Exam 1 Eval & Treatment

What are the 4 main parts of evaluating patients

1. Assessment

2. Goal Setting

3. Intervention Therapy

4. Reasess

What are the 5 stages of assessment

1. Pre-participation physical examination

2. On the field/acute assessment immediately after acute injuries

3. Off the field/in the clinic assessment after first aid has been rendered

4. Progress Re-assessment after treatment

5. Ergonomic Risk Assessment (ERA) to determine if there’s an increased risk of injury in the workplace.

What is an Ergonomic Rick Assessment (ERA)

An Ergonomic Risk Assessment (ERA) is a systematic evaluation of a workplace to identify potential ergonomic hazards that could lead to musculoskeletal disorders. This assessment helps in designing workspaces and tasks to reduce strain and improve worker comfort.

Off the Field in the Clinic assessments include these steps in order

More detailed, thorough, comprehensive assessment

• History

• Observation/Inspection

• Palpation

• Nerve Assessment (if appropriate)

• Fracture Tests

• Range of Motion(Active, Passive, Resisted)

• Manual Muscle Testing

• Special Tests

• Determining the differential diagnoses/Assessment Decisions

• Immediate Treatment (action)

What are the 9 treatment goals

1. Control swelling

2. Control Pian

3. Establish core stability

4. Re-establish neuromuscular control

5. Restore postural control and stability(balance)

6. Restore ROM and flexibility

7. Restore muscle strength, endurance, and power

8. Maintain cardiorespiratory fitness

9. Functional progressions

What is the foundation for assessment and therapeutic exercise

Biomechanics

What are pathomechanics

Mechanical forces applied that adversely change the body’s structure and function

• Flat feet

What is etiology

The study of the cause or origin of a disease or condition, including factors that lead to its development.

What is mechanism of injury

The specific process or event that leads to bodily harm or injury, often detailing how forces are applied to tissues. (PF+INV)

What is pathology

structural & functional changes that occur from the injury process

What are subjective symptoms

Symptoms that are reported by the patient and not directly observable by the clinician, such as pain or fatigue.

What are signs or objective symptoms

Signs that can be observed and measured by the clinician, such as swelling, redness, or bruising, indicating the presence of an injury or condition.

The name of specific condition is called the

Diagnosis

A predicted outcome/course of healing is called a

Prognosis

What is a working diagnosis?

A preliminary diagnosis based on available information, guiding initial treatment decisions while further evaluations are pending.

What is sequela

A condition that results from a previous disease or injury, often leading to lasting effects.

• Osteoarthritis after a joint sprain or surgery

What is a syndrome

A collection of symptoms and signs that occur together and characterize a particular abnormality or condition. A syndrome often indicates a specific disease or disorder and can result from various etiologies.

What is Accuracy in clinical applications

The ability to determine which patients have disorder and which don’t

What is sensitivity

Probability of a positive test among patients with the disease or condition

What is specificity

The probability of a negative test among patients without the disease or condition.

What is the Eular clinical prediction rule

A clinical tool that helps to estimate the probability of a patient having a specific condition(OA), based on the presence of certain clinical features and outcomes.

Why are PROMs so helpful to fill out

Patient-reported outcome measures (PROMs) provide valuable insights into a patient's health status, treatment effectiveness, and quality of life directly from the patient's perspective.

Give 5 examples of PROMS

1. Knee: IKDC

2. Hip: HOS

3. Shoulder/elbow: ASES, KJOC

4. Ankle: FAAM

5. Arm/Hand: DASH

What are the 4 things to consider before using available tools for practice

• What can I use

• How can I use it

• Is it within my scope of practice

• Need a level of humility about what we can do and what we can’t do

What are the thermal conductive energy modalities

Heat and Ice

What are the electrical energy modalities

Electrical stimulating currents and iontophoresis

What are the sound energy modalities

• Ultrasound

• extracorporal

• shockwave therapy

What are the mechanical energy modalities

Intermittent compression

traction

massage

What is the Overload Principle

In order for any tissue to get stringer(tensile strength) that muscle must be overloaded what its normally accustomed to. It needs to be progressively overloaded such as resistance training

What is the Specific Adaptation to Imposed Demands (SAID) principle

states that the body will adapt specifically to the types of demands placed on it during training. This principle emphasizes that training should be tailored to the specific goals of the individual.

• The more specific the program relative to desired outcomes the better results

When energy comes in contact with tissue what needs to happen

• Needs to be absorbed for physiological effects to occur

• Each modality transfers energy into or out of tissue

What happens when taking History in the evaluation process

• Get as much info as possible

• Calm and Reassuring

• Simple and not leading

• Open ended (no Yes or No)

• Document exactly what the patient says

What you have to determine

• Pain characteristics (1-10)

• Injury location

• What, How, & When

• Dull, aching, cramping of muscles

• Other sensations

• Previous injuries

• Function

• Feeling of instability

• Sudden or slow onset

• Bone pain(localized or piercing)

• Vascular: poorly localizes and aching

What are things to observe during an evaluation

• Begins at the time of injury or when the patient enters the clinic

• Compare to uninjured

• How does the patient move (limp, jerky, or asynchronous movements)

• Disposition of patient

• Abnormal sounds(clicking, snapping, or crepitus)

• Body asymmetries, deformities, swelling, atrophy, or acchymosis

What are the 7 cardinal signs of inflammation

1. Swelling

2. Tenderness

3. Redness

4. Increased temperature

5. Loss of function/movement

6. Posture

7. Function(gait)

What are the rules of palpation

• Symmetry

• light pressure and gradually increasing

• Begin away from sight of injury and gradually move toward it

• Bony palp

• Soft tissue palp

• Swelling, lumps, gaps, atrophy

• Temperature/texture

• Dysesthesia (Decreased sensation)

• Anesthesia (numbness)

• Hyperesthesia (Increased sensation)

When would you suspect a nerve involvement

• Suspecting: nerve compression, stretch injuries, or entrapments

• Sensory changes: Numbness, tingling, or burning(stingers/burners)

• Motor weakness: Reduced strength, poor grip, twitching, or muscle atrophy

• Performance impairment: Decreased coordination, instability, knee buckling, or foot drop

• Pain patterns: Radiating nerve pain, worsened by specific movements(squatting and throwing) midline pain along the spinal cord

• Autonomic changes: Abnormal sweating or temperature changes in the affected area

Steps of Nerve Assessment

• Myotomes: Group of muscles supplied by a single nerve root

• Test isometrically

• Dermatomes: Area of skin supplied by a single nerve root (Eyes closed assessment)

• Dull or sharp distinctions

• Reflexes

Fracture test information

• Bump/Tap for single bones

• Squeeze 2 or more long bones in parallel

• If positive, we stop there and refer for imaging to confirm the fracture

What are the three movement assessments in order

1. Active

2. Passive

3. Resistance

What is active movement assessment

A method where the patient moves a joint or limb voluntarily without assistance, assessing range of motion and muscle control.

• Only tells us if they can move their limbs concentrically(against gravity)

What is passive movement assessment

A method where an examiner moves a patient's joint or limb without the patient's assistance(relaxed), assessing range of motion and identifying any restrictions or pain.

• Move the body part until we hit resistance

• Helps us understand what’s going on at the joint, such as its ROM, pain, or structural resistance

What are end feels in PT examinations

End feels are the sensations felt by an examiner at the end of a range of motion during passive movement assessment, indicating the nature of resistance encountered, such as hard, soft, or firm.

What are the 4 NORMAL end feels

1. Bone to bone

2. Muscular (springy)

3. Capsular (joint, fascia, ligaments) (hard)

4. Soft tissue approximation

What are the 4 ABNORMAL end feels

1. Muscle spasm(guarding)

2. Empty (normally capsular, but motion goes beyond what is normal)-beyond capsular resistance

3. Loose (patient has chronic injury to a ligament or joint capsule, overtime it can’t do its job, and the ligament or capsule goes beyond normal)

4. Springy block (When a structure is floating or folded in a way in the joint that it gets into the joint line and limits full ROM

What is Cyriax’s conclusion about AROM pain and PROM pain in the opposite directions

If u have active pain while moving a muscle and passive pain in the opposite direction, you are most likely looking at contractile tissue(muscle)

What is Cyriax’s conclusion about AROM and PROM pain in same direction

When there’s AROM pain and passive pain in the same direction, then it’s most likely an inert injury(anything besides muscle)

What is the difference between a goniometer and an inclinometer

A goniometer measures the angle of joint motion, while an inclinometer measures the angle of inclination or tilt, often useful for assessing spinal alignment.

What is the main purpose of resistance ROM

To assess a patient's contractile tissues strength and identify any muscle weaknesses or imbalances by applying resistance during movements.

How is resistance ROM testing done

Contract muscles against our resistance through the full ROM

Why can there be no pain during AROM but pain during RROM?

Because we didn’t stretch the muscle out enough while contracting it

IF Resistance ROM hurts but AROM doesn’t then what do we do

Manual muscles tests by isolating muscles for a given ROM

How do we do a manual muscle test

We assess muscle strength by isolating the muscle and applying resistance at a specific joint angle through isometric contraction to evaluate its maximum strength.

What is the objective of a manual muscle test

Have them hold it for 3 seconds (5/5)

Push in the opposite direction of the isolated muscles job to assess the strength and function of individual muscles.

What does a 5 mean on a scale

It indicates normal strength with full range of motion against gravity and resistance.

• Full 3-second hold

What does a 4 mean on a scale

It indicates good strength, allowing for a full range of motion against gravity but with some resistance.

• 1-2 second hold

What does a 3 mean on a scale

Indicates that the muscle can move through the full range of motion against gravity but cannot hold against any added resistance, signifying fair strength.

• Needs a break

What does a 2 mean on a scale

Full ROM with gravity eliminated, indicating poor strength.

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What does a 1 mean on a scale

A visable contraction or twitch

If after doing ROM tests Actively, passively, and resisted it comes out to be inert, then what?

Go into special tests because can’t do MMTs on joints

Facts about Special Tests

• Used to detect specific pathology

• To substantiate what has been learned previously (answering what you thought was going on)

• Could be ligament stability, impingement, tightness, circulation, imbalances, alignment discrepancies, etc

What are important considerations when performing special tests

• Body positioning

• You and patient

• Relaxation of patient

• Hand placement and stabilization

• Attention to detail

What is Joint play

Joint play refers to the small, passive movements between joint surfaces that allow for normal joint function. It is essential for assessing joint mobility and stability during physical examinations.

• Only done if there are no special tests for the affected area after ruling out MMTs

• Performed in OPEN PACKED position

• Include Roll, Spin, and slide which accompany physiological movement of a joint

• Usually just for hands and feet

What are 4 questions to ask yourself after evaluation?

1. Can I treat them?

2. Do I need to refer, and to whom?

3. What can I help the patients with today?

4. Do they need a splint, crutches, or a brace

How do perform a functional evaluation

• Start with easy and progress to more stressful on injured structures

• Utilize valid and reliable tests

• Helps determine risk of injury due to limb asymmetry

• Measures ability to tolerate forces

• Serves as a good correlation to ability

What re the 2 times we do functional tests?

1. After initial eval and we haven’t found anything then we need to recreate how they injured it

2. After rehab to see if they can go back to playing or their job

Why do we document

• Important when communicating with other medical professionals, patients, and insurance companies

• Insurers use ICD-10

what does SOAP not stand for

S- Subjective history O- Objective findings, A- Assessment, P- Plan

Subjective - history

Be as specific as possible

Use quotes

Objective measureable and reproducible

• Details evaluation

• Allows others who read it to know exactly what was done and what the results were (other clinicians, insurance companies, etc)

• Observation, palpation(what you touched and what level of pain, if it hurt)

• If nerve assessment

• If Fracture test

• ROM, AROM, PROM, RROM, MMT

• Special tests

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Assessment - 3 parts

1. Diagnosis/impression

2. Problem list - Most likely to least likely of what’s wrong - List every single thing that is not normal

3. Treatment goals

Plan - todays tx(treatment) and future plans

Include problems that still need to be addressed

Ex: put modalities on

• educated on home care instructions and bracing

• Advised the patient to go to their orthopedic, primary care, neurologist, etc.

A short term goal is considered how long

2 or less weeks

A long term goal is considered what

More than 2 weeks

A mini goal is considered what

1-2 days

What are the 6 different treatment goal parts

1. Audience: patient

2. Behavior: what will be accomplished

3. Condition: how the task will be measured

4. Degree: measurable amount required to meet the goal

5. Timeframe: amount of time in days/weeks required to meet goals (put in terms on mini/short/long term goals)

6. Functional component: to demonstrate the purpose of performing a given task