Intro to MSK

What are the 3 parts of a patient history you must gather?

Patient interview

Data for first order decision

Data for differential diagnosis

During the “first order decision” phase of the history, what are you deciding?

If the pt is appropriate for PT

If you determine during the history that a pt has a non-neuromusculoskeletal (NMS) condition, what is the correct action?

Refer out

If you determine during the history that a pt has a neuromusculoskeletal condition, what is the correct action?

Treat - they are appropriate for PT

If you determine during the history that a patient has a combination of NMS and non-NMS issues, what is the appropriate action?

Both treat and refer out

The Generic Self-Report Outcome measure is a good screening questionnaire because:

It has patients give a few activities that they are struggling with, and allows them to compare those over time

A red flag indicates:

Serious pathological concerns

A yellow flag indicates:

Adverse prognostic indicators, like emotional response, pain behavior, beliefs about care

A blue flag indicates:

Perceptions about relationship between work and health

A black flag indicates:

Professional culture, health care policy, insurance reimbursement

A pink flag indicates:

Positive patient factors!

Short term fear of pain is not necessarily bad because:

Adaptive behavior allows the injury to heal

Long term fear of pain is detrimental because:

Maladaptive behavior may impair daily function and cause greater physical disability

What are the 3 types of pain?

Nociceptive

Peripheral neuropathic

Central sensitization

If a pt’s pain feels like a diffuse/vague ache, what does this indicate?

Somatic or visceral response

If a pt complains of hot, burning, or electric pain, what does this indicate?

nerve root damage (radicular)

True or false: All radicular pain is referred pain, but not all referred pain is radicular

True

What are the 6 diagnosis classifications?

Pain mechanism

Impairment based

Clinical practice guidelines

Treatment based

Medical

Acute injury

Nociceptive pain comes from what kind of stimuli?

Chemical, mechanical, thermal

Peripheral neuropathic pain stems from what potential injuries?

Peripheral nerve lesions from trauma, compression, inflammation

To identify an impairment based dx, what is the PT assessing?

What impairments are related to the pt’s functional limits

If a pt has decreased ROM from contracture, what is happening physiologically?

True adaptive shortening of skin, fascia, muscle, or joint capsule

If a pt has decreased ROM from adhesions, what is happening physiologically?

Abnormal adherence of collagen fibers to tissue

If a pt has decreased ROM from trigger point, what is happening physiologically?

Hyperirritable nodule within a taut muscle

What could be some reasons the pt has difficulty moving

Pain

Weakness

Decreased ROM

What is the clinical practice guideline for dx of low back pain WITH mobility deficits?

Soft tissue, joint, nerve

What is the clinical practice guideline for dx of low back pain WITH decreased movement coordination?

Motor control, muscle activation, timing

What is the clinical practice guideline for dx of low back pain WITH decreased muscle performance?

Strength, endurance, power

What is the purpose of treatment based dx?

Attempt to cluster signs and sx of pt’s who benefit from a certain treatment type

What are examples of non-neuromuscular pathologies?

Cancer

DM

Heart disease

What kind of MOI causes macrotrauma?

Immediate, noticeable injury - sprain, fracture, dislocation

What kind of MOI causes microtrauma?

Repetitive loading, excessive compression, over-training

What are the 2 types of medical dx?

Structural and pathoanatomical

A grade 1 ligamentous sprain can bear what level of weight?

Full

A grade 2 ligamentous sprain has what kind of end feel?

Defined/firm

A grade 2 ligament sprain has what kind of tear?

Partial tear of collagen fibers

A grade 3 ligament sprain has what kind of tear?

Near or fully complete

A grade 3 ligamentous sprain has what kind of end feel?

Empty

A 1st degree muscle strain results in what kind of muscle test response?

Strong but painful

A 2nd degree muscle strain results in what kind of muscle test response?

Weak and painful

Tendinopathy causes pain with what movements?

PROM and active use of involved tendon

In a pt with tendinopathy, what is the typical response to a resisted static (isometric) test?

Strong but painful

In a pt with tendinopathy, what should be the tx for pain relief?

Isometric exercise

To stimulate repair, what exercises should a pt with tendinopathy use?

Slow, heavy isotonic with eccentric component

What is the time frame for inflammation stage of a fracture?

1-6 days

What is the time frame for reconstruction stage of a fracture?

Day 7-9

What is the time frame for remodeling stage of a fracture?

Day 10-30

A compression fracture is most common in what part of the body?

Thoracic vertebrae

What is the criteria to be diagnosed with osteoarthritis/degenerative joint disease?

Decreased joint space + symptoms of pain, stiffness, crepitus

How does secondary OA occur?

Result of injury like fracture, repetitive trauma,

How does primary OA occur?

No known cause

What age does RA typically develop?

15-50

RA is characterized by:

Joint deformity and bony ankylosis (drifting)

What is the onset timeline of RA?

Suddenly over weeks/months

In someone with RA, stiffness usually lasts _____ mins after waking

60+

What is chondromalacia?

Breakdown of cartilage

What is radiculopathy?

A nerve root lesion

A nerve root lesion (radiculopathy) can cause what kind of reflex?

Hyporeflexia

Hyporeflexia is a ___ motor neuron injury?

Lower

MOIs for peripheral nerve injury include:

Laceration, compression, stretch

What is myelopathy?

Disease/disorder of spinal cord itself

Myelopathy can cause what kind of reflex reaction?

Hyperreflexia

Myelopathy is a _____ motor neuron injury?

Upper

What is neuropraxia?

Physiologic nerve block caused by ischemia (restricted blood supply) from pressure or stretch

What kind of nerve injury is associated with pain, no muscle weakness, and fast recovery?

Neuropraxia

What is axonotmesis?

Axon degeneration distal to injury site, myelin sheath damaged

What causes axonotmesis?

Prolonged stretch/compression causing ischemia/necrosis

What is neurotmesis?

Complete severance of nerve

What kind of nerve injury has no pain, muscle atrophy, sympathetic function loss?

Neurotmesis

What is compartment syndrome?

Pressure inside a compartment (like a limb) causing nerve damage

How long after compartment syndrome sets in does muscle loss become irreversible?

4-8 hours

What is the test for CN I?

Close eyes and 1 nostril, hold something scented to nose and have them identify

What is the test for CN II?

Peripheral vision - pt cover an eye, look at my nose, and tell me when they can’t see the finger

What is the test for CN III?

Pt close 1 eye and follow finger:

Up, down, in, up and out

What is the test for CN IV?

pt close 1 eye, follow finger down and in

What is the test for CN V?

Touch bilateral forhead, cheeks, jaw

Clench teeth, apply pressure to chin

What is the test for CN VI?

Pt close 1 eye, follow finger to the side

What is the test for CN VII?

Taste something sweet/sour, close eyes right, puff out cheeks

What is the test for CN VIII?

Pt close eyes, rub fingers together away from ears

What is the test for CN IX?

Taste on back of tongue, swallow, say AHH and watch uvula

What is the test for CN X?

Gag reflex, swallow, uvula

What is the test for CN XI?

Pt shrugs shoulders up, pull on scapular spine

What is test for CN XII?

Stick tongue out

What direction does the tongue deviate to if CN XII damaged?

The weak side: if right side weak, tongue turns to the right

What direction does the uvula deviate if CN IX is damaged?

The strong side: like a kettle bell swings to the handle side that is still attached

What are the 3 symptoms of a nerve problem?

Numbness/tingling

Electric shock

Decreased reflexes, ROM, strength

What is the dermatome test for L1?

Upper anterior thigh/inguinal line

What is the dermatome test for L2?

Mid anterior thigh

What is the dermatome test for L3?

Medial femoral condyle

What is the dermatome test for L4?

Medial malleolus

What is the dermatome test for L5?

Dorsum of 3rd MTP joint

What is the dermatome test for S1?

Lateral heel

What is the dermatome test for S2?

Popliteal fossa

What is the dermatome test for S3?

Ishcial tuberosity - ask if they have any changes in sensation with bathroom?

What is the dermatome test for S4?

Perianal area - ask if they have any sensation changes with bathrooom

What is the myotome test for L1, 2, 3?

Hip flexion

What is myotome test for L3, 4?

Knee flexion

What is the myotome test for L4, 5?

Dorsiflexion and inversion

What is the myotome test for L5, S1?

Great toe extension

What is the reflex for L4?

Knee jerk