Week 1: Principles and Concepts of PT Evaluation

Physical Therapists

Physical Therapists

provide care to patients/clients of all ages who have impairments, activity limitations, and participation restrictions.

Patient/Client Management Model

• applied for the purposes of rehabilitation, habilitation, maintenance, of health or function, prevention of functional decline, and in healthy person: enhancement of of performance

• on going on iterative process that begins during the very first contact with patient or client including when the PT starts gathering patient/client health information

• examination, evaluation, prognosis, and intervention

Examination

• comprehensive screening and specific testing process leading to diagnosis and/or appropriate referral

• subjective and objective measures

Evaluation

• synthesis of all data gathered from examination process to establish diagnosis, prognosis, and POC

• deflects the severity of current problem, possibility of multi-system involvement, presence of pre-existing systemic conditions/diseases, and stability of conditions

Red Flag

• any S/Sx that would indicate the problem is not MSk dso

• serious problem that should be referred to appropriate health professionals

Yellow Flag

any S/Sx that denotes problems that may be more severe requiring a more extensive examination.

Open-Ended Question

• narrative information

• preferred way of questioning

Closed/Direct Questions

• specific information/answer

• often used to fill details given from open-ended questions

• answerable by yes or no

Pain

an unpleasant, sensory and emotional experience associated with actual or potential tissue damage, or describe in terms of such damage.

Acute

• often severe, continuous, and disabling

• more irritable

• associated with anxiety

• type of pain that is new - injury just happened

Chronic

• aggravating; not intense

• previous experiences; pt knows how to deal with it

• associated with depression

• with patient for a long time, common with work-related MSK injuries

• caused mostly by poor posture

Primary Hyperalgesia

• when tissue has been damaged, the substances that are released lead to inflammation and peripheral sensitization of nociceptors

• results in localized pain

• occurs during acute pain

Secondary Hyperalgesia

• if the new injury does not follow a normal healing pathway and becomes chronic, central sensitization may occur

Acute Injuries

present for 7-10 days

Subacute Injuries

10 days - 7 weeks

Chronic Injuries

more than 7 weeks

Constant Pain

type of pain that suggest chemical irritation, tumors, or visceral regions.

Periodic/Occasional Pain

type of pain associated with activity, position or posture that brings out the symptoms.

Episodic Pain

type of pain related to some activity.

Locking

• joint cannot be moved through full ROM

• caused by meniscal tear

Giving Way

• feel of the joint to buckle

• muscle weakness

Laxity

• excessive ROM of the joint

• no pathology present

Flexibility

• ability of one or more joint to be moved on available ROM

• depends on the function of contractile tissues, primarily the ligaments and joint capsule resistance

• can be static: available of ROM of one or more joint or dynamic: ease of movement

Instability

• inability to control the joint during its movement

Translational Instability

• pathologic/mechanical

• loss of control of small arthrokinematic joint movements that occur when pt. tries to stabilize the joint during movement

Anatomical Instability

• clinical/gross

• instability/pathological hypermobility

• excess or gross physiological movement in the joint where the pt. becomes apprehensive at the end of the ROM because of the subluxation or dislocation is imminent

Function Instability

• inability to control wither arthrokinematic or osteokinematic movement in the available ROM either consciously or unconsciously during functional movement

• evident during high speed or loaded movement

Voluntary Instability

initiated by muscle contraction.

Involuntary Instability

initiated by positioning.

Circle Concept of Instability

injury to one side of the joint can cause injury to other side/parts of the joint.

Observation

• looking or inspection phase

• done to gain information and visible defects, functional deficits, or abnormalities of patient

Vital Signs

indicators of the body's physiological status and response to physical activity, environmental conditions, and emotional stressors.

Scanning Examination

• developed by James Cyriax

• emphasizes the joints of the body, their movement and stability

• necessary to examine all appropriate tissues remains sound

• assessment of spinal cord, nerve roots, and peripheral nerves

Active Movements

• physiological movements

• used to check if there is any pain or discomfort in the ROM

Passive Moments

• anatomical movements

• motion is done by PT and pt is relaxed through out (0 contraction_

• the PT should know if pain or restriction predominates

End Feel

the sensation the examiners "feels" in the joint as it reaches the end ROM.

Soft End Feel

soft tissues approximation.

Firm End Feel

muscular/capsular/ligamentous.

Hard End Feel

bone to bone contact.

Capsular Pattern

pattern of limitation or restriction

Joint Play

• also termed as "accessory movement"

• it is a small ROM that can be obtained only passively by the examiner

• not under voluntary control, important for full painless functions and full ROM of joints

• necessary to make sure joints is functioning normally

• < 4mm = normal

Loose Packed Position

minimal congruency between the articular surfaces and is in position of greatest laxity and passive separation

Closed Packed Position

• two joint surfaces fit together precisely-congruent

• joint surfaces are tightly compressed

Spasticity

refers to muscle tone in which there may be collapse of muscle tone during testing.

Rigidity

refers to involuntary resistance being maintained during passive movement and without collapse of muscle.

Flaccidity

no muscle tone.

Edema

is an abnormal accumulation of fluid of a body part.

Special Test

• to determine whether a particular type of disease, condition, or injury is present

• if (+), may indicate a disease or condition

• if (-), does necessarily rule out the disease

Diagnostic Imaging

• used to confirm and establish a diagnostic

• used to determine the severity of an injury

• used to determine the progression of a disease

• determine the stage of healing

• enhance patient treatment

• determine anatomical alignment

Plain Film Radiography

• conventional plain film radiography "x-rays"

• anatomical position; patient

Alignment Bone Density Cartilage Space Soft Tissues

ABCD Radiographic Analysis

Arthrography

invasive technique in which air, a water-soluble contrast material containing iodine, or a combination of the two (double contrast) is injected into a joint space, and a radiograph is take of the joint.

Computed Arthrography

provides a three-dimensional definition of the joint, and the dye helps to delineate articular surfaces and joint margins.

Venogram and Arteriogram

used to diagnose arteriosclerosis, investigate tumors, and demonstrate blockage after traumatic injury.

Myelography

• an invasive imaging technique that is used to visualize the soft tissues within the spine

• a water-soluble readiopaque dye is injected into the epidural space by spinal puncture

Tomography

• has become a common imaging technique for musculoskeletal disorders, especially when computed enhanced (CT scan)

• it produces cross-sectional imaging of the tissues

Magnetic Resonance Imaging

noninvasive painless imaging technique with high contrast resolution that uses exposure to magnetic fields, not ionizing radiation, to obtain an image of bone and soft tissue.

Radionuclide Scanning

• uses chemicals labeled with radioactive isotopes which are injected intravenously several hours before the scan to localize specific organs that concentrate a particular chemical.

• useful for skeletal metastasis, stress fractures, and osteomyelitis

Discography

• injecting a small amount of radiopaque dye into the nucleus pulposus of an IV disc under radiographic guidance,

• used to determine disruptions in the nucleus pulposus or annular fibers of the disc

Fluoroscopy

used to show motion in joints through X-ray imaging, guidance technique for injections.

Diagnostic Ultrasound

involves transmission of high frequency sound waves into the tissue by a transduce through complete agent by calculation of the time it takes for the echo to return to the transducer for different interfaces.

Xeroradiography

used when margins between areas of different densities need to be exaggerated.