Chapter 1: Patient/Client History, Systems Review, and Tests and Measures

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Chapter 1: Patient/Client History, Systems Review, and Tests and Measures
2015-02-22 16:00:25
PT Examination
NPTE Review
Chapter 1: Physical Therapy Examination
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  1. Plain Film Radiographs (X-Rays)
    • Used to demonstrate bony tissues
    • More dense structures appear whiter
    • Readily available, relatively inexpensive
    • Con = exposure to radiation
    • Typically use anterior-posterior and lateral views
    • Used for viewing dysfunction and/or disease of bones
  2. Computed Tomography (CT) Scans
    • Uses plain film x-ray slices that are enhanced by a computer to improve resolution
    • Multiplanar (tissues viewed from multiple directions
    • Used to assess complex fractures, facet dysfunction, disc disease, or stenosis of spinal canal or intervertebral foramen
    • Better quality and better visualization of bony structures than plain films
    • Also demonstrates soft tissue (not as well as MRI)
    • Fairly expensive, patient exposed to radiation
  3. Discography
    • Radiopaque dye injected into disc
    • Used to identify abnormalities within disc (annulus or nucleus)
    • Needle inserted into disc with assistance of radiography (fluoroscopy)
    • Not commonly used, expensive, may be painful, risk of infection
  4. Magnetic Resonance Imaging (MRI)
    • Uses magnetic fields rather than radiation
    • Excellent visualization of tissue anatomy 
    • Two types of images: T1 and T2
    • T1: demonstrates fat within the tissues and is used to assess bony anatomy
    • T2: suppresses fat and demonstrates tissue with high water content (soft tissue structures) 
    • Expensive, pt's with claustrophobia don't do well
    • May not be able to use with patients who have metallic implants
  5. Arthrography
    • Invasive technique
    • Inject water-soluble dye into area, observed with radiography
    • Used to identify abnormalities within the joint (i.e. tendon ruptures)
    • Expensive and carries risk (invasive)
  6. Bone Scans (Osteoscintigraphy)
    • Chemicals laced with radioactive tracers are injected
    • Isotope settles into areas with high metabolic activity of bone
    • Radiograph taken to demonstrate any "hot spots" of increased metabolic activity
    • Used for patients with dysfunctions (RA, stress fractures, bone cancer, infection within bone)
  7. Diagnostic Ultrasound
    • High-frequency sound waves used
    • Limited by contrast resolution, small viewing field, how deep it penetrates, and poor penetration of bone
    • Assesses soft tissue dysfunctions
    • No known harmful effects at this time
  8. Myelography
    • Invasive technique using water-soluble dye
    • Dye visualized as it passes through vertebral canal to observe anatomy within region
    • Seldom used, requires hospital stay overnight
    • Traditionally used for diagnostic assessment of discs and stenosis
  9. Laboratory Tests
    • Used to screen patients, assist with making diagnosis, or monitoring
    • Multiple tests (blood tests, serum chemistries, immunological tests, pulmonary function tests, arterial blood gases, fluid analysis) 
  10. Electrodiagnostic Testing
    • Electroneuromyography (ENMG) and nerve conduction velocity (NCV) tests 
    • Commonly used to assess and/or monitor musculoskeletal conditions