Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd
Upload
76 views

Principles of Musculoskeletal Assessment: Introduction To Clinical Studies Traumatology RHS 231 Dr. Einas Al-Eisa

The document outlines the principles of musculoskeletal assessment, including obtaining an accurate patient history, performing both subjective and objective examinations, and using special tests to evaluate signs, symptoms, range of motion, neurological function, and pain response in order to make a correct diagnosis. Physiotherapists should assess patients initially and monitor progress using standardized assessment methods like the SOAP note format. A comprehensive musculoskeletal assessment incorporates patient history, observation, examination of movement, palpation, and diagnostic imaging.

Uploaded by

roshinisuresh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
76 views

Principles of Musculoskeletal Assessment: Introduction To Clinical Studies Traumatology RHS 231 Dr. Einas Al-Eisa

The document outlines the principles of musculoskeletal assessment, including obtaining an accurate patient history, performing both subjective and objective examinations, and using special tests to evaluate signs, symptoms, range of motion, neurological function, and pain response in order to make a correct diagnosis. Physiotherapists should assess patients initially and monitor progress using standardized assessment methods like the SOAP note format. A comprehensive musculoskeletal assessment incorporates patient history, observation, examination of movement, palpation, and diagnostic imaging.

Uploaded by

roshinisuresh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 36

Principles of

Musculoskeletal Assessment

Introduction to Clinical Studies


Traumatology
RHS 231
Dr. Einas Al-Eisa
Purpose of Assessment:

• To understand the patient’s problem from


the patient’s and clinician’s perspectives.

• “Diagnosis is only a way of applying one’s


anatomy” (Cyriax, 1982).
When should physiotherapists
assess patients?

• On first patient contact:


– to determine the patient’s problem &
treatment plan

• During the treatment:


– to check improvement versus deterioration
When should physiotherapists
assess patients?

• Following each treatment:


– to judge the efficacy of the intervention

• At the beginning of each new treatment:


– to determine the lasting effects of treatment
and the effect of other activities on the
patient’s signs & symptoms
Subjective & Objective Assessment

• Symptoms = what the person complains


about (e.g., my knee hurts)

• Signs = what can be measured or tested


(e.g., anterior drawer test for ACL injuries)
Subjective & Objective Assessment
• Subjective assessment:
– to gather relevant information about the site,
nature, and onset of symptoms
– review the patient’s general health and past
treatments

• Objective assessment:
– to determine abnormalities using special tests
(without bias)
Correct Diagnosis depends on:

1. Knowledge of functional anatomy


2. Accurate patient history
3. Diligent observation
4. Thorough examination
Differential Diagnosis involves:

• Clinical signs & symptoms


• Physical examination
• Knowledge of pathology & mechanisms of
injury
• Provocative tests
• Laboratory & diagnostic imaging
techniques
The Problem-oriented Medical
Records Method: SOAP

• S = Subjective (Patient History)


• O = Objective (Observation)
• A = Assessment (Examination)
• P = Plan
Assessment should be:

• Sequential
• Organized
• Comprehensive
• Reproducible
Total Musculoskeletal Assessment
• Patient History
• Observation
• Examination of movement
• Special tests
• Reflexes and cutaneous distribution
• Joint play movement
• Palpation
• Diagnostic imaging
Patient history
• Complete medical history with special
emphasis on the portion with the greatest
clinical relevance

• Listen to the patient

• Ask questions, but don’t lead the patient

• “Red flags”
Red flags
• Cancer: persistent pain at night, loss of
appetite, unusual lumps
• Cardiovascular: shortness of breath,
dizziness, constant calf pain, discolored
feet, chest pain
• Gastrointestinal / Genitourinary: severe
abdominal pain, heartburn, vomiting
• Neurological: changes in hearing or vision,
severe headache, fainting, balance
problems
Questions to ask:
• Age & occupation?
• Why has the patient come for help?
• Was there a trauma or repetitive activity?
= The mechanism of injury
• Was the onset of the problem slow or sudden?
• Where are the symptoms that bother the
patient?
• What are the movements or activities that
aggravate or relieve the pain?
Pain Questions:
• How long has the problem existed?
(acute, subacute, chronic pain)

• Are the intensity, duration, and frequency


of pain changing? (pain scale)

• Is the pain associated with rest, activity, or


certain postures?
Type of pain?
• Nerve pain: sharp, burning, run in the
distribution of specific nerves

• Muscle pain: dull, aching, & hard to localize

• Bone pain: deep & very localized

• Vascular pain: diffuse, aching, poorly


localized (referred to other areas)
Principles of Examination
• Test the normal (uninvolved) side first
• Active movements first, then passive, then
resisted isometric movement
• Painful movements are done last
• Apply over pressure with care (if active
ROM is restricted or to determine the end-feel)
• Myotomes testing: contractions must be
held for 3-5 seconds
“ Does it hurt when I do this? ”
Spinal cord & Nerve roots
• Dermatome = the area of skin supplied by
a single nerve root

• Myotome = group of muscles supplied by


a single nerve root

• Sclerotome = an area of bone or fascia


supplied by a single nerve root
Neurological testing
• Dermatome: may exhibit sensory changes for
light touch and pin prick

• Myotome: assessed by performing isometric


resisted tests held for 3-5 seconds
(L1-L2: hip flexion, L3: knee extension, L4: ankle
dorsiflexion & inversion, L5: extension of big toe,
S1-S2: plantar flexion & knee flexion, S3-S4:
muscles of the pelvic floor & bladder)
Neurological testing
• Reflexes:
– dull reflexes
lower motor neurone dysfunction

– brisk reflexes
upper motor neurone dysfunction

– the qudriceps reflex (L3)


– the achilles tendon reflex (S1)
Neurological testing
• Reflexes:

• The qudriceps reflex


¾L3

• The achilles tendon reflex


¾S1
Referred Pain
• Pain felt in a part of the body that is
usually far from the tissue that have
caused it.
• May be due to misinterpretation by the
brain as to the source of the painful
stimulus.
• Indicates that one of the structures
innervated by a nerve root is causing signs
& symptoms in other tissues supplied by
that same nerve root.
Radiating (radicular) Pain

= Pain felt in a dermatome, myotome, or


sclerotome because of direct involvement
of a spinal nerve root.
Palpation
• After the tissue at fault has been identified,
palpate for tenderness to determine the
extent of the lesion within that tissue.
• When palpating, note:
– Differences in tissue tension (muscle tone)
– Tissue texture (swelling)
– Tenderness
– Temperature variation
Functional Assessment
• Measurement of a whole-body task
performance ability
• Relates the effect of the injury on the
patient’s life
• But first, establish what is important to the
patient
• Should include repeated movements
under different loads
Joint End Feel (passive ROM)
• = the sensation which the examiner feels in the
joint as it reaches the end ROM

• There are 3 normal end feels:


¾ Bone-to bone: hard & painless (elbow extension)
¾ Soft tissue approximation: movement stops due to
soft tissue compression (elbow & knee flexion)
¾ Tissue stretch: feeling of a springy or elastic
resistance from the ligaments or capsule (Achilles
tendon, or wrist flexion)
Joint End Feel
Soft Firm
Hard
(Tissue (Tissue &
(Bony)
apposition) capsular stretch)
Joint End Feel
• Bony block to movement (hard feel)
arthritic joints

• An empty feel or resistance at the end of


the range
may be due to severe pain associated with
infection, active inflammation, or a tumor
Joint End Feel
• Springy block (rebound feel) at the knee
torn meniscus blocking knee extension

• Spasm (sudden, relatively hard feel)


muscle guarding

• Hard arrest of movement


capsular involvement
Joint Play (accessory) Movements
• = The small ROM that can be obtained by
the examiner beyond the active ROM

• Joint dysfunction = loss of joint play


movement

• Joint play mobilization should be done in a


loose packed position
Joint Position
• Loose packed (resting) position = the
position at which the joint is under the
least amount of stress (capsule, ligaments,
bone contact).

• Close packed position = the position in


which the majority of joint structures are
under maximum tension.

You might also like