Upper Ext Test 1

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Author:
tayball723
ID:
105706
Filename:
Upper Ext Test 1
Updated:
2011-10-03 05:15:55
Tags:
Upper
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Description:
Notes for test 1
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  1. what are the five elements of patient management
    • examination: comprenensive screening process
    • evaluation: clinical judgement from info
    • Diagnosis: describes/identifies the impact of a condition or disease process on the level of the system and at the level of the whole person
    • Prognosis: predicted optimal level of improvement in function
    • intervention: at/pt techniques and procedures
  2. to diagnose you need to have...
    • (poppl)
    • Proper interview skills
    • observe clinical signs and symptoms
    • palpation tests
    • physical examination
    • labratory and diagnostic imaging techniques
  3. what is the purpose of an evaluation
    • to fully understand a patients problems
    • from patients and clinical perspective
    • physical basis for symptoms that the patient is complaining of
  4. Soap notes....
    • Subjective: history symptoms
    • Objective: observation, signs palpation, neurological, circulatory
    • Assessment: conclusion from info
    • Plan: treatment, rehab, referral, re-eval
  5. Sequential Method...
    • CORN
    • comprehensive
    • organized
    • reproducible
    • not random
  6. During eval... kinetic chain
    connected and compensation
  7. During eval... Bilateral comparison
    • uninvolved vs involved
    • gain trust, rapport, base line comparison
    • shows partient what to expect
  8. Patient history (drips)
    • Develop rapport
    • repetition (ask Qs in diff way)
    • interviewing
    • past injuries, surgeries
    • social/family history
  9. History Considerations.... POOP
    • pain location
    • occupation, sport, position
    • onset
    • previous ans similar injury
    • ... consitency of pain
  10. observation? GLAC
    • Gait: etc walking pattern
    • looking/inspection
    • Assess symmetries that may be related to pathology
    • clothing may interfere
  11. Scanning...?
    • survey of body
    • 10 seconds
    • involves educated guess
  12. scanning...? (overt pain behavior)
    • gaurding
    • bracing
    • rubbing
    • grimacing
    • sighing
  13. some observations..? BOSS
    • body alignment: anterior/lateral
    • obvious deformity: structural, functional, dynamic
    • scars
    • soft tissure contours
  14. palpations...?
    • move distally to injured part
    • patient relaxed
    • body part supported
    • with a purpose
  15. palpations (tissue)
    • tension: spasticity, ridgity, flaccid
    • texture: direction of fibers
    • thickness: edema, swelling
  16. Examination Principles..
    • voluntary consent
    • some tests casuse pain: painful motions done last
    • confirms or refutes suspected diagnosis
    • systematic
    • care needed for irritable conditions
  17. examination uninvolved test first
    • unless bilateral movement is needed
    • bilateral comparison:
    • sets standards/base/norm
    • show patient what to expect
    • develop trust
  18. AROM...
    • (active range of motion)
    • on contractile tissue (mm)
  19. PROM
    • Passive range of motion (helper)
    • inert tissue (non mm)
    • quality of end feel
    • at the end of motion how does it feel?
  20. AROM and PROM
    • done individually
    • incomplete arom followed by overpressure (prom)
    • use caution
    • determine end feel
  21. more on end feels
    • bone to bone
    • soft tissue
    • tissue stretch
    • not normal ones (MECS)
    • mm spasm
    • capsular
    • empty (missing ligs)
    • springy block (bone fragment maybe)
  22. spinal cords and nerve roots!
    • there are 31
    • 8 cervical
    • 12 thoracic
    • 5 lumbar
    • 5 sacral
    • 1 cocygeal
  23. types of nerve roots
    • dermatome: senseory distribution, area of skin innervated by nerve root
    • myotome: group of mms innervated by nerve root
    • sclerotome: bone or fascia innervated by nerve root
  24. types of nerve injuries
    • myelopathy: spinal cord/brain lesion
    • radciulopathy: nerve root lesion
    • plexopathy: plexus branch lesion
    • neuropathy: peripheral nerve lesion
  25. nerve issues :(
    • burner stinger: compression of root, cause atrophy
    • referred pain: distance from actual injury
    • neural tension: puts nerve on stretch
    • nerve palsy: paralysis
  26. specific joints
    • diff between contractile, inert, and nervous tissue
    • hypomobile: is decreased motion
    • hypermobile: increased motion
  27. active movements and physiological barriers
    • caused by...
    • pain
    • weakness
    • nerve lesion
    • (cheat by using accessory motions)
  28. Passive movements and anatomical barriers
    pain!!!
  29. Manual MM/myotome testing
    • Held for 5 secs to detereming weakness
    • joint in neutral/resting position/mid range of motion
    • may have to test in diff range to illicit symptoms
    • at times, dont let pain interfere w/ test
    • (except when suspecting fracture)
  30. MMT grading scale
    • 5: full rom with max resistance
    • 4: full rom with mod resistance
    • 3: full rom against gravity
    • 2: full rom with gravity eliminated
    • 1: no rom, slight contraction
    • 0: no palpable contraction
  31. ligamentous stress tests and joint play movements
    • STRAG
    • stress to pain
    • tests ligaments and capsule
    • repeated
    • avoid spasm or mm guarding
    • gentle pressure
  32. loose packed position
    • least amnt of stress
    • greatest joint capacity
    • least amnt of contract surface
    • position when doing a mobilization/ligament test
  33. close packed position
    • max tension
    • joint surfaces in contract
    • max joint stability

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