Foundations of Biomechanics & NeuroMusculoSkeletal Management – Week 2 Diagnostic Decision-Making

Question-and-Answer flashcards covering key concepts from Week 2 lecture on differential diagnosis, classification systems, pain mechanisms, impairment identification, CPGs, treatment-based classification, structural pathologies, fracture and nerve injury grading, and acute injury management.

What is the House of Delegates definition of a physical therapy diagnosis?

A label encompassing a cluster of signs and symptoms commonly associated with a classification, disorder, syndrome, or category of impairments in body structures & function, activity limitations, or participation restrictions.

Diagnosis is positioned in what two main parts of the PT management process?

1) During the patient interview/triage (differential diagnosis) and 2) after tests & measures are completed.

According to Michael Reiman, what are the first three examination steps for musculoskeletal patients?

1) Patient interview with outcome measures, 2) broad observation, 3) triage/screening with sensitive tests to rule out non-related sources (neuro, cognitive, functional, UQS/LQS).

What are the three first-order clinical decisions a PT can make after initial examination?

Treat, Treat & Refer, or Refer.

During triage, which critical conditions must be ruled out before treating as NMS?

Cancer, infection, fracture, visceral/non-mechanical sources, or other conditions that mimic a neuromusculoskeletal problem.

List the six diagnostic classification systems inside the biopsychosocial model.

1) Pain Mechanism Classification, 2) Impairment-Based Diagnosis, 3) Clinical Practice Guidelines (CPGs), 4) Treatment-Based Classification (TBC), 5) Structural/Pathoanatomical Medical Diagnosis, 6) Acute Injury classification.

Which pain mechanism involves activation of peripheral nociceptive fibers by chemical, mechanical, or thermal stimuli?

Nociceptive pain.

What characterizes central sensitization pain?

Amplified neural signaling within the CNS producing pain hypersensitivity—danger signals are magnified, thresholds lowered, and receptive fields expanded.

Peripheral neuropathic pain originates from lesions or dysfunction in which structures?

Peripheral nerve, dorsal root ganglion, or spinal nerve root due to trauma, compression, inflammation, or ischemia.

Nociceptive pain is typically associated with what clinical situations?

Acute neuromusculoskeletal injury or postoperative conditions.

In an Impairment-Based Diagnosis, how do relevant impairments guide care?

The identified impairments (“contributing factors”) direct the intervention plan, which is then reassessed for change.

List the three broad reasons that may underlie a patient’s difficulty moving.

1) Pain, 2) Weakness/decreased motor control, 3) Decreased range of motion (joint or soft-tissue hypomobility).

Give three examples of potential neuromusculoskeletal impairments.

Sensory deficits (pain, proprioception), decreased aerobic capacity/endurance, abnormal motor control or joint mobility issues.

What is the primary focus of APTA Orthopaedic Section Clinical Practice Guidelines?

They give evidence-based recommendations for examination, diagnostic classification, prognosis, intervention, and outcomes related to movement, structure, function, and pain.

Name two advantages of using Clinical Practice Guidelines.

1) Summarize large volumes of research with graded evidence quality, 2) Provide recommended exams and treatments to aid decision-making.

Name two disadvantages of relying solely on Clinical Practice Guidelines.

1) Offer limited information about the specific patient in front of you, 2) Do not fully incorporate clinician experience or patient values.

List the three low-back-pain diagnostic subgroups outlined in the CPGs.

LBP with Mobility Deficits, LBP with Movement Coordination Deficits, and LBP with Muscle Performance Deficits.

What is the primary purpose of Treatment-Based Classification (TBC)?

To cluster signs and symptoms into subgroups likely to benefit from a specific type of treatment (initially for lumbar and cervical regions).

Give one factor that favors inclusion in the Manipulation subgroup of TBC.

Recent onset of symptoms or the presence of segmental hypomobility.

Give one factor that favors inclusion in the Stabilization subgroup of TBC.

Younger age, positive prone instability test, or presence of aberrant movements.

During motion testing, what finding supports inclusion in the Specific Exercise subgroup of TBC?

Centralization of symptoms with movement in one direction and peripheralization in the opposite direction.

What amount of laxity is expected in a Grade 1 ligament sprain?

No increased laxity or residual instability; stress tests are normal but painful.

How is a Grade 3 ligament sprain characterized?

Complete or near-complete ligament rupture with marked laxity, no firm end-feel, significant swelling, and possible inability to bear weight—often requiring surgery.

What key feature identifies a mild (1st-degree) muscle strain?

Local tenderness with strong but painful resisted contraction and minimal performance loss.

Name a hallmark clinical sign of a moderate (2nd-degree) muscle strain.

Weak and painful resisted contraction along with noticeable swelling or ecchymosis.

Differentiate dislocation from subluxation.

Dislocation is complete loss of joint congruency; subluxation is an incomplete or partial dislocation with residual contact of joint surfaces.

What historical factor commonly precedes tendinopathy?

Chronic overload or repetitive overuse of the tendon.

What is the typical finding on resisted isometric testing for tendinopathy?

Strong but painful contraction at the musculotendinous unit.

Outline the general exercise progression recommended for tendinopathy management.

Begin with isometrics for pain relief, progress to slow heavy isotonic loading with an eccentric component to promote matrix repair.

Name the three main phases of fracture healing.

Inflammation (days 1–6), Reconstruction/callus formation (days 7–9), Remodeling (days 10–30 and beyond).

List two fracture types other than simple and spiral.

Avulsion fracture and compression fracture (stress fractures are another example).

Which classification system is used for pediatric growth-plate fractures?

Salter–Harris Classification (SALTR Types I–V).

When reading an X-ray, what three general categories should be assessed?

Alignment, Bones, and Cartilage (the ABCs).

List the three categories of articular cartilage injury discussed.

1) Degenerative Joint Disease/Osteoarthritis, 2) Rheumatoid Arthritis, 3) Osteochondritis Dissecans (chondromalacia).

Differentiate primary from secondary osteoarthritis.

Primary OA has no known cause and develops over time; secondary OA follows a specific articular injury such as fracture, meniscal tear, or repetitive microtrauma.

Give two systemic symptoms typical of rheumatoid arthritis but absent in osteoarthritis.

General fatigue/malaise and low-grade fever (others: weight loss, rheumatoid nodules).

Which knee lesion involving cartilage and subchondral bone is known as osteochondritis dissecans?

A focal lesion most commonly on the medial or lateral femoral condyle of the knee.

How do reflex findings differ between LMN and UMN lesions?

Lower Motor Neuron lesions cause decreased or absent reflexes (hyporeflexia), whereas Upper Motor Neuron lesions cause increased reflexes (hyperreflexia).

Define radiculopathy.

A nerve root lesion producing pain, sensory change, and/or motor deficit along the corresponding dermatome/myotome.

What are the three Seddon (or Sunderland) categories of peripheral nerve injury?

Neuropraxia (Grade I), Axonotmesis (Grade II), and Neurotmesis (Grade III).

Describe neuropraxia.

A transient physiologic conduction block without axonal disruption; pain and minimal weakness with full recovery in minutes to days.

Describe axonotmesis.

Axon and myelin damage with Wallerian degeneration distal to the lesion; connective tissue sheaths remain intact—motor and sensory loss with months-long recovery.

Describe neurotmesis.

Complete severance of the nerve including connective tissue coverings, resulting in total loss of function; recovery requires surgery and is often incomplete.

Within how many hours must compartment syndrome be relieved to avoid irreversible muscle loss?

Within 4–8 hours of onset of increased compartment pressure.

Name the six elements of the Acute Injury Intervention Progression Model.

Pain management, Motion, Motor Control, Strength/Power/Endurance, Proprioception, and Skilled/Functional Activity leading to Full Activity.

Why is PT diagnosis often considered a combination of classification systems?

Most patients fit more than one system; identifying the dominant system on Day 1 helps prioritize initial treatment while using elements of the others concurrently.

After the interview and triage, what are the two primary purposes of selecting specific tests & measures?

1) Confirm or refine the working diagnosis (and refute alternatives), 2) Identify relevant impairments contributing to functional limitations.

What does SINSS stand for when assessing pain?

Severity, Irritability, Nature, Stage, and Stability.

List two psychosocial factors important to identify during diagnostic reasoning.

Fear-avoidance beliefs, depression, anxiety, lifestyle factors, work demands, coping strategies.

What do the abbreviations UQS and LQS stand for?

Upper Quarter Screen and Lower Quarter Screen.

During triage, which non-mechanical pain sources must be considered?

Visceral organ pathology and other conditions that mimic musculoskeletal pain.

Central Sensitization Syndrome is also referred to as what?

Chronic Pain Syndrome.

Give one impairment category that falls under “difficulty moving.”

Joint hypomobility, soft-tissue hypomobility, pain-induced motor control deficit, or muscle weakness.

Which exam procedures are used to detect joint hypomobility?

Active ROM, Passive ROM, and Passive Accessory Motion (PAM) testing.

Why must joint hypomobility be matched to the patient’s chief complaint?

It is clinically relevant only if it correlates with the functional limitation or pain the patient reports.

What radiographic finding supports an osteoarthritis diagnosis?

Decreased joint space (often with osteophyte formation).

Why should clinicians avoid fearful terminology like “bone on bone” with OA patients?

Such language can increase fear and pain catastrophizing, negatively influencing outcomes.

How does pain influence motor control according to the lecture?

Pain alters central programming, leading to modified movement patterns that can perpetuate pain and weakness.

Which test’s positive result favors inclusion in the Stabilization subgroup of TBC?

The prone instability test.

What does FABQ stand for, and why is it relevant in TBC classification?

Fear-Avoidance Beliefs Questionnaire; low FABQ scores may favor manipulation or stabilization subgroups, while high scores can be a factor against certain interventions.