Transcript cc280b5712ed0d2

ORTHOPEDIC
PHYSICAL
ASSESSMENT
BY
Dr:Osama Ragaa
Assistant prof. of physical therapy
Batterjee college for medical sciences&technology
Principles and Concepts
• A correct diagnosis depends on knowledge of functional anatomy,
an accurate patient history, diligent observation, and a thorough
examination.
• The differential diagnosis process can involve the use of clinical
signs and symptoms, physical examination, knowledge of pathology
and mechanisms of injury, provocative tests, and laboratory and
diagnostic imaging techniques.
• The purpose of the assessment should be to fully understand the
patient’s problems.
• One of the common assessment recording methods
used is the problem-oriented medical records method,
which uses “SOAP” notes. SOAP stands for the four
parts of the assessment: subjective (history), objective
(observation, examinations), assessment (interpretation).
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• Continuous assessment is needed to determine how the
patient’s condition is responding to treatment.
• In general, the therapist compares one side of the body
(abnormal or injured) with the other side of the body
(normal).
Total Musculoskeletal Assessment:
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Patient history.
Observation.
Examination of movement.
Special tests.
Reflexes and coetaneous distribution.
Joint play movements.
Palpation.
Diagnostic imaging.
Home assessment.
Patient History (Listening to the patient):
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Past medical history.
Name, age, sex, occupation.
Chief complaint (why has the patient come?).
Was the onset of the problem slow or sudden?.
What are the exact movements that cause the pain?.
Is the pain constant or periodic?.
Family history.
Drug history.
Observation (Inspection):
• What is the body alignment?.
• Is there any obvious deformity?.
• Are the soft tissue contours normal(muscle
wasting)?.
• Are the color of the skin normal?.
• IS there any swelling or redness?.
• Is there any abnormal sound in the joint an
movement?.
• What is the patient’s facial expression?.
Examination of movements:
Active movements(physiological movements)
Passive movements(end feel):
-A hard or bony end feel.
-A firm or springy end feel.
-A soft end feel.
Resisted isometric movements:
-Strong& pain free (no lesion in the contractile unit)
-Strong& painful (mild or moderate muscle strain).
-Weak& painful (sever lesion around the joint).
-Weak& pain free (rupture of muscle, tendon or injury
of nerve supply).
Functional movements (activities of daily living
ADLs):
• Eating, dressing, transfer, walking,
shopping activities.
Special Tests:
• Specially designed tests to confirm
preliminary diagnosis or to make
differential diagnosis.
• For example: Lachman test to check on
torn ACL.
Or straight leg raising test to check on sciatic
nerve compression:
Reflexes and cutaneous distribution:
• The therapist test deep tendon reflexes (using reflex
hammer)& skin sensation (using pin prick) to obtain
an indication of the nerve or nerve roots supplying
the reflex or dermatome.
Joint play (accessory or arthrokinematic)
movements:
• Small ROM obtained only passively (not under voluntary
control).
• Less than 4mm in any direction.
• Necessary for full painless function and full ROM of the
joint.
• If affected, this movement must be restored before
voluntary movement can be fully accomplished.
• Joint should be in the resting (loose packed) position.
Arthrokinematics
– Roll
• Incongruent surfaces – new pts to new pts
• Rolling occurs in the same direction as
physiological movement
– Slide (Glide)
• Congruent surfaces – one pt to new point
• Concave-Convex Rule
– Spin
• Bone rotates around a stationary axis
Palpation:
• Determine joint tenderness.
• Feel variation in temperature.
• Discriminate differences in tissue tension
and muscle tone.
• Note any abnormal sensation or crepitus.
Diagnostic imaging:
• X- ray.
• MRI.
• CTS.
Problem list(according to priority)
Treatment plan:
Short-term goals
e.g.: decrease pain, decrease inflammation,
decrease effusion, increase ROM.
Long-term goals
e.g.: increase muscular strength, endurance,
flexibility, increase balance and proprioception.
Methods
-Reassessment of patient condition
periodically.
-Refer back to the physician if new
problem(s) arises or if patient is not
responding to physical treatment.
Critical question:
After few sessions of physical therapy, one of
your patient is not responding enough to treatment.
Why do you think ???
THANK YOU