MSK Assessment PDF

MSK Assessment Wednesday, January 22, 2025 7:55 AM Overview of Cyriax, concept of selective tension and interpretation Components of MSK Examination History - Components, how to conduct yellow flags, red flags, immediate medical referral - Pain: types, sources, assessment, patterns, acute...

MSK Assessment Wednesday, January 22, 2025 7:55 AM Overview of Cyriax, concept of selective tension and interpretation Components of MSK Examination History - Components, how to conduct yellow flags, red flags, immediate medical referral - Pain: types, sources, assessment, patterns, acute vs chronic Boissonnault Examination Scheme - Review medical history/patient profile - History/interview begins - Presenting complaints/functional limitations review relevant medical history - Review of systems *history begins with family and personal history - Take note of people who answer all yes or no - Always review findings with them during interview History points: - Determine information C/C and MOI - Determine if acute, subacute, chronic and general irritability - Determine contraindications for PT: red/yellow flags or immediate referral - Establish baseline - Determine PMHx - Discuss and agree on goals - Information on DDx, and which tests and measures to perform - Helps determine which interventions might be effective __________________________________________________________________________________ Do's and Don'ts of interviewing - Appropriate atmosphere ○ Maintain eye contact ○ Comfortable distance ○ Address/alter questions to patients understanding - Try to get the interview to be a conversation - Do not ask close-ended questions; ask open ended questions - Funnel Sequence ○ Move from open ended questions to closed and then to follow up questions - Paraphrase the conversation - Be a good listener - Be patient - Don’t interrupt - Communication ○ Be aware of tone of voice, eye contact, body language, personal space, facial expression ○ Look at their verbal and nonverbal behavior ○ Be compassionate and caring in body language - Be culturally competent __________________________________________________________________________________ General Principles - Age ○ OA common in older individuals ○ Shoulder impingement  15-35 result of muscle weakness  >40 result of degeneration ○ Onset of ankylosing spondylitis: 15-35 ○ Prostate cancer: men >50 - Gender ○ May be an issue in certain diseases or conditions - Race ○ Certain diseases more prevalent in certain racial groups - PMHx ○ General health ○ Major illnesses ○ Surgeries/hospitalizations ○ Accidents/injuries ○ Allergies ○ Medications: present/past/ - FHx ○ Heredity and familial illnesses ○ Ach problems ○ Mental health issues - Growth/Development ○ Dominance, development, congenital problems - Occupation/School ○ Level of education ○ Job type - Recreational activities - Ask when last physical, eye exam, hearing, dental - Lifestyle ○ Smoking ○ Drug use ○ Nutrition ○ Sexual history - Living Environment ○ Home ○ Who they live with. - SHx ○ Personal characteristics - Current fitness level ○ Knowledge of patients lifestyle exercise # Immediate Cause Red Flag Cause - Functional Status/Activity Level 1 Angina pain not relieved in 20 mins MI Sever unrelenting neoplasm or acute neuromuscular ○ How does present condition affect patients ability pain especially at injury 2 Angina w/ nausea, sweating MI night 3 Bowel/bladder incontinence; +/- saddle Cauda Equina Pain unaffected by - - Immediate Medical Referral=911 anesthesia lesion medication or position - Red Flag 4 Anaphylactic shock allergy ○ Symptoms or conditions that may require attention and supersede physical therapy in severe pain with no - 5 S/S of inadequate ventilation cardiopulmonary MOI primary provider of service as they are typically indicative on nonmechanical conditions failure or pathologies of visceral origin Severe Spasm - - Yellow Flag 6 PT with DM who is confused, lethargic, or diabetic coma Psychological overlay psychological problems ○ Indicate need for extensive examination change in mental function Loss of appetite cancer, systemic disease - Other Flags 7 Pt with McBurney's point or rebound Appendicitis or ○ Signs of Abuse tenderness peritonitis unexplained weight GI disorder, hyperthyroidism, cancer ○ Questions: loss or diabetes 8 sudden worsening of intermittent Thromboembolism  Are you safe at home? claudication Unexplained weight congestive heart failure, Exam 1 Page 1  - Yellow Flag 6 PT with DM who is confused, lethargic, or diabetic coma Psychological overlay psychological problems ○ Indicate need for extensive examination change in mental function Loss of appetite cancer, systemic disease - Other Flags 7 Pt with McBurney's point or rebound Appendicitis or ○ Signs of Abuse tenderness peritonitis unexplained weight GI disorder, hyperthyroidism, cancer ○ Questions: loss or diabetes 8 sudden worsening of intermittent Thromboembolism  Are you safe at home? claudication Unexplained weight congestive heart failure,  Are you safe in your relationship? gain hypothyroidism or cancer 9 Throbbing chest, back or abd pain that Aortic aneurysm or ○ What to do. increases with exertion accompanied w/ a abd aortic Dizziness upper cervical, inner ear, sensation of a "heartbeat" lying down and aneurysm vertebrobasilar, craniovertebral palpable pulsating abd mass ligament tear, etc quadrilateral SC compression, vertebrobasilar paresthesia ischemia bilateral root signs neoplasm, cord compression, Yellow Flags Yellow Flags and symptoms paralysis Abnormal S/S Drop attacks arm pain lasting neoplasm, neurologic dysfunction Bilateral Symptoms Vertigo greater than 2-3 months Symptoms ANS symptoms Peripheralizing nystagmus - Neurological Symptoms Progressive Weakness unusual fatigue thyroid, systemic disease, neoplasm (RA, lupus, CA, MS) Abnormal sensations Progressive gait disturbances visual disturbances all kinds, (MS, neoplasm) Saddle Anesthesia Multiple inflamed Joints frequent or severe neoplasm, migraines headaches UMN signs Psychosocial Stresses fever or night sweats systemic disease, infection Fainting Circulatory or skin changes Frequent nausea or common many diseases, GI vomiting SOB CV, pulmonary, asthma Musculoskeletal Examination - MSK Examination- Test and Measures - Tests and Measures 1 Observation 2 Inspection 3 Active Movements 4 Passive Movements 5 Resisted Isometrics 6 Neuromuscular Testing 7 Special Tests 8 Provocation Tests 9 Joint Play 10 Palpation 11 Functional Assessment 12 Testing Related Areas 13 Imaging/Diagnostic Tests Observation - Observe Inspection - Inspect Screen/Scan: how to perform and what to look for - Screen Selective Tension: how to perform and interpret findings - Movement testing - Resisted testing - Neuromuscular testing - Palpation Special Tests - Special Provocation tests - Provocation Joint Play - Joint Functional Assessment - Functional Testing of related areas - Testing General information regarding imaging and diagnostic tests - General Exam 1 Page 2