PT 121 – Principles & Concepts of Physical Therapy Evaluation

Vocabulary flashcards covering major terms, tests, concepts, pain behaviors, imaging, measurement properties, and clinical patterns from the PT 121 lecture on physical therapy examination and evaluation.

Patient/Client Management Model

Framework outlining examination, evaluation, diagnosis, prognosis, intervention, and outcomes for PT care.

History (in PT evaluation)

Subjective information gathering about onset, symptoms, past medical issues, lifestyle, and goals.

Systems Review (PT)

Brief, hands-on screening of cardiopulmonary, integumentary, neuromuscular, musculoskeletal systems and communication/cognition.

Review of Systems

Question-based screening of each body system to detect signs/symptoms of medical disease requiring referral.

Red Flag

Historical finding indicating the need for immediate medical referral (e.g., unexplained weight loss).

Yellow Flag

Historical finding suggesting need for more extensive PT examination (e.g., high pain catastrophizing).

Observation (examination component)

Visual inspection to detect posture, skin changes, gait, functional movement, and overt pain behaviours.

Guarding

Stiff, interrupted movement pattern used to protect a painful body part.

Bracing

Fixed posture where an extended limb supports abnormal weight distribution due to pain.

Rubbing (pain behaviour)

Patient repeatedly touches or holds a painful area.

Grimacing

Facial expression showing pain—furrowed brow, narrowed eyes, clenched teeth.

Sighing (pain behaviour)

Exaggerated exhalation often accompanying discomfort or frustration.

Scanning Examination

Quick spine–or–extremity screen (active, passive, resisted, myotomes, sensory) to localize the problem source.

Active Movement

Motion produced voluntarily by the patient.

Passive Movement

Motion produced by the examiner with the patient relaxed.

Resisted Isometric Movement

Static contraction against examiner resistance used to test contractile tissue.

End Feel

Quality of resistance perceived at the end of passive movement.

Bone-to-bone End Feel (normal)

Abrupt hard stop, e.g., elbow extension.

Soft Tissue Approximation End Feel

Soft, compressible stop when soft tissues meet, e.g., knee flexion.

Tissue Stretch End Feel

Firm elastic resistance from capsule/ligament, e.g., ankle dorsiflexion.

Early Muscle Spasm End Feel

Sudden arrest of movement due to acute protection after injury.

Hard Capsular End Feel

Stiff, leathery stop typical in frozen shoulder.

Empty End Feel

Pain stops the movement before resistance is felt (e.g., acute bursitis).

Springy Block End Feel

Rebound effect suggesting internal derangement, e.g., meniscal tear.

Capsular Pattern

Predictable proportional limitation of joint motion indicating total joint capsule involvement.

Noncapsular Pattern

Motion restriction not matching capsular pattern; suggests single ligament, muscle, or internal derangement.

Loose Packed Position

Joint position of minimal congruency and slack ligaments, best for joint play testing.

Close Packed Position

Position of maximal congruency and ligament tension; joint surfaces locked.

Joint Play Movements

Small, involuntary accessory motions assessed to gauge capsule/ligament integrity.

Mennell’s Rules

Guidelines for safe, valid joint play testing (patient relaxed, one movement at a time, uninvolved side first, etc.).

Palpation

Hands-on assessment of tissue tension, temperature, tenderness, and abnormalities.

Tenderness Grading

Gr I: pain; Gr II: pain & wince; Gr III: wince & withdrawal; Gr IV: refuses palpation.

Synovial Swelling

Boggy, spongy edema developing 8–24 h post-injury.

Hemarthrosis

Hard, tense, warm swelling appearing soon after injury due to intra-articular bleeding.

Pitting Edema

Thick, slow-moving fluid that leaves an indentation when pressed.

Special Tests

Provocative maneuvers used to confirm, differentiate, or clarify clinical hypotheses.

Deep Tendon Reflex Grading

0 = absent, 1 = diminished, 2 = average, 3 = brisk, 4 = clonus (hyperreflexia).

Babinski Reflex

Extension of big toe & fanning of toes on sole stroking; indicates pyramidal tract lesion in adults.

Hoffmann Reflex

Thumb/finger flexion after flicking distal phalanx; pathologic sign of upper motor neuron lesion.

Outcome Measure Categories

Self-report, performance-based, observer-reported, clinician-reported tools used to quantify patient status.

Validity

Extent to which a measure accurately assesses the intended construct.

Inter-rater Reliability

Consistency of scores when different examiners assess the same patient.

Intra-rater Reliability

Consistency of repeated scores by the same examiner over time.

Responsiveness

Ability of an instrument to detect clinically important change.

Ceiling Effect

Most participants score near the top, limiting detection of improvement.

Floor Effect

Most participants score near the bottom, limiting detection of decline.

Minimal Clinically Important Difference (MCID)

Smallest score change perceived as beneficial by the patient.

Pain Type: Dull, Aching

Often arises from muscle tissue.

Pain Type: Sharp, Shooting

Characteristic of nerve root irritation.

Pain Type: Burning, Stinging

Common in sympathetic nerve involvement.

Patient History Components

General info, chief complaint, HPI, medical & past history, family, social, psychosocial, review of systems.

Vital Signs (definition)

Objective measures—HR, BP, RR, temperature—indicating basic physiologic status.

Dermatome

Skin area supplied by a single spinal nerve root.

Myotome

Group of muscles innervated by a single spinal nerve root.

Nerve Root

Initial segment of a spinal nerve emerging from the spinal cord; carries motor and sensory fibers.

Tendinosis

Degenerative intratendinous changes without inflammation.

Tendinitis

Symptomatic tendon degeneration with vascular disruption and inflammatory repair response.

Paratenonitis

Inflammation of the tendon’s outer layer (paratenon) alone.

Upper Crossed Syndrome

Pattern of tight pectorals/upper traps-levator and weak deep neck flexors/rhomboids-serratus anterior.

Lower Crossed Syndrome

Pattern of tight iliopsoas/erector spinae and weak abdominals/gluteals.

Functional Assessment

Evaluation of how injury affects daily activities; may use jump, hop, balance, transfers, etc.

Diagnostic Imaging

Use of radiologic modalities to confirm diagnosis, gauge severity, and guide treatment.

X-ray (Plain Radiography)

Readily available imaging good for bony anatomy; limited for soft tissue; involves ionizing radiation.

ABCDs Search Pattern

Systematic radiograph review: Alignment, Bone density, Cartilage spaces, Soft tissues.

Arthrography

Contrast injection into joint to visualize capsule, surfaces, and communications; can be CT-guided.

Venography

Contrast study to detect deep vein thrombosis or venous abnormalities.

Arteriography

Imaging of arteries (heart, brain, kidneys, etc.) using contrast dye.

Myelography

Contrast study of spinal canal to assess cord, roots, meninges via X-ray/CT.

Computed Tomography (CT)

Cross-sectional X-ray imaging ideal for complex or intra-articular fractures and bone tumors.

Magnetic Resonance Imaging (MRI)

Non-ionizing scan using magnetic fields; excels at soft-tissue, CNS, meniscal or ligamentous lesions.

Fluoroscopy

Real-time X-ray imaging to view joint motion or guide injections; higher radiation dose.

Diagnostic Ultrasound

High-frequency sound imaging for tendons, ligaments, muscles, masses, effusions—no radiation.

Medical Diagnosis vs PT Diagnosis

Medical looks at cellular disease; PT identifies functional impact at whole-person level.

Outcome Measures Selection Considerations

Purpose, target construct, psychometrics, cost, clinician burden, resources, and patient factors.

Patient-Reported Outcome Measure (PROM)

Tool in which patients directly rate their health status without interpreter (e.g., McGill Pain Questionnaire).