's Scratch Test Scapulothoracic rhythm/Glenohumeral Movement During abduction the arm should be able to abduct to 20 degrees with no

A 75-year-old woman comes to you complaining primarily of neck pain but also of stiffness. She exhibits a dowager's hump. There is no history of trauma. Describe your assessment plan for this patient.

osteroporosis vs. cervical spodylosis (arthritis) Osteoporosis - Abnormal loss of bony tissue resulting in fragile porous bones can lead to dowagers hump.The presence of a dowager's hump (spinal curvature) in elderly patients indicates multiple vertebral fractures and decreased bone volume. NON CONTRACTILE POSTURAL; DOWAGERS HUMP/ HYPERKYPHOSIS; ANTERIOR HEAD CARRAIGE; PALPATIONS; HYPERTONICITY BACK OF NECK AND ANTERIOR CHEST. FUNCTIONAL ASSESSEMENT; LOOKING UP AT SKY. Can not do. Action coming form lower lumbar to do; complensation AROM; FLEXION LIMITED EXT OF CERVICAL FINE PROM; limited and pain AR rom: ok strength of rhomboids length of pecs JOINT PLAY; C6/C7c LESS MOVEMENT. ORTHO; SPURLINGS

48-year-old man comes to you complaining of a painful hand. He happened to hit it against a metal door jam as he was going outside. During the next few days, the hand became swollen and painful, and he has become very protective of it. Describe your assessment of this patient.

postural ok palpation; pain on palpation of hand dorsal side. THIS ONE IS STUPID. STRENGTH; flexion of fingers weak length; extensors; fine joint play myotome; c7 SOT Allens vascular

A 21-year-old female synchronized swimmer comes to you complaining of pain in her side. She says she was kicked when she helped boost another athlete out of the water 5 days ago. Describe your assessment plan for this patient.

rib fracture vs rib hypomobility

A 38-year-old woman comes to your clinic complaining of chest pain with tenderness at the costochondral junction of two ribs on the left side. Describe your assessment plan for this patient.

rib hypomobility or tietze syndrome

A 45 year-old male retired master swimmer comes in complaining of right sided shoulder pain. He states that when he was training he swam approximately 2000 meters per day. He had many cortisone shots in his shoulder over the course of his athletic career. Further to the pain, he states that he can no longer raise him arm over his head and it is difficult to get his wallet out of his back pocket some days. Obvious expressions of pain and an audible "crunching/crackling" sound is heard during the assessment yet he continues to perform all daily tasks and states that the pain is manageable and keeps using his arm as best he can.

sub acromial bursitis or biceps tendonitis

• Infrequent &/or difficulty passing • Bloating/cramping • Hard, dry stool • Frequent flatulence • Low back/abdominal pain • Autointoxication

• CONSTIPATION