Severity
intensity of symptoms & the effect on functional ability
Non, Min, Mod, Max
Irritability
amt of activity to produce exacerbations & the time it takes to subside (ease)
(Non, min, mod, max)
Nature
the structure(s) involved
Stage
stage of healing of the injury
acute, subacute, chronic
Stability
how stable the injury is
stable, progressing, worsening
Components of the SUBJECTIVE exam
- patient profile
- chief complaint (P1)
- site of symptoms (body chart)
- behavior of symptoms
- history (past & present)
- special questions
- patient goal
Patient profile
age, gender, current daily activity level, work status, hobbies/recreation, psychosocial factors
Site of symptoms
- types of pain
- body chart
location & description
- visceral (diffuse & difficult to locate)
- deep somatic (dull, aching & poorly localized)
- superficial somatic (sharp & well defined)
- peripheral neuropathic pain (burning, tingling, stabbing, pins & needles)
Must clear other areas & determine if there is a relationship
Behavior of symptoms
severity - 24hour period, 7 days a week
irritability - aggravating & easing factors
History
present condition history
- determine stage & stability
past history if same or similar disorder
Special questions
general health, medication, BP, operations, diagnostic imaging, systems review
Components of OBJECTIVE Exam (10)
- for peripheral joint assessment
- Observation (posture, mvmt limitations, edema, skin, etc)
- Scanning (cervical &/or lumbar spine, neuro-segmental exam)
- AROM
- PROM
- Flexibility
(goniometry for 3-6 if applicable) - Joint play (PAM’s)
- MMT
- Special tests
- Palpation
- Additional tests (functional, gait, balance, questionnaires)
Cervical & lumbar spine scans
Cervical
- flexion, extension, & rotation w/ OP
- quadrant (side bending w/ rotation) - NO OP
Lumbar
- flexion & extension w/ OP
- quadrant - NO OP
Objective - rule out possible referral pain from spine
What do PAM’s tell us in the Objective Assessment?
- restricted vs. unrestricted
If UNrestricted…
- excessive motion = instability or joint laxity (hypermobility)
- Normal = intergrity of ligaments & capsule
If restricted…
- limited distraction = contracture of conn. tissue
- painful distraction = poss. tear in conn. tissue
- easing pain w/ distraction = articular surface is affected
- painful compression = articular surface affected
- easing pain w/ compression = joint capsule/ligaments are affected
What does MMT tell us?
besides their level of strength…
Strong & painless = normal
Weak & painless = complete tear/rupture, palsy or neuropathy
Strong & painful = partial tear or minor muscle lesion
Weak & painful = must do more assessment; could be big problem
