Week 1 Independent Learning Physiotherapy Assessment PDF

Reha3015 Musculoskeletal Physiotherapy Week 1 ‐ Independent Learning Physiotherapy Assessment Pre‐tutorial Activity (Quiz) 1. Quiz  The quiz covers material from subjective assessment, objective assessment, gait aids, funct...

Reha3015 Musculoskeletal Physiotherapy Week 1 ‐ Independent Learning Physiotherapy Assessment Pre‐tutorial Activity (Quiz) 1. Quiz  The quiz covers material from subjective assessment, objective assessment, gait aids, functional anatomy, biomechanics, pathology and pharmacology.  Please use the references recommended in each of these units, online databases via the UWS library homepage and textbooks.  Preferred answers to this activity will be posted on vUWS for each student that completes the activity and submits it via vUWS (Independant Learning Folder Week 1). 1. (a) List two special questions you should ask all patients in a subjective examination. Pain that wakes you up at night Recent and sudden weight loss (b) Describe why you should ask each of the above questions. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2. Complete the body chart for the description below. The patient reports diffuse pain on the posterior aspect of the left forearm that is constant (5/10) with no report of sensory changes, no neck pain and no shoulder pain. The patient reports intermittent pain (2/10) at the site of a fracture (open fracture of the mid‐shaft of left tibia & fibula) that has a dressing over the wound (dry). The lower leg pain is aggravated when walking and the patient reports tingling on the dorsum of the left foot after walking 10mins. Recently (1/52) the patient reports the onset of right knee pain (around the knee cap) when walking, but denies locking, clicking or giving way of the right knee. The patient reports no previous injury to the legs but reports having had LBP 5yrs ago Reha3015 Musculoskeletal Physiotherapy (across the back) that was aggravated when sitting for >30mins. The patient denies feeling LBP, hip pain (left or right), left knee pain or right ankle pain. Constant 5/10 Pain °paraesthesia/anaesthesia   This is an example of how the first case may recorded. 3. List two clinically significant findings for a passive joint ROM test of hip extension. Pain on affected side Firm v springy end feel 4. Describe why you must ensure that the axillary support of axillary crutches is measured to a level below the axilla. Avoid compression of the neurovascular bundle that passes through the axilla 5. Describe 3 factors that will ensure validity of a muscle strength test of the ankle plantarflexors. ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 6. In determining the social history of a patient, list 3 key questions you would ask. ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Reha3015 Musculoskeletal Physiotherapy 7. What are the key principles you should follow when interpreting a plain film (radiograph)? ABCs A – Adequacy & Alignment B ‐ Bones C ‐ Cartilage s – soft tissues 8. List 5 commonly used analgesics including 3 that may be taken orally, one that may be administered via an intravenous drip (PCA) and one that may be administer via a suppository. For each drug also describe the recommended adult dose. Paracetemol – Oral. X2 500mg tablets every 4hrs Tramadol – Oral. 25mg every morning (initial dose) & may be increased to 25mg x4/day (i.e.; 100mg/day) Indomethacin – Oral or suppository. 50‐200mg per day Morphine – IV 4‐15mg every 3‐4hrs; IM or subcutaneous 2.5‐20mg every 3‐4hrs; oral/sublingual 5‐30mg every 3‐4hrs; Rectal 10‐30mg every 4hrs. 9. What is a red flag? Possible serious underlying pathology 10. What is a yellow flag? Psychosocial indicators suggesting increased risk of progression to long‐term distress. 11. List the 3 factors that determine irritability. (i) Severity of pain (ii) Amount of activity to aggravate pain (iii) Amount of time to allow pain to reduce. 12. When measuring AROM of hip adduction, what are the anatomical landmarks you may use to ensure reliability of the measurement? Proximal/Stable arm:__________________________________________________ Axis of rotation:______________________________________________________ Distal/Moving arm:___________________________________________________ 13. Describe the end feel of the following movements if the joint is unaffected. Reha3015 Musculoskeletal Physiotherapy Hip extension springy Knee Extension firm Ankle dorsiflexion springy to firm Hip internal rotation springy to firm Hip External rotation springy 14. List one reason why you might have greater PROM than AROM for ankle dorsiflexion. muscle weakness, active insufficiency, pain due to contractile component, pain inhibition of muscle (weakness) 15. For each condition below list 1‐3 outcome measures that may be appropriate. Search the databases (eg. pubmed, sciencedirect) for appropriate outcome measures. Some functional outcome measures are listed: 6MWT, 10MWT, Berg Balance Scale, DASH, Tampa Scale, Functional Status Questionnaire, AAOS Lower Limb Questionnaire, ADL Scale of Knee Outcome, Foot Function Scale, Functional Assessment System, Harris Hips Score, Index of Severity for Hip OA, Index of Severity for Knee OA, KOOS, Western Ontario and McMaster OA Index, Lower Extremity Functional Scale, Neck Disability Index Questionnaire, Oswestry Low Back Disability Questionnaire, Patient Specific Functional Scale, Roland Morris Disability Questionnaire, Upper Limb Functional Index. Neck pain Low Back Pain Upper Limb Function Lower limb function Knee function Endurance Activities of Daily Living Pain Fear of Movement Spinal Cord Injury Wheelchair Mobility Stroke 16. List the effects of bed rest. Postural hypotension,  risk of respiratory infection ( lung volumes and MCC, impaired immune response),  risk of DVT & emboli (venous stasis, Reha3015 Musculoskeletal Physiotherapy hypercoagulopathy, blood vessel damage),  strength & ROM, osteopenia, reduced coordination, wt loss, constipation, loss of appetite, DM (glucose intolerance), incontinence, urinary tract infection, psychological impairment and dependency 17. Describe the osteokinematics of the humerus relative to the glenoid during shoulder abduction that allow the humeral head to stay enlocated. The schematic below is a posterior view of the right gleno‐humeral joint. Humerus rolls cephalad and slides caudad on the glenoid cavity. 18. From the following representation of the gait cycle, answer the following questions. Neuman (2010) What muscle(s) control the loading response? Quadriceps Femoris at knee Reha3015 Musculoskeletal Physiotherapy At which point is the centre of mass at its lowest point in the vertical axis? During double limb support What muscle group controls ankle motion during the terminal stance period? Plantarflexor muscle group Reha3015 Musculoskeletal Physiotherapy Post‐tutorial Activity 2. Reading  Solomon, L., Warwick, D., & Nayagam, S. (2010). Apley's System of Orthopaedics and Fractures (9 ed.). London: Hodder Arnold. p 3‐28. (recommended text)  McRae, R. (2010). Clinical Orthopaedic Examination (6th ed.): Churchill Livingstone. Elsevier. p 1‐32. (vUWS)  Andrew, J. G., Herrick, A. L., & Marsh, D. R. (2000). Musculoskeletal Medicine and Surgery. Sydney: Churchill Livingstone. p 5‐13. (vUWS) 1. Define or describe each of the possible symptoms that a patient may report (Apley’s p3‐ 5; Andrew et al. p5‐13)) Pain, stiffness, weakness, instability, sensory changes (tingling/p&n),loss of movement, sensation of swelling 2. Document the question(s) you may ask about the mechanism of injury. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 3. Document the question(s) you may ask about pain. area, nature of pain (sharp, ache, lancinating, burning, dull ache), radiating, deep, superficial, constant, intermittent, sudden or gradual onset. 4. List features you would look for during observation of a patient. General features: compensatory mechanisms; facial expression, mode of transferring and gait, etc. Local features: rubor (redness), tumor (deformity/swelling), skin condition or changes, wounds, pus, colour (vascular supply) Reha3015 Musculoskeletal Physiotherapy 5. List findings of a palpation examination that would be clinically significant. Warmth, pain, allodynia, hypersensitivity, deformity, difference between sides, differences from normal or expected findings, temperature (cold/warm) 6. List the different types of radiological imaging available for assisting with diagnosis. x‐ray, ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography  Atkinson, K., Coutts, F., & Hassenkamp, A.‐M. (1999). Physiotherapy in Orthopaedics. A Problem‐Solving Approach (2 ed.). Sydney: Elsevier. Churchill Livingstone. p 71‐86. (vUWS)  McRae, R. (2010). Clinical Orthopaedic Examination (6th ed.): Churchill Livingstone. Elsevier. p 1‐32. (vUWS) 1. Create a table that summarises the myotomes (C5 – T1 and L2‐S1). Identify the predominant nerve root and the movement(s) that you may test. See: McRae p1‐33 and tute guide for week 1 2. Describe the possible findings (sensory and motor) if there was a lesion to the ulnar nerve, median nerve at the wrist. Ulna nerve: loss of sensation to volar aspect of medial 1.5 fingers and loss of strength to hypothenar eminence, ulnar claw hand, mm wasting to interossei muscles and therefore abduction or adduction of fingers may be weaker than the unaffected side. Median nerve: see McRae p1‐33 3. Describe the possible findings (sensory and motor) if there was a lesion to the radial nerve at the quadrangular space. Sensory change to dorsum hand and forearm. Possibel wrist drop (unable to extend wrist). 4. Describe the possible findings (sensory and motor) if there was a lesion to the median nerve at the wrist. See: McRae p1‐33 and tute guide for week 1 Reha3015 Musculoskeletal Physiotherapy  Khurana, J. S. (2009). Bone Pathology (2nd ed.). Philadelphia: Humana Press. p 61‐76 (vUWS) 1. Define the instantaneous axis of rotation. Most of the bones of the body do not rotate around fixed axes of rotation but rather around a moving instantaneous axis of rotation that is simply the axis of rotation of a segment at a given moment. 2. What is Wolff’s Law? Adaptive changes observed in tissue such as bone occur in response to the stress acting on the tissue. 3. Describe the mechanism of how each of the following fractures may occur. (see Khurana) (i) Stress fracture ___________________________________________________________________________ ___________________________________________________________________________ (ii) Compression fracture ___________________________________________________________________________ ___________________________________________________________________________ (iii) Spiral fracture __________________________________________________________________________ __________________________________________________________________________ 4. Describe the main difference(s) in load bearing ability between tendon and ligament. ___________________________________________________________________________ ___________________________________________________________________________ Reha3015 Musculoskeletal Physiotherapy 5. Intervertebral discs are described as being anisotropic. Describe why this is important. See Khurana 6. List modifiable and non‐modifiable risk factors for bone injury. For each factor give a brief description of how it increases the risk of bone injury. Age (>50) History of falls Gender Disease (osteoporosis) Bone mineral density Nutrition Exercise While other risk factors such as cigarette smoking, excessive alcohol consumption, use of high dose corticosteroids, and a family history of fracture contribute to risk, they are largely reflected in the bone mineral density measurement. 7. What effects does exercise have on bone? See Khurana p74‐76 Reha3015 Musculoskeletal Physiotherapy Recommended references to answer quiz questions Questions 1‐2  Pierson, F. M., & Fairchild, S. L. (2008). Principles and Techniques of Patient Care (4th ed.). St. Louis: Elsevier: pp 2‐20.  Refshauge, K., & Gass, E. (2005). Musculoskeletal Physiotherapy. Clinical Science and Evidence‐ Based Practice (2nd ed.): Elsevier: pp 117‐163.  Maitland, G. (2005). Maitland's Peripheral Manipulation (4th ed.). Sydney: Elsevier: Chapter 3: pp 39‐69. Question 3  Palmer, M. L., & Epler, M. E. (1998). Fundamentals of Musculoskeletal Assessment Techniques (2nd ed.). Sydney: Lippincott Williams and Wilkins: p3‐31 Question 4  Pierson, F. M., & Fairchild, S. L. (2008). Principles and Techniques of Patient Care (4th ed.). St. Louis: Elsevier: pp 215‐226. Question 5  Palmer, M. L., & Epler, M. E. (1998). Fundamentals of Musculoskeletal Assessment Techniques (2nd ed.). Sydney: Lippincott Williams and Wilkins: p3‐31 Question 6  Refshauge, K., & Gass, E. (2005). Musculoskeletal Physiotherapy. Clinical Science and Evidence‐ Based Practice (2nd ed.): Elsevier: pp 157‐159. Question 7  Swain, J., & Bush, K. W. (2009). Diagnostic Imaging for Physical Therapists: Saunders Elsevier. p22‐28 Question 8  https://www.mimsonline.com.au/Search/Search.aspx (via UWS library page)  http://www.australianprescriber.com/content/search  http://www.ciap.health.nsw.gov.au/specialties/medications.html  http://www.nps.org.au/  http://www.pbs.gov.au/browse/medicine‐listing Question 9 – 10  Refshauge, K., & Gass, E. (2005). Musculoskeletal Physiotherapy. Clinical Science and Evidence‐ Based Practice (2nd ed.): Elsevier: pp 144‐157. Question 11  Maitland, G. (2005). Maitland's Peripheral Manipulation (4th ed.). Sydney: Elsevier. p135 Question 12  Palmer, M. L., & Epler, M. E. (1998). Fundamentals of Musculoskeletal Assessment Techniques (2nd ed.). Sydney: Lippincott Williams and Wilkins: p17‐19 Question 13  Maitland, G. (2005). Maitland's Peripheral Manipulation (4th ed.). Sydney: Elsevier. p155‐156 Question 14  Use clinical reasoning. Question 15  Functional outcome scores on vUWS Question 16  Knight, J., Nigam, Y., & Jones, A. (2009). Effects of bed rest 1: cardiovascular, respiratory and haematological systems. Nursing Times, 105(21), 16‐20.  Knight, J., Nigam, Y., & Jones, A. (2009). Effects of bed rest 2: gastrointestinal, endocrine, renal, reproductive and nervous systems. Nursing Times, 105(22), 24‐7.  Nigam, Y., Knight, J., & Jone, A. (2009). Effects of bed rest: musculoskeletal and immune systems, skin and self‐perception. Nursing Times, 105(23), 18‐22. Reha3015 Musculoskeletal Physiotherapy Question 17  Neuman, D. A. (2010). Kinesiology of the Musculoskeletal System (2nd ed.). St. Louis: Mosby: Elsevier. p 4‐12 Question 18  Neuman, D. A. (2010). Kinesiology of the Musculoskeletal System (2nd ed.). St. Louis: Mosby: Elsevier. p 627‐665 Question 19‐22  Huether, S. E., & McCance, L. L. (2008). Understanding Pathophysiology (4th ed.). St. Louis: Mosby: Elsevier.p121‐139, 305‐315 Question 23  Sheridan, M. D. (2008). From Birth to Five Years (3rd ed.). New York: Routledge. (online)