Screening for Disease and Pain Patterns

a process where PTs make clinical judgments based an data from an examination, may identify problems that require another provider

what is a PT evaluation

treat, refer, both

what are the options post evaluation

early release and outpatient surgeries, aging

what are the main types of patients seen in PT

to rule out disease as being responsible for symptoms and determine if there is an undiagnosed medical condition

what is the purpose of a systems review/disease screening

CVP, endocrine, ENT, eyes, GI, GU, reproductive, skin, neuro, musculoskeletal

what are the systems that we need to review as PTs

physical or emotional

what types of changes regarding a patients health status should PTs take note of

review patient data, patient interview/history, physical exam

what is the screening process

intro, CC, HCI, PMH, PLF, personal/family history, wrap up

what are the parts of a history

age, race/ethnicity, sex/gender, occupation

what are risk factors that fit into personal/family history

from the skin, well localized

what is a cutaneous source of pain

skin, fascia, tendons, periosteum

what are somatic superficial sources of pain

bone, nerves, muscles, tendons, ligaments blood vessels poorly localized

what are deep somatic sources of pain

diffuse, not localized pain usually from the organs

what is visceral pain

sharp, shooting, burning, tingling sensation related to dysfunction of the NS

what is neuropathic pain

pain felt in an area different than the injury (usually well localized)

what is referred pain

muscle pain such as tension, spasm, trauma, deficiency

wat is myofascial pain

systemic or musculoskeletal

what can joint pain be caused by

pain in the musculoskeletal system in a dermatome, scerlotome, or myotome

what is radicular pain

pain that increases with increased systolic pressure

what is arterial pain

exercise, fever, bending over

what activities can increase systolic pressure

pleural and tracheal pain

pain with changes in respiratory movements, usually described as throbbing

GI pain

pain that is increased with peristalsis, usually relieved with fasting or defication

neoplasm or ischemia

what can pain at rest be caused by

musculoskeletal disorders, may be due to systemic causes

pain with activity is usually found with...

CVP and GI

what are common pain patterns to the shoulder

CVP, GI, UG

what are common pain patterns for the low back

CV, GI, and UG

what are pain patterns to the lumbar and pelvic region

cramping, colicky pain, cyclic pain, abdomen and low back

what types of sensations would one feel if there were spasms of the smooth muscles walls of the GI tract

Cardiovascular

What system is usually involved with sensations of throbbing, cramping, or aching

with pressure, tightness, or heaviness in thorax, neck, face, or UE

when would vitals and immediate screening of the CV system be called for

nervous system

weakness, poor balance, numbness, and pins and needles are symptoms felt by...

symptom changes with position, movement, or posture. PT intervention has an effect on the symptom and the pain is not worse at night

what symptoms usually indicate musculoskeletal involvement

vary depending on the organ, intermittent pain, change in intensity, worse at night

what are some symptoms with visceral involvement

heart disease, surgery, smoking, family history

follow up questions should be asked about what things regarding medical history

vitals and edema

how can we screen CVP system

pliability, integrity, color, scarring

how can we screen skin

symmetry, ROM, GST

how can we screen MSK

cognition

what system is the first to show signs of dysfunction in dehydration

observation, vital signs, inspection, palpation, percussion, auscultation

what are tools PTs can use to screen for disease

mental status

level of alertness, coherent sppech, alert to day, date, and time, memory and confusion are all indicators of a patients...

muscle wasting, hair loss, dry flakey skin, abdominal distention, fatigue/lethargy, bruising

what are symptoms of malnutrition

bad breath, alcohol, fruity breath

what types of odors should PTs watch out for

diabetic ketoacidosis

fruity breath is a symptom of...

observe and inspect

what types of things can we do with the skin?

texture, color, temp, breakdown, mobility and elasticity

what types of things can we observe/inspect about skin

asymmetry, border, color, diameter, evolution

what types of things do we look for regarding cancer

shingles

this painful rash occurs on a dermatome due to a viral infection present in the DRG

window test, look for the presence of a gap between nails

how would be test for abnormal nail shapes

oxygen deprivation

what is usually the cause of clubbing

not easily seen or palpated

what do normal lymph nodes feel/look like

firm, hard, and tender

what do abnormal lymph nodes feel like

anterior cervical lymph node

what is this lymph node

posterior cervical lymph node

what is this lymph node

tonsilar lymph nodes

what is this lymph node

submandibular lymph node

what is this lymph node

submental

what is this lymph node

supraclavicular lymph node

what is this lymph node

periauricular

what is this lymph node

posterior auricular

what is this lymph node

occipital lymph node

what is this lymph node

axilla

besides the lymph nodes in the head and neck, where else can we palpate lymph nodes

wide and flat

when palpating abdomen, how should hands be positioned

light pressure initially, going deeper if there is no pain. quadrants should be compared

how do we palpate the abdomen pressure wise and location

tenderness, mass, pain, guarding, referred pain

what are things of not with abdominal pain

peritoneal inflammation

pain with rebound tenderness suggests...

rebound tenderness

this test uses firm, downward pressure followed by a quick release

flatness, dullness, resonance, tympani

what are sounds that can be heard with percussion of the abdomen

LBP, dull ache on the left side of abdomen, abdominal heartbeat, palpable mass in abdomen

what are signs and symptoms of an abdominal aortic aneurism

starting on the left side of the midline, find pulse and move laterally to determine width

how do we palpate the abdominal aorta for signs of AAA

reproduced back pain

what are we looking for with palpation of the abdominal aorta

abdominal organ transplant, kidney disease, appendicitis, suspected aortic aneurism

when is palpation of the abdomen contraindicated

Collicky at the costovertebral angle, not changing with position

what type of pain is associated with kidney complications

percussion: flat hand over the costovertebral angle and thump with the other hand

what would be done with suspected kidney pain

McBurney's point, rovsing test, psoas sign, obturator sign, iliopsoas test

what are tests for appendicitis

rovsing test

this test puts pressure on the LLQ with a quick release producing symptoms in RLQ

psoas sign

contraction of the psoas through SLR or a stretch of the psoas by hip extension producing RLQ pain

obturator sign

test that internally and externally rotates the hip looking for reproduction of symptoms

iliopsoas test

have the pt raise the LE 30 cm off the table with resistance

patellar pubic percussion test

symmetry of sound

what is the PT looking for with patellar pubic percussion

gradual, progressive, cyclical pain that is constant and doesn't get better

what are general symptoms of visceral pain

bone, cancer

viscerogeneic pain has a disproportional relief of __________ pain from ____________

change in bowel/bladder, sore throat, unusual bleeding, a lump, indigestion, change in mole/wart, cough/hoarseness

what are red flags for cancer

uncontrolled HF or pulmonary edema, myocarditis, unusual fatigue, dyspnea, dizziness

what are precusions/contraindications to therapy

frequency of urination, excessive thirst and appetite, weight loss, orthostatic hypotension, blurred vision, sensory deficits, extremity pain

what are signs and symptoms of diabetes

diabetes diagnosis, recent blood tests, A1C

if it is suspected that someone has diabetes, what things should we ask?

embryologic development, multisegmental innervation, direct pressure and shared pathways

what are the 3 mechanisms of pain referral patterns

T9-L1

what dermatome is effected with renal pain

ischemia, inflammation, infection

what are causes for renal pain

it is constant, dull, aching and boring

how is ischemic renal pain different than inflammatory or infectious

it decreases with changes in position

how is inflammatory renal pain different than ischemic or infectious

there is no difference with change in position

how is infectious renal pain different than ischemic or inflammatory

posterior subcostal and costovertebral region, ipsilateral groin

where is renal pain

suprapubic region and low back

where are urologic pain referred to

moderate to severe and intermittent

how would one describe urologic pain

significant urinary urgency, dysuria, tenesmus

what are signs and symptoms of urologic pain

renal is more ipsilateral, urologic is more central

what is the difference between renal and urologic pain

mid-lower abdomen and sacral region

where is large intestine pain referred to

dull steady cramping

how would someone with large intestine pain describe their pain

mid abdomen and back

where is small intestine pain referred to