Ortho Test 1
What are two examples of the clinical need to examine for movement analysis?
1. a way to observe the pt to look for things that may be causing pain while performing activities 2. look objectively and functionally to see if the Tx is effective
What are the two types of swelling observed from palpation for condition?
1. edema--- extra-articular swelling... outside the joint 2. effusion--- intra-articular...inside the joint
What types of interpretations could you have from the MSTT?
1. no problem present= can hold against resistance with no pain 2. tendonitis= hold against resistance but with pain 3. partial tear= can NOT hold against resistance and have pain 4. complete tear= can NOT hold against resistance and has no pain
What are possible errors included in the palpation for tenderness?
1. subjective vs objective= palpation is subjective, not objective 2. private vs public= palpation should be private, which presents difficulty in presentation 3. reliability of performance= palpation can not be performed by 2 persons in the same spot at the same time
What is the difference between a symptom and a sign?
A symptom is what the patient describes to the physical therapist and a sign is observed by the physical therapist
What is the difference between an impairment and a tissue specific impairment?
Impairment= any loss or abnormality in psychological, physiological, or anatomic structure or function but does not explain the CAUSE (leads to functional impairment) TSI= identifies the cause....must contain a specific tissue and impairment/dysfunction
What is the purpose of manipulation?
Improve function and decrease pain. Additionally: restore more normal motion, improve tolerance to insult, and aids nutrition and healing
Why perform joint manipulation?
In order to improve function, decrease pain, restore more normal motion, aid nutrition and healing, and increase tolerance to insult of injury. Also, to for the psychological, mechanical, and neurophysiological effects.
What is the concept of instability? What are the theoretical constructs of instability?
Instability can be present as a limited Classical AROM and Classical PROM Theoretical Constructs: 1. Biomechanical 2. Neurophysiological 3. Pain 4. Muscle (Length/Tension)
What are the capsular pattern characteristics?
- Inert structure is at fault -Active and passive movements are painful in same direction -resisted movement do not hurt -pain comes on as limit of range is approached -ROM describes a pattern characteristic to that joint
Describe the capsular pattern. Use example of GH joint.
- Joint AROM - Joint PROM Classical Quantity ( Shoulder ER>ABD>IR) - Joint PROM Classical Quality (end-feel) - Joint PROM Accessory Quantity (Anterior>Inferior>Posterior) -Joint PROM Accessory Quality
What are examples of specific infections?
- Pyogenic Tenosynovitis - Osteomyelitis - Pott's Disease
What are the clinical uses of palpation in detection of what?
-temp. -swelling -size -behavior - gap in muscles - bony enlargement all can be found using palpation for condition and help determine/ narrow down impairment and the course of the rest of the exam
What is the purpose of the exam by physical therapist?
-to clarify the nature and extent of an impairment -to determine diagnosis and develop a treatment plan -to establish a basis for progress
What is the purpose of the evaluation/ diagnosis by a physical therapist?
-to evaluate the qualitative and quantitative data collected from the exam to help determine the diagnosis and prognosis
What are the abnormal end-feels?
1. Capsular Tightness-harsh resistace wwith reduced or absent creep 2. Joint adhesion- sudden and sharp stop in one direction 3.Abnormal Muscle- abnormal contractile resistance... tight muscle 4. Bony block- sudden hard/rigid stop 5. Abnormal cartilage- rough, grating 6. Displaced Meniscus- bounce back, springy rebound 7. Pannus- soft with crunchy 8. Ligamentous/ Capsular Laxity- increased movement with firm arrest 9. Swelling- bggy, soft
What are the 5 pieces of data we need from PROM?
1. Classical PROM Quantity (goni, degrees) 2. Classical PROM Quality (end-feel) 3. Accessory PROM Quantity (hypomobile, hypermobile, normal) 4. Accessory PROM Quality (end-feel) 5. Change in symptoms
What are the principle of Rx according to Salter?
1. Do no harm 2. Base your Tx on accurate diagnosis and prognosis 3. Select Tx with specific aims 4. Cooperate with laws of nature 5. Be realistic and practical in Tx 6. Select Tx for pt. as an individual
What are the 6 variables of manipulation?
1. Force-- direction and magnitude 2. Duration-- # of times and amount of times long enough to get effect 3. Type of Manipulation-- non-thrust or thrust 4. Temperature-- cold vs. warm 5. Amplitude-- oscillation, graded movement 6. Velocity--fast vs. slow (speed) sufficient force= mechanical effects Inc. temp.= more pliable (stretch) Dec. temp.= more brittle/ break (snap adhesions)
What are the capsular pattern findings?
1. Joint AROM 2. Joint PROM Classical Quantity 3. Joint PROM Classical Quality 4. Joint PROM Accessory Quantity 5. Joint PROM Accessory Quality
What are the decision making elements for technique selections?
1. Nature of dysfunction/impairment 2. Stage of condition-healing 3. Tissue reactivity 4. Subject reactivity 5. Functional Goal (s)
What are the normal end-feels?
1. Normal Soft tissue approximation-- ssoftt an sponggy end-feel due to muscle appproximation 2. Normal Muscle elastic, and slow end feel due to stretch of tendo/muscle 3. Normal Cartilage- hhard/rigid sudden stop de to cartilage articular mrgin 4. Normal Capsule-- ffirm arrest and creep due to capsule 5. Normal Ligament-- ffirm arrest without creep due to ligament
What are the 4 categories of intervention and a description of each?
1. Palliative- treatment for pain (rest, heat, or ice)... IF NO PAIN, YOU DON'T DO THIS STEP 2. Preparatory to corrective treatment- preparing the tissue for something else (massage, oscillations, TENS) 3. Corrective Treatment- trying to make a difference in the tissue (manipulation, exercises, ultrasound, transverse friction) 4. Supportive Treatment- what will be done outside the clinic that will compliment what was done in the clinic (back school, posture, HEP, education)
What are the effects of manipulation?
1. Psychological-- thorough examination, hands on/ human touch, and dramatic motion with perhaps a "pop" 2. Mechanical-- alter positional relationships, stretch out restrictions and snap adhesion (only through aggressive manipulations). 3. Neurophysiological-- fires articular mechanoreceptors, fires cutaneous and muscular receptors, and abates nociception and resultant muscle states (decrease pain input)
What are the criteria for manipulation?
1. Pt. Position 2. Therapist Position 3. Loose Pack Position 4. Joint Alignment 5.Stabilizing Hand 6. Manipulating Hand 7. Direction of Force 8. Amount of Force
What are the indications for the use of manipulation techniques?
1. Restricted Accessory Movement (Limited Joint Mobility) 2. Neurophysiological Effects (gate pain effect) 3. Disease, if present, is NOT a factor ---Joint dysfunction, due to restriction of accessory joint motion causing pain or restriction of motion during normal physiologic movement
What are the 4 groups of inflammatory disorders of bones and joints?
1. Specific Infections- causative organism can be detected 2. Rheumatic Diseases- broad group of inflammatory disorders 3. Metabolic Diseases- either incr. or decr. in bone deposition or bone resorption 4. Mechanical Irritation- repeated physical injury causing inflammation, chronic repetitive strain, or microtrauma
What are the six clinical manifestations of inflammation?
1. Swelling- exudate forming from changing pressure in capillaries 2. Pain- increased pressure within the tissue 3. Redness- vascular response 4. Heat- vascular response 5. Loss of function-- swelling and pain initially than by destruction of articular cartilage and scar formation 6. Muscle Inhibition- swelling doesn't allow muscle to fire correctly
What is the examination finding?
information gathered from a test or measure; signs or data
What is the purpose/principle behind the initial observation?
loosely observe the pt.'s posture, gait, guarded motions, freedom/ease, etc. Non-Specific Observation
What is the purpose/principle of MMT?
method of measuring muscle strength --- used to determine the degree of muscle weakness
What is an oscillation?
movement of a joint back and forth using a list of grades
Define intervention.
purposeful skilled interactions between the physical therapist and patient in order to improve the impairment that is consistent with the diagnosis and prognosis
Define outcome.
results of patient management which includes the physical therapy interventions in impairments, functional limitations, wellness, risk reduction, and prevention.
What is the purpose/principle of neuromuscular/ neurovascular tension?
rule in or rule out neurovascular pathology -Reflex Testing -Myotome Testing (muscle strength) -Dermatome Testing (sensation) -Neural Testing -Pulses
What is the definition of a manipulation/mobilization according to Paris?
skilled passive movement to a joint
What is the purpose/principle of palpation for tenderness?
specific palpation and trying to provoke symptoms such as pain with compression of tissue --- performed after tissue at fault is identified --- Subjective
What are example TSI for a joint capsule and what exam step would stress it to determine the tissue reactivity?
Joint Capsule: - Laxity - Adhesion - Tight - Effusion Stress Joint: PROM Accessory or Special Test
What is the purpose/principle of Joint PROM?
asses end-feel and determine quality of movement for PROM (normal or abnormal)
what is the difference between the capsular pattern of restriction vs the non-capsular pattern of restriction?
capsular pattern of restriction follows a specific pattern in the degree of loss of ROM for each joint... ex: shoulder ER> ABD> IR non capsular pattern of restriction may only show loss of ROM in one direction due to any other abnormal end feels
Describe the Joint Alignment criteria for manipulation.
identify joint alignment by palpating across the joint line using the step up and step down assessment
Define disability.
inability to engage in gender and/or age specific roles in a particular social context or physical environment
Define participation restriction.
problems an individual may experience in involvement in life situations
What is the patient/client related information for an intervention?
process of informing, educating, or training patients, families, and caregivers to promote and optimize physical therapy services
Define examination.
process of obtaining a history, performing a systems review, and selecting/administering special tests and measures to gather data
Define a MD diagnosis vs. a PT diagnosis?
-- can be the same or could be different M.D. Dx--- uses labels to identify disease, disorders, or condition at the level of the cell, tissue, organ, or system. P.T. Dx--- uses labels to identify the impact of a condition on the function level of the system and at the level of the whole person
What is he MSTT purpose and application include?
-- detects any contractile irritability ~ quantity of muscles ~ joint position of during application to ensure isolation of muscle and proper muscle being tested ~ position of neighboring joints to prevent neighboring joint interfering ~amount of force by using 2 fingers to apply enough force for contraction
Describe the direction of force criteria for manipulation.
-Apply with the use of gravity when possible. -Operator's forearm should be in line with the direction of the application of force -Force is either parallel (glide) or perpendicular (distraction) to the concave surface.
Analyze, by citing two clinical examples, the occurrence of false positive or false negative results by not maintaining the loose pack position for assessment/treatment of accessory movements.
-False Positive - an evaluation of decreased accessory PROM may be wrong. Accessory PROM my actually be normal, but if the jt was not in the loose packed position then the surrounding capsule/ligaments were taut and could have caused the limitation in movement. -False Negative - Evaluation as normal accessory PROM that is really abnormal. The jt may actually be hypermobile in accessory motion due to lax ligaments, etc, allowing for the movement; but this would not show up b/c the capsule/ligaments would already have been pulled taut if the jt were not in loose packed position. Therefore accessory PROM would seem normal, not excessive.
What are the adverse reactions to manipulation treatment?
-Increased swelling, pain, & guarding -Decreased Mobility ****STOP WHAT YOU ARE DOING IF THESE OCCUR
Explain the convex/concave rule and interpret the use of this rule to component motion evaluation/treatment.
-convex moving on concave: roll and glide in opposite direction -concave moving on convex: roll and glide in same direction
What is the rates of healing?
50% of healing in the first 2 weeks 80% of healing in the first 6 weeks 100% of healing has occurred by the 12th week
What are the concepts of clinical management?
>Treatment of and beyond the specific pathologic process involved [ don't just treat the dysfunction/impairment, treat the causative factors] >etiology factors= search for causative factors of dysfunction >Psychosocial Implications= emotional limitations (fearful of movement) or how it effects their life
"What is the difference between chiropractic manipulation and physical therapy manipulation?"
A chiropractor moves patient into end-range even if the pt. has laxity in that joint. A physical therapist would manipulate for laxity by strengthening.
What is the difference between a medical diagnosis and a diagnosis by a physical therapist?
A medical diagnosis identifies diseases and a physical therapist diagnosis is more concerned with the functional impairments associated with disease. (through the 18 step examination)
What are the 2 types of Joint PROM we will examine?
Classical PROM (osteokinematics, physiological) Accessory PROM (Arthrokinematics)
What is the difference between component motion and joint play for accessory movements?
Component Motion- under voluntary control and usually a glide -Motions that take place in a joint that facilitate a particular active motion -Used to detect joint dysfunction that interferes with active motion Joint Play Motions- not under voluntary control and usually a distraction -occurs only in response to outside forces -Used to detect the ability of a joint to relieve and absorb extrinsic forces
How is the direction of force related to the treatment plane?
Direction of force is either parallel or perpendicular to the treatment plane (concave surface).
What are the 4 grades of oscillations and describe each?
Grade 1= small amplitude, beginning range Grade 2= large amplitude, beginning to middle range Grade 3= large amplitude, middle to end range Grade 4= small amplitude, end range
What are the 3 grades of distractions?
Grade 1= unweighting the joint surface (bunching of the skin) Grade 2= Taking up the joint capsule slack Grade 3= stretching the joint capsule
What are the stages of tissue reactivity and a descriptions of each?
HIGH- pain before tissue restriction (at resistance) --> oscillations (gate pain) MODERATE- pain at tissue restriction (at resistance) --> oscillate-stretch-oscillate LOW- no pain at restriction (at resistance) --> stretch
What are the stages of Subject Reactivity and a description of each?
HIGH- pt. cannot perform functional activities b/c of the complaints MODERATE- pt. can perform functional activities but has complaints during the activity... most likely will have post activity complaints LOW- pt. can perform functional activities without any complaints during activity... may or may not experience post activity complaints
Define clinical manifestations/clinical features?
How the patient is presenting the signs and symptoms
What are the stages of condition and a description of each?
IMMEDIATE- within few minutes of onset of injury (first aid by pt. is most effective) ACUTE- condition is worsening (goal: limit worsening) SUB-ACUTE- pt. is commencing to improve but still fragile SETTLED- condition is stabilized and corrective Tx are well tolerated (can be more aggressive with Tx at this point) CHRONIC- at approximately the 15th week, primary healing is finished. (Pain behavior have developed and patient is despondent with possibility of psychosocial implications)
What is the concept of laxity? What are the theoretical constructs for laxity? (being the reason why)
Laxity can present as a limited AROM and classical PROM Constructs: -Biomechanical -Neurophysiological -Pain
What are two types of manipulation techniques?
Non-thrust (glide and distraction)--- low velocity Thrust--high velocity, low amplitude
What are the 18 steps to extremity exam?
Pain Assessment Initial Observation History Structural Inspection Palpation for Condition Joint AROM Joint PROM MSTT MLT MMT Special test Movement Analysis Palpation for Tenderness Neuromuscular/ Neural Tension Imaging Evaluation Diagnosis/ Prognosis Intervention
What is the difference in the purpose and technique of palpation for condition and palpation for tenderness?
Palpation for condition allows for the pt. to become familiar with physical therapist touch and build rapport. - performed with entire hand and broad contact over area to help detect and superficial problems. (not provoking symptoms) Palpation for tenderness is done to isolate the exact location of the impairment/ pain and intended to provoke the patient's specific symptoms - more aggressive technique and uses one or two fingers to pinpoint location
What are the 10 musculoskeletal practice patterns?
Pattern A: Primary Prevention/Risk Reduction for Skeletal Demineralization -Pattern B: Impaired Posture -Pattern C: Impaired Muscle Performance -Pattern D: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM associated with Connective Tissue Dysfunction -Pattern E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM associated with Localized Inflammation -Pattern F: Impaired Joint Mobility, Motor Function, Muscle Performance, ROM, and Reflex Integrity associated with Spinal Disorders -Pattern G: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM associated with Fracture -Pattern H: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM associated with Joint Arthroplasty -Pattern I: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM associated with Bony or Soft Tissue Surgery -Pattern J: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM associated with Amputation
Define diagnosis.
Physical therapists organizes the data into defined clusters, syndromes, or categories that help determine the prognosis and intervention
What is an example of the PT/Client model?
Physical therapists performs the initial examination/evaluation, determines the diagnosis and prognosis, and finally doing a follow-up on the patient after discharge
Describe the patient position and therapist criteria for manipulation.
Pt. Position= positions patient comfortably Therapist Position= position to use large muscle groups and proper bodymechanics
Describe Loose pack position criteria for manipulation.
Relaxed position where the joint capsule and ligaments are on slack -Joint is least congruent allowing for less cartilage/bone interference -Angular Position: best for osteokinematic position to measure goni
Describe the stabilizing hand and manipulating hand criteria for manipulation.
Stabilizing Hand- one joint surface needs to be stabilized or fixed Manipulating Hand- force isolated to one joint surface and needs to be as close to joint line as possible
How do you determine the subject reactivity?
Subject reactivity is found in the History. -- determined by what the pt. reports they can or cannot do
What types of Tissue Specific Impairment could you find from a MSTT?
Tendon--- 1. -itis 2. -osis 3. partial tear 4. complete tear
What is the purpose/principle behind Pain Assessment?
gives you the idea of the location/ cause of pain
Swelling is not always inflammation. What differentiates them?
The presence of the cardinal signs differentiates inflammation from swelling.
What are the contraindications and precautions for manipulations?
There are NO absolute contraindications. Precautions: Joint Replacement Acute Inflammation Muscle Holding Anti-coagulant therapy Hypermobility Hemarthrosis Disease states
How do you determine the tissue reactivity?
Tissue reactivity is determined by the therapist DOING something to the tissue to stress it. 1. Identify the tissue specific impairment 2. What exam step did you find the TSI? 3. Did that exam step stress the tissue? Ex: MLT (muscle/ tendon), Palpation for tenderness (bursa), PROM Accessory (joint capsule)
What is the purpose of clinical management?
To get better at managing the overall spectrum of the pt's care
What is the difference between traction and distraction?
Traction= application of force Distraction=application of force and joint separation
What is referenced to the concave surface of the joint?
Treatment Plane
What is the purpose/principle of palpation for condition?
Utilize bilateral gentle touch with broad contact and observation to look for warmth, joint effusion, atrophy, scars, wounds or inflammation Avoid provoking symptoms.
What must a Tissue Specific Impairment contain?
a tissue and a dysfunction/impairment
How is coordination, communication, and documentation associated with interventions?
administrative and supportive processes that ensure the appropriate, comprehensive, efficient, and effective quality of care from admission to discharge of a patient
What is the purpose/principle of Joint AROM?
allows you to check for normal or abnormal active range. (under voluntary control) --Measure ROM: 1. how much ROM 2. quality of ROM 3. Symptoms of movement
What is the purpose/principle behind History?
allows you to determine the pt.'s symptoms and problems
Which type of accessory movement applies only to the convex-concave rules?
component motions
What is the purpose/principle of imaging?
correlate image to clinical findings ** use imaging at end to avoid bias and inaccuracy in case it is misleading
Define prognosis.
determining the level of optimal improvements that may be attained through the intervention and the time frames expected to reach that level
Define activity limitation.
difficulties an individual may have in executing activities
What is etiology? What is pathogenesis?
etiology= cause of disease Pathogenesis= development and progression of disease
What is the PT/Client Management leading to optimal outcomes?
examination evaluation diagnosis prognosis intervention --encompasses all the interactions between the physical therapist and patient including the follow-up
What is the purpose/principle behind Structural Inspection?
observe the general posture, shape, spine, and aids Structural vs. functional -appearance is abnormal and of compensatory type -appearance is abnormal and of acquired type
What is the purpose/principle of movement analysis?
observe the patient performing a FUNCTIONAL activity
Define evaluation.
physical therapist makes clinical judgments based on the data gathered during the exam
What is the purpose/principle of MSTT?
to detect contractile irritability in a target tissue (tendon, muscle) ---gentle contraction ---look for strength of contraction through holding and observing for pain
What is the purpose/principle of MLT?
to determine the length of the muscle is normal, limited, or excessive. target tissue: muscle Impairment: tight muscle
What is the purpose/principle of special tests?
used to confirm or reject a hypothesis --- beware of validity and reliability of special tests ****key diagnostic step
