MS Lecture 1 (part 1)

kms013's version from 2016-01-29 17:17


Question Answer
Core componenets of examination and treatment:1. determine CC 2. establish goals 3. Obtain hx and complete physical examination 4. hypothesize cause for CC 5. plan and implement treatment 6. assess response to tx
Methods for determining examination and tx: (the WHAT and the WHY):1. determine lesion/pathology present 2. ID jt mvmts that are abnormal 3. ID activites and examination procedures that alter the pts sx 4. A combination of the above
Oreopedic examination has ______ over the past _________ because of a small group of clinicians.evolved, half-century
List of clinicans involved in changing tx:James Cyriax;Geoffrey Maitland; John Mennell; Fred Kaltenborn; Stanley Paris; Paul Williams; Robin McKenzie; Shirley Sharmann
from what decent was James Cyraix?Britian
Who is considered the father of conservative orthopedic medicine?James Cyriax
Who created a systematic approach to pt. evaluation?James Cyriax
What is the most widely used approach to pt. evaluation of orthopedic pts? And who created it?James Cyriax's SYSTEMATIC APPROACH
What was James Cyriax's general philosophy?1. All p! comes from a lesion 2. All treatment must reach a lesion 3. All tx must exert a benefitial effect on a lesion
James Cyriax classifies soft tissue lesion as 2 types: ____ & ______.Contractile & Inert
What is a contractile soft tissue lesion as determined by Cyriax?mm, tendon/tendonous insertion into bone
What is an inert soft tissue lesion as determined by Cyriax?tissue that is not capable of producing tension/ non-contractile
Evaluation designed to determine what type of lesion is present: For example, if resisted isometric ER of the shoulder is p!ful, its suggested that.....a contractile lesion is present in one of the ER
CP: Why do we measure AROM & PROM?to determine if a lesion is inert or contractile
Did Cyiaix support palpation?No; he believed palpation may be misleading when attempting to determine the site of a lesion. Since he believed p! can be referred, he felt palpation tests are misleading bc the pts inability to accurately localize the site of the lesion
What is referred p!?P! perceived by the pt to be at one site other than the location of the lesion
CP: Does literature/evidence support Cyraix's palpation belief?No: Palpation is benefitial
Who placed importance more on the pts p! than a p!?James Cyriax
Explain the difference b/w p! and the pts p!This continues to be a gold standard. When attempting to ID the location of a lesion, the pts p! must be produced during testing bc that is what they are there to see you for!
Cyriax believed the majority of spinal problems are from ______IVD
Sudden onset of spinal sx is due to_______ and can be treated with ______ (Cyraix)displaced annulus fibrosis; manipulation
Gradual onset of spinal sx is due to _____ and can be treated w ________ (Cyriax)herniation of the nucleus; traction
What did Cyriax believe that has since been disproven regarding spinal p!Cyriax did not feel spinal p! arises from the many ligaments and facet jts in the spine (all of which are innervated)
CP: What dictates the type of pathology present?The TYPE and COMBINATION of signs determined by the therapist to be present during an examination
Who believed in diagnosis by selective tissue tension? (STT)James Cyriax
What does diagnosis via selective tissue tension depend on? (STT)diagnosis depends on applying fx to different tissue in different ways and asking pt to report the results
The importance of STT is equally placed on ________ & ___________. 1. what movements are p!ful/limited 2. what movements are full ROM and p!less
When an active mvmt is performed, the jt moves and the mm contract. Therefore, if an active mvmt hurts, ____________ may be the source of the sx.either the jt structure or the contractile tissue
What is the purpose of STT method?The purpose is to determine the exact location of soft tissue lesion and whether the tissue involved is contractile or inert (non-contractile)
AROM assesses...AROM-- 1. pt willingness & ability 2. Range of active mvmts available 3. Ability to produce the mm fx required for an active mvmt
What is AROM used for?a SCREENING tool to ID the general body region the sx are originating from and to determine which mvmts and mm to examine in detail
PROM assessess....ability of intert tissues to allow motion at a jt (pt states whether or not p! is provoked)
Each passive mvmt of a jt must be tested why?to distinguish b/w capsular and non-capsular patterns of mvmt restrictions
Any discrepancy b/w AROM and PROM is noted (this is key)....why?Because it helps in determining if it is an inert or contractile issue
What person do isometric tests and p!ful arc fall under?Cyriax
What does resistive isometric tests assess?the tension producing capability of a specifc mm group
What does resistive isometric test determine?whether the pts p! complaints are originating from the mm group being tested
for resistive isometric tests, where should the mm be positioned? near mid-range
What is p!ful arc?p! felt near the mid-range position of the jt which then disappears as the position is passed in either direction
what does a p!ful arc imply?a structure is pinched (impinged) b/w two bony structures
If AROM and PROM are each p!ful; the p! appears as the limit of the range is reached and the resisted mvmts does not hurt, what does this indicate?aan INERT structure is at fault
if PROM is p!ful in one direction and AROM is p!ful/weak in the opposite direction, waht does this indicate?contractile structure is at fault
If resisted mvmts are strong and p!ful, this suggests....a minor lesion of mm or tendon
if resisted mvmts are weak and p!less, this suggests, a complete rupture of the mm or tendon tested
if resisted mvmts are weak and p!ful, this suggests...a serious lesion of the tested structure
If all resisted mvmts are p!ful, this may suggest....emotional hypersensitivity or inorganic cause for the p!
if all resisted mvmts are p!less and normal, this may suggest....there is no lesion in the mm group tested
If resisted mvmts in a direction produce p! after a number of repititions, this may suggest...intermittent claudication may be present
what is intermittent claudication?Claudication is pain caused by too little blood flow, usually during exercise. Sometimes called intermittent claudication, this condition generally affects the blood vessels in the legs, but claudication can affect the arms, too.
if all passive mvmts are to a full, but there is an inability to perform one or more mvmts actively, or more mm may be incapable of producing a normal amt of tension
if excessive ROM is found, then......capsular ligamentous laxity is present
According to Cyriax, one of the more common lesions is....a diffuse capsular lesion or "arthritis"
When may a pt be dx'd w arthritis?if they are found to have limitations in PROM in a predictable pattern (capsular pattern, meaning the entire jt is involved)
What is a capsular pattern?a limitation of mvmt at a jt which occurs in a predicable pattern
According to Cyriax, a capsular pattern is limited by...a diffuse lesion resulting in inflammation and eventually, tissue shortening in the entire jt capsule or synovial membrane
What is a non-capsular pattern?limitation in the PROM at a jt that do not fall into these predictable "capsular" patterns
According to Cyriax, a non-capsular pattern indicates...either a ligamentous adhesion, an internal derangement (cartilage lesion), or an extra-articular lesion
view the capsular pattern handout!GRRRRR
What country was Geoffrey Maitland from?Australia
Geoffrey Maitland (PT) emphasized the need to....determine the area, depth, nature, behavior, and chronology of the pts sx and record them on a body chart
Maitland was the first to look at what?"quality" of sx/complaints
Maitland's body charts are used to look at what?ID potential dermatomes and/or nerve roots (may indicate level of involvement)
Maitland stressed the importance of determining how ____ & ___ affect p! characteristicsdaily activities, movement
Who introduced the concept of "comparable sign?"G. Maitland
Why are comparable signs useful?They help determine if pt is responding to therapy
CP ____ --> _______ --> _________ according to MAITLANDAssess --> treat--- > reassess (comparable signs!!)
In Maitland's approach, what is key?REASSESSMENT
Maitland claimed the best approach to determine if a type of tx is successful is to determine...the effect of that tx on the pts COMPLAINT rather than the effect of tx on the specfic structure
Example: If a pt was unable to reach into his back pocket b/c of shoulder p!, the best way of determining if your tx had any effect would be to have the pt actually reach into his back pocket. Who supports this method?Geoffrey Maitland (comparable sign)
In general, what did maitland believe couldn't be determined?specific structure or structures which are causing the pts fxl problems
Who was supporter of accessory motion?Maitland
The measurement of______ was a major part of Maitland's evaluation.Jt accessory motion
_______ of _____ is essential for normal active and passive jt mvmtsFull range, accessory mvmts
a loss of ____________ produces a restriction in the normal range of jt motionan accessory motion
CP: in order to have full ______ motion, you must have full ______ motionosteokinematic, arthrokinematic
what can be detected by appropriate clinical testing?Normal or restricted accessory mvmt (this is jt mobility assessment)
Maitland recommends the assessment of what three factors during accessory motion testing?1. total amt of motion available 2. smoothness or feel the jt has as its tested 3. p! the pt reports during the test (these factors have yet to be examined for reliability in an appropriately designed clinical study)
Maitland believes that "inherent to using jt mobs is the assumption that you....""have to know what normal accessory motion is"
Maitland stated that _____ is needed with jt mobs?much experience
Maitland never defined what normal is, but he implied normal is determined by....feeling the amount of motion in a large number of "normal jts"
What do we now know normal is?the pts uninvolved side
is there sufficient evidence to suggest that a certain definable amt of accessory motion has to exist before the jt is considered normal?No; lack of evidence
There is probably a large variability of _____ when comparing the same jt of normal subjectsthe amt of accessory motion available (therefore, this has to be an area of concern with most approaches to evaluation and tx advocated in orthopedic PT)
Accessory motion could be used to: (2)1. reproduce the pts sx 2. compare to the uninvolved side to determine if the amt of motion is normal/abnormal and to determine if the end feel of the involved jt is normal/abnormal
Spinal accessory motion is difficult to test. Why?Because there is no uninvolved side by which an examiner can compare
Although reasonable, evidence is lacking to suggest that accessory motion in a jt should be.....equal bilaterally (examination procedures and tx that involve the application of accessory motion should be used clinically with these limitations in mind)
What did John Mennell emphasize?the importance of treating pts based on S/S
A major part of John Mennells examination involves _________.the assessment of "jt play" or accessory motion
What did Cookson and Kent say that Mennell did not consider? Did Menell agree?Cookson and Kent said Mennell did not consider mm to be a cause of pts p! but Mennell DID consider mm to be a source of p!
Did Mennell include palpation in his examination?Yes
Who described numerous tests designed to determine the cause of a pts sx?Mennell (the reliability of these tests have not been examined clinically)
Who received his training from Mennell and Stoddard (another osteopath)?Fred Kaltenborn
Mennell and Stoddard (who taught Fred Kaltenborn) followed the teachings of who regarding the type of examination to be done on pts?Cyriax
Fred Kaltenborn emphasized the determination of what 3 factors during examination?1. Whether the problem is primarily jt or soft tissue (treat the appropriate tissues) 2. If jt hypomobility or hypermobility is present (tx to "normalize mobility") 3. Whether jt p! or inflammation predominates (then the p! is treated)
Kaltenborns main contributions to orthopedic PT is....manual therapy (particularly the tx of soft tissue lesions w the hands)
Kaltenborn is known for what rule?concave-convex
Kaltenborn's approach is a fusion of what 3 things?Cyriax, chiropractic, and osteopathy
Kaltenborn recommended the use of....stabilizing belts during mobilization to apply fx for a prolonged period of time to a jt w a loss of motion (this would seem logical if a permanent length change in a shortened tissue (for example a capsular/ligamentous structure) is desired
Kaltenborn recommends...traction fx during tx, esp when treating p!ful jts
Kaltenborn emphasized that mobilization techniques should not...incr p!
Kaltenborn recommends to check the ROM of pts involved jt when and why?shortly after tx to check for change in ROM or p!
Kaltenborn claimed jt accessory motion is divided in ___ grades/categories7
Paul Williams popularized the concept that....low back p! pts need to avoid positions of lumbar extension and maintain a flexed lumbar position at all times
Paul williams was the originator of Williams Flexion Exercises

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