Week 1: Principles and Concepts of PT Evaluation

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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
- comprehensive screening and specific testing process leading to diagnosis and/or appropriate referral - subjective and objective measures
- 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
an unpleasant, sensory and emotional experience associated with actual or potential tissue damage, or describe in terms of such damage.
- often severe, continuous, and disabling - more irritable - associated with anxiety - type of pain that is new - injury just happened
- 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.
- joint cannot be moved through full ROM - caused by meniscal tear
Giving Way
- feel of the joint to buckle - muscle weakness
- excessive ROM of the joint - no pathology present
- 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
- 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.
- 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
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
refers to muscle tone in which there may be collapse of muscle tone during testing.
refers to involuntary resistance being maintained during passive movement and without collapse of muscle.
no muscle tone.
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
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.
- 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
- 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
- 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
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.
used when margins between areas of different densities need to be exaggerated.