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). 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: 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): 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