Week 1- Subjective/Objective

Components of subjective exam

Body chart, behavior of symptoms (irritability), HPI (mechanism of injury, previous care), screening (flags, general health)

What should you determine from the chart review

Questions for subjective, rehab/maintenance, exam/differential dx/ initial hypothesis, discharge planning

What should you decide from the subjective

Referral, differential dx

Key components of objective exam

Functional assessment, ROM, strength, palpation

What side should you test first?

UNAFFECTED

Which component of the PT evaluation is an efficient means of collecting data to GUIDE the differential diagnosis

Screen

What term describes the impact of a condition on function at the level of the system and at the level of the whole person

PT diagnosis

CAUTION warning signs for cancer

C: Change in bowel or bladder habits. A: A sore that does not heal. U: Unusual bleeding or discharge. T: Thickening or lump I: Indigestion or difficulty in swallowing. O: Obvious change in a wart or mole. N: Nagging cough or hoarseness.

What assesses general movements involving multiple muscles

RIM (resisted isometric testing)

What assesses function and strength of specific muscles

MMT

Arc of motion attained by a subject during unassisted voluntary joint motion. Important for assessing contractile tissue

AROM

Arc of motion attained by an examiner without assistance from the subject. Important in assessing inert tissues and end feels

PROM

What gives insight into the type of structure that is limiting further motion

end feels

Which kind of end feel is described as soft tissue approximation

soft

Which kind of end feel is described as muscular/capsular/ligamentous stretch

firm

Which kind of end feel is described as bone contacting bone

hard

Which kind of end feel is described as no real end feel because pain prevents end ROM… No resistance is felt except for protective muscle spasming

empty end feel

Which side should you assess first?

UNAFFECTED

What is the first thing you should do before taking a goniometric measurement

Identify patient's irritability

What term describes the ROM measurement of a joint that is crossed by a two joint muscle may be affected by the position of the second joint. Thus, the second joint must be positioned to put slack on the two joint muscle

Passive Insufficiency

Contraindications of ROM evaluation

1. Dislocation or unhealed fx
2. Immediately post surgery (to tendons, ligaments, muscles, joint capsule, skin)
3. Myositis ossificans present

Most stable joint position with MAX joint congruency and capsule/ligament tension

Closed packed

Mobile joint position with LEAST joint congruency and capsule/ligament tension

Open packed

In what joint position is strength testing done

Open packed

Which kind of strength test is matching patient force output, graded, gentle, anticipating a response, and for ASSESSING

make test

Which kind of strength test is overcoming patient force output, more aggressive, used to get an idea of force output, and is for SCREENING

break test

What should you always do before a strength screen/MMT

AROM (ensure patient can perform the motion against gravity first)

Which MMT grade has no observed or palpable contraction

0

Which MMT grade has palpable or observed contraction without joint movement

1

Which MMT grade has the ability to move through part of the full available ROM GRAVITY ELIMINATED

2

Which MMT grade has the ability to move through part of the full available ROM AGAINST GRAVITY

3

Which MMT grade has the ability to move through the full available ROM against MODERATE manual resistance

4

Which MMT grade has the ability to move through the full available ROM against MAXIMAL manual resistance

5

Which MMT grade has the ability to move through part of the full available ROM against MINIMAL manual resistance

3+

Why do you need to palpate the exact muscle during MMT

patients can compensate to get the same motion without the right muscle

MMT contraindications

1. when ROM is contraindicated
2. When inflammation is present
3. When pain is present

What should you investigate as the pain source when AROM and PROM are restricted and painful in the SAME direction

Inert tissue

What should you investigate as the pain source when AROM and PROM are restricted and painful in the OPPOSITE direction

contractile tissue