Rehab Unit 1 - Musculoskeletal Exam

- Bones

- Muscles

- Tendons

- Synovial Sheaths

- Cartilage

- Menisci

- Capsules

- Ligaments

What does the musculoskeletal assessment include?

- Identify impairments of the musculoskeletal system and establish the patient's starting status.

- Identify tissues causing the impairment or that the impairments are affecting in the surround tissues.

- To establish appropriate goals, treatments, and outcomes of treatments.

- To determine the equipment needs of the patient to function at home, work, and play such as orthotics, assistive devices.

- To asses the effectiveness of therapy.

- To motivate the patient.

What are the purposes of the musculoskeletal assessment?

- Patient History

- Vital Signs

- Mental Status

- Observation/Inspection

- Palpation

- Anthropometric Characteristics

- Range of Motion

What are the components of musculoskeletal exam?

Pain

Part of the history and periodic assessment of the patient's condition is assessing ______.

Vital Signs

_____ ______ are used whenever there is knowledge or a belief that the CV system is compromised to assess the patient's reaction to the treatment being given.

Mental Status

____ ____ includes the patient's orientation to person, place, and time as well as general arousal state and communication abilities.

- Age

- Pathological condition

- Injury

- Medication

What can mental status affect?

Observation/Inspection

______ begins when you first see the patient, whether it is them in the bed, or in the waiting room, walking into the PT department, or etc.

Palpation

What is the first assessment after observation?

Palpation

______ will help the PT to decide what other assessments are needed and will help you identify where tender areas are, if the area has a normal or abnormal feel to it whether that is bony, soft tissue, temperature, edema, pain, or etc.

Unaffected side

What side should palpation be done on first?

A system of progressing from distal to proximal and superficial to deep is needed for a thorough assessment.

What kind of system is used for palpation to get a thorough assessment?

Anthropometric Characteristics

_____ ______ include body measurements, such as limb lengths (true and apparent LL discrepancy), circumferential measurement to assess joint effusion, edema, muscle hypertrophy and atrophy.

- PROM

- AROM

- End feels with PROM

- Patterns of joint limitations (capsular and noncapsular patterns of PROM)

What does ROM include?

AROM

______ is a measure of osteokinematics such as flex/ext, ABD/ADD, IR/ER, etc.

Yes

Should an estimate of the AROM be done before performing goniometric measurements with a goniometer?

True

T/F

If the patient can complete AROM fully without complaints of pain or symptoms, then PROM is not necessary.

Decreased AROM

_____ ______ may be indicative of pathology in the capsule, ligament, muscle, soft tissue tightness (bursa, blood vessels, or nerves), joint surface abnormalities, and/or muscle weakness.

Pain

______ during AROM may be due to contacting, stretching, or pinching of contractile tissues such as muscles, or their tendons due to stretching or pinching of noncontractile tissues such as ligaments, joint capsules, and bursa as well as nerves.

True

T/F

Not all limitations of AROM will be a result of musculoskeletal injuries or pathologies.

From pathology in other body systems such as neurological pathologies and dysfunction.

What can limitations also be indirectly caused by?

True

T/F

You should expect to find slightly more PROM than AROM as a joint can be passively pushed through more range than actively taken.

End Feel

During PROM, it is important for the PT and PTA to take the joint through its full ROM to determine what the ______ ______ is, whereby determining whether it is normal or abnormal.

PROM

______ assessment reveals abnormalities in the bone or joint surfaces or tightness of muscles, tendons, ligaments, or the joint capsule.

No

Does PROM tell anything about the strength of the muscle or coordination?

- Moving

- Stretching

- Pinching of noncontractile structures (ligaments, joint capsules, bursa, and nerves)

What can pain during PROM be caused by?

Yes

Can pain at the end of PROM be due to stretching of noncontractile as well as contractile structures (muscles & tendons)?

Capsular vs. Noncapsular Patterns

Noting ______ _______ ________ of limitations of passive ROM will also assist the clinician toward isolating the pathological or injured structure.

Ligament Stress Tests

What will narrow down injury and pathology further?

Capsular Patterns

______ ______ are restricted passive joint motions involving most of all joint motions.

- Joint Effusion

- Capsular Fibrosis

What are capsular patterns due to?

Capsular Fibrosis

_____ ______ is secondary to acute capsular inflammation, chronic low grade capsular inflammation, or immobilization of the joint and causing collagen changes of the entire capsule which decrease its extensibility.

Noncapsular Patterns

______ ______ are restricted passive joint motion involving 1-2 motions.

- Internal derangement of the joint.

- Adhesion of part of the joint.

- Extra capsular lesions (ligament shortening, muscle strain, muscle shortening - contracture, bursitis, tendonitis).

Noncapsular patterns are due to conditions that do not involve the entire joint capsule such as ______, _______, and _______.

Arthrokinematic Motion

_____ _____ is the accessory motions of roll, spin, and glide of the joint surface.

Concave or convex joint surface that is moving.

What does the direction of the rolling and gliding dependent upon?

Same

If the concave joint surface is moving, the gliding occurs in the _______ direction.

Opposite

If the convex joint surface is moving, the gliding occurs in the _______ direction.

False - it IS necessary for full symptom-free motion.

T/F

Normal arthrokinematic motion is NOT necessary for full and symptom-free osteokinematic motion.

Strength

One way to measure muscle performance is by measuring muscle _______ via MMT, hand-held dynamometry, and isokinetic dynamometry.

Power

Another way to measure muscle performance is by measuring muscle _______, which is the product of strength and speed.

Endurance

Lastly, muscle performance can be measured by muscle _______ which is the ability of the muscle to contract repeatedly over time. This can be measured by the number of reps of an exercise the patient can perform in a certain amount of time.

Special Tests

______ _____ are used to try and isolate a particular pathology or injury so as to confirm or establish a diagnosis.

Thomas Test

What special test is used to check the length of the hip flexors?

Ober Test

What special test is used to check the tensor fascia lata?

Palen's Test

What special test is used for carpal tunnel syndrome?

Homen's Sign

What special test is used to check for DVT in posterior leg area?

Acute Stage

_____ _____ occurs up to the first 48-72 hours after onset.

Subacute Stage

_____ ______ occurs after the acute stage and lasts up to 2 weeks to several months after onset.

Chronic Stage

_____ _____ is if symptoms continue for up to 3-6 months after onset.

Acute Inflammation

______ ______ is characterized by swelling (edema), increased temperature (calor), redness (erythema), and pain (pain). In this stage, patients do not usually tolerate stretching or contracting of the tissue that is involved, thus patients must be monitored for signs of increased inflammation and worsening of the condition.

Chronic Inflammation

_____ _____ is when there is little to no swelling or redness and little to no increased temperature. Pain typically occurs only at the extremes of ROM when the end feel is reached or with moderate to maximal amount of isometric resistance.

- They usually tolerate stretching and contracting of the tissue well.

- Will require increased loading of the tissue to bring about improvement of the condition.

How do patients usually tolerate in the chronic inflammation stage?