Additional Information
Book Details
Abstract
Learn how to screen for red flags and when to refer clients to a medical specialist! Differential Diagnosis for Physical Therapists: Screening for Referral, 6th Edition provides a step-by-step approach to screening for systemic disease and medical conditions that can mimic neuromuscular and musculoskeletal problems. It describes both red flags and yellow flags, so you can recognize the signs and symptoms for conditions outside the scope of physical therapy practice. This edition includes new information on women’s health issues. Written by experienced PT practitioner Catherine Cavallaro Goodman, this book helps you determine whether a client’s symptoms require physical therapy or physician referral!
- UNIQUE! Five-step screening model is systems- and symptoms-based, and follows the standards for competency established by the American Physical Therapy Association, covering past medical history, risk factor assessment, clinical presentation, associated signs and symptoms, and review of symptoms.
- UNIQUE! Case studies are based on clinical experience and give real-world examples of how to integrate screening information into the diagnostic process and when to treat or refer.
- Evidence for the screening process is based on peer-reviewed literature, reporting on the sensitivity, specificity, and likelihood ratios of yellow (cautionary) and red (warning) flags.
- Key Points to Remember boxes at the end of each chapter provide quick, bulleted summaries of critical information.
- Quick-reference summaries include tables, boxes, follow-up questions, clinical signs and symptoms, and case examples.
- Screening tools and checklists are found in the book and on the Evolve website, and are downloadable and printable for use in the clinic.
- Quick response (QR) codes that can be scanned on a smartphone, tablet, or other mobile device provide links to valuable screening tools such as lists of questions for screening specific problems, checklists, intake forms, and assessment tests
- New content on women’s health expands coverage of this important topic.
- UPDATES reflect the most current information on screening for referral.
- New associate editors — John Heick and Rolando Lazaro — bring fresh insight, as respected physical therapy educators.
- New! Color tabs make it easier to locate chapters and topics.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Differential Diagnosis for Physical Therapists | i | ||
| Differential Diagnosis for Physical Therapists | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| CONTRIBUTORS | vii | ||
| AUTHOR’S INTRODUCTION: A BRIEF HISTORY OF THE BOOK | ix | ||
| PREFACE | xi | ||
| ACKNOWLEDGMENTS | xiii | ||
| Enhance your Learning and Practice Experience | xv | ||
| APPENDIX A: SCREENING SUMMARY | xv | ||
| APPENDIX B: SPECIAL QUESTIONS TO ASK (SCREENING FOR) | xv | ||
| APPENDIX C: SPECIAL FORMS TO USE | xvii | ||
| APPENDIX D: SPECIAL TESTS TO PERFORM | xvii | ||
| CONTENTS | xix | ||
| Differential Diagnosis for Physical Therapists | xxi | ||
| I -\rIntroduction to the Screening Process | 1 | ||
| 1 - Introduction to Screening for Referral in Physical Therapy | 1 | ||
| EVIDENCE-BASED PRACTICE | 1 | ||
| STATISTICS | 2 | ||
| KEY FACTORS TO CONSIDER | 2 | ||
| REASONS TO SCREEN | 3 | ||
| Quicker and Sicker | 3 | ||
| Natural History | 4 | ||
| Signed Prescription | 4 | ||
| Medical Specialization | 4 | ||
| Progression of Time and Disease | 6 | ||
| Patient/Client Disclosure | 7 | ||
| Yellow or Red Flags | 7 | ||
| MEDICAL SCREENING VERSUS SCREENING FOR REFERRAL | 9 | ||
| DIAGNOSIS BY THE PHYSICAL THERAPIST | 10 | ||
| Further Defining Diagnosis | 10 | ||
| Purpose of the Diagnosis | 12 | ||
| Historical Perspective | 12 | ||
| Classification System | 13 | ||
| DIFFERENTIAL DIAGNOSIS VERSUS SCREENING | 13 | ||
| Scope of Practice | 14 | ||
| DIRECT ACCESS AND SELF-REFERRAL | 14 | ||
| Primary Care | 16 | ||
| Direct Access Versus Primary Care | 16 | ||
| Autonomous Practice | 16 | ||
| Reimbursement Trends | 16 | ||
| DECISION-MAKING PROCESS | 17 | ||
| Past Medical History | 18 | ||
| Risk Factor Assessment | 18 | ||
| Clinical Presentation | 19 | ||
| Associated Signs and Symptoms of Systemic Diseases | 19 | ||
| Systems Review Versus Review of Systems | 19 | ||
| CASE EXAMPLES AND CASE STUDIES | 20 | ||
| PHYSICIAN REFERRAL | 20 | ||
| Suggested Guidelines | 21 | ||
| Special Considerations | 21 | ||
| Documentation and Liability | 22 | ||
| Guidelines for Immediate Medical Attention | 22 | ||
| Guidelines for Physician Referral | 25 | ||
| General Systemic | 25 | ||
| For Women | 25 | ||
| Vital Signs (Report These Findings) | 25 | ||
| Cardiac | 25 | ||
| Cancer | 25 | ||
| Pulmonary | 26 | ||
| Genitourinary | 26 | ||
| Gastrointestinal | 26 | ||
| Musculoskeletal | 26 | ||
| Precautions/Contraindications to Therapy | 26 | ||
| Clues to Screening for Medical Disease | 26 | ||
| RED FLAG | 26 | ||
| REFERENCES | 28 | ||
| 2 - Interviewing as a Screening Tool | 30 | ||
| CONCEPTS IN COMMUNICATION | 30 | ||
| Compassion and Caring | 30 | ||
| Communication Styles | 31 | ||
| Illiteracy | 31 | ||
| English as a Second Language | 31 | ||
| The Physical Therapist’s Role | 31 | ||
| CULTURAL COMPETENCE | 32 | ||
| Minority Groups | 32 | ||
| Social Determinants of Health | 33 | ||
| Cultural Competence in the Screening Process | 33 | ||
| Resources | 35 | ||
| THE SCREENING INTERVIEW | 35 | ||
| Interviewing Techniques | 35 | ||
| Open-Ended and Closed-Ended Questions | 35 | ||
| Follow-Up Questions. The funnel sequence is aided by the use of follow-up questions, referred to as FUPs in the text. Beginning ... | 36 | ||
| Paraphrasing Technique. A useful interviewing skill that can assist in synthesizing and integrating the information obtained dur... | 36 | ||
| Interviewing Tools | 36 | ||
| Resources. The Family/Personal History form presented in this chapter is just one example of a basic intake form. See the compan... | 37 | ||
| CLIENT HISTORY AND INTERVIEW | 37 | ||
| Key Components of the Client History and Interview | 37 | ||
| Family/Personal History | 39 | ||
| Resources | 39 | ||
| Follow-Up Questions (FUPs) | 39 | ||
| Age and Aging | 43 | ||
| Sex and Gender | 44 | ||
| rMen. It may be appropriate to ask some specific screening questions just for men. A list of these questions is provided in Chap... | 44 | ||
| Men and Osteoporosis. Osteoporosis has been reported to be underdiagnosed in men. Normal aging results in loss of bone mineral d... | 44 | ||
| Women. The incidence of strokes is greater in middle aged and older women compared with men. In addition, these women also have ... | 44 | ||
| Life Cycles. For women, it may be pertinent to find out where each woman is in the life cycle (Box 2.5) and correlate this infor... | 45 | ||
| Women and Hormone Therapy (HT). Hormone therapy (HT, also known as hormone replacement therapy or HRT, or menopausal hormone the... | 45 | ||
| Women and Heart Disease. When a 55-year-old woman with a significant family history of heart disease comes to the therapist with... | 46 | ||
| Women and Osteoporosis. As health care specialists, therapists have a unique opportunity and responsibility to provide screening... | 46 | ||
| Race and Ethnicity | 46 | ||
| Resources. Definitions and descriptions for race and ethnicity are available through the Centers for Disease Control and Prevent... | 46 | ||
| Past Medical and Personal History | 46 | ||
| Eating Disorders and Disordered Eating. Eating disorders, such as bulimia nervosa, binge eating disorder, and anorexia nervosa, ... | 47 | ||
| General Health | 47 | ||
| Medications. Although the Family/Personal History form includes a question about prescription or OTC medications, specific follo... | 48 | ||
| Recent Infections. Recent infections, such as mononucleosis, hepatitis, or upper respiratory infections may precede the onset of... | 48 | ||
| Screening for Cancer. Any “yes” responses to early screening questions for cancer (General Health questions 5, 6, and 7) must be... | 48 | ||
| Substance Abuse. Substance refers to any agent taken nonmedically that can alter mood or behavior. Addiction refers to the daily... | 48 | ||
| Risk Factors. Many teens and adults are at risk for using and abusing various substances (Box 2.6). Often, they are self-medicat... | 49 | ||
| Signs and Symptoms of Substance Use/Abuse. Behavioral and physiologic responses to any of these substances depend on the charact... | 49 | ||
| Screening for Substance Use/Abuse. Questions designed to screen for the presence of chemical substance abuse need to become part... | 50 | ||
| Resources. Several guides on substance abuse for health care professionals are available.88,89 These resources may help the ther... | 50 | ||
| Alcohol. Other than tobacco, alcohol is the most dominant addictive agent in the United States. Statistics regarding alcohol abu... | 50 | ||
| Effects of Alcohol Use. Excessive alcohol use can cause or contribute to many medical conditions. Alcohol is a toxic drug that i... | 50 | ||
| Signs and Symptoms of Alcohol Withdrawal. The therapist must be alert to any signs or symptoms of alcohol withdrawal, a potentia... | 51 | ||
| Screening for Alcohol Abuse. In the United States alcohol use/abuse is often considered a moral problem and may pose an embarras... | 51 | ||
| Physical Therapist’s Role. Incorporating screening questions into conversation during the interview may help to engage individua... | 53 | ||
| Recreational Drug Use. As with tobacco and alcohol use, recreational or street drug use can lead to or compound already present ... | 54 | ||
| Tobacco. It is reported that one in five deaths in the United States is as a result of the use of tobacco. Persons who smoke are... | 54 | ||
| Caffeine. Caffeine is a substance with specific physiologic (stimulant) effects. Caffeine ingested in toxic amounts has many eff... | 55 | ||
| Sugar Substitutes. Sugar substitutes (also termed “high-intensity sweeteners” by the Food and Drug Administration [FDA]) are add... | 56 | ||
| Client Checklist. Screening for medical conditions can be aided by the use of a client checklist of associated signs and symptom... | 56 | ||
| Medical and Surgical History. Tests contributing information to the physical therapy assessment may include radiography (x-rays,... | 56 | ||
| Surgical History. Previous surgery or surgery related to the client’s current symptoms may be indicated on the Family/Personal H... | 56 | ||
| Clinical Tests. The therapist will want to examine the available test results as often as possible. Familiarity with the results... | 56 | ||
| Work/Living Environment. Questions related to the client’s daily work activities and work environments are included in the Famil... | 56 | ||
| When to Screen. Taking an environmental, occupational, or military history may be appropriate when a client has a history of ast... | 57 | ||
| Resources. Further suggestions and tools to help health care professionals incorporate environmental history questions can be fo... | 58 | ||
| History of Falls. Falls is a serious and costly health concern in the United States. In the United States, falls are the leading... | 58 | ||
| Risk Factors for Falls. The ability to maintain upright balance in static and dynamic conditions is a result of a complex intera... | 58 | ||
| Screening for Risk of Falls. Aging adults who have just started to fall or who fall frequently may be fearful of losing their in... | 60 | ||
| Resources. As the population of older people in the United States continues to grow, the number of falls and injuries related to... | 60 | ||
| Vital Signs. Taking a client’s vital signs remains the single easiest, most economic, and fastest way to screen for many systemi... | 60 | ||
| CORE INTERVIEW | 61 | ||
| History of Present Illness | 61 | ||
| Chief Complaint | 61 | ||
| Pain and Symptom Assessment | 61 | ||
| Insidious Onset | 61 | ||
| Trauma | 61 | ||
| Intrinsic Trauma. An example of intrinsic trauma is the unguarded movement that can occur during normal motion. For example, the... | 61 | ||
| Extrinsic Trauma. Extrinsic trauma occurs when a force or load external to the body is exerted against the body. Whenever a clie... | 65 | ||
| Assault. Domestic violence is a serious public health concern that often goes undetected by clinicians. Women (especially those ... | 65 | ||
| Screening for Assault or Domestic Violence. The American Medical Association (AMA) and other professional groups recommend routi... | 65 | ||
| Elder Abuse. Health care professionals are becoming more aware of elder abuse as a problem. Last year, more than 5 million cases... | 67 | ||
| Clinical Signs and Symptoms. Physical injuries caused by battering are most likely to occur in a central pattern (i.e., head, ne... | 67 | ||
| Workplace Violence. Workers in the health care profession are at risk for workplace violence in the form of physical assault and... | 67 | ||
| The Physical Therapist’s Role. Providing referral to community agencies is perhaps the most important step a health care provide... | 68 | ||
| Reporting Abuse. The law is clear in all U.S. states regarding abuse of a minor (under age 18 years) (Box 2.12) | 68 | ||
| Documentation. Most state laws also provide for the taking of photographs of visible trauma on a child without parental consent.... | 69 | ||
| Resources. Consult your local directory for information about adult and child protection services, state elder abuse hotlines, s... | 69 | ||
| Medical Treatment and Medications | 69 | ||
| Medical Treatment | 69 | ||
| Medications | 70 | ||
| Risk Factors for Adverse Drug Events. Pharmacokinetics (the processes that affect drug movement in the body) represents the bigg... | 70 | ||
| Potential Drug Side Effects. Side effects are usually defined as predictable pharmacologic effects that occur within therapeutic... | 71 | ||
| Nonsteroidal Antiinflammatory Drugs (NSAIDs). NSAIDs are a group of drugs that are useful in the symptomatic treatment of inflam... | 71 | ||
| Side Effects of NSAIDs. In 2015, the Food and Drug Administration (FDA) strengthened its earlier warning regarding the risk of h... | 71 | ||
| Screening for Risk Factors and Effects of NSAIDs. Screening for risk factors is as important as looking for clinical manifestati... | 72 | ||
| Acetaminophen. Acetaminophen, the active ingredient in Tylenol and other OTC and prescription pain relievers and cold medicines,... | 72 | ||
| Corticosteroids. Corticosteroids are often confused with the singular word “steroids.” There are three types or classes of stero... | 73 | ||
| Opioids. Opioids, such as codeine, morphine, tramadol, hydrocodone, or oxycodone are safe when used as directed. They do not cau... | 73 | ||
| Prescription Drug Abuse. The U.S. Drug Enforcement Administration has reported that more than 7 million Americans abuse prescrip... | 73 | ||
| Hormonal Contraceptives. Some women use birth control pills to prevent pregnancy, whereas others take them to control their mens... | 73 | ||
| Antibiotics. Skin reactions (see Fig. 4.12) and noninflammatory joint pain (see Box 3.4) are two of the most common side effects... | 74 | ||
| Nutraceuticals. Nutraceuticals are natural products (usually made from plant substances) that do not require a prescription to p... | 74 | ||
| The Physical Therapist’s Role. For every client the therapist is strongly encouraged to take the time to look up indications for... | 74 | ||
| Resources. Many resources are available to help the therapist identify potential side effects of medications, especially in the ... | 76 | ||
| Current Level of Fitness | 76 | ||
| Sleep-Related History | 77 | ||
| Stress (see also Chapter 3) | 77 | ||
| Final Questions | 78 | ||
| Special Questions for Women | 78 | ||
| Special Questions for Men | 78 | ||
| HOSPITAL INPATIENT INFORMATION | 78 | ||
| Medical Record | 78 | ||
| Nursing Assessment | 79 | ||
| PHYSICIAN REFERRAL | 80 | ||
| Guidelines for Physician Referral | 81 | ||
| MEDICATIONS | 83 | ||
| Previous Medical Treatment | 83 | ||
| Activities of Daily Living (ADLS) | 83 | ||
| Final Question | 83 | ||
| REFERENCES | 84 | ||
| 3 - Pain Types and Viscerogenic Pain Patterns | 90 | ||
| MECHANISMS OF REFERRED VISCERAL PAIN | 90 | ||
| Embryologic Development | 91 | ||
| Multisegmental Innervation | 92 | ||
| Direct Pressure and Shared Pathways | 92 | ||
| ASSESSMENT OF PAIN AND SYMPTOMS | 93 | ||
| Pain Assessment in the Older Adult | 94 | ||
| Pain Assessment in the Young Child | 98 | ||
| Characteristics of Pain | 99 | ||
| Location of Pain | 99 | ||
| Description of Pain | 99 | ||
| Intensity of Pain | 100 | ||
| Frequency and Duration of Pain | 100 | ||
| Pattern of Pain | 101 | ||
| Aggravating and Relieving Factors | 102 | ||
| Associated Symptoms | 102 | ||
| SOURCES OF PAIN | 103 | ||
| Cutaneous Sources of Pain | 104 | ||
| Somatic Sources of Pain | 105 | ||
| Visceral Sources of Pain | 106 | ||
| Neuropathic Pain | 108 | ||
| Referred Pain | 108 | ||
| Differentiating Sources of Pain4 | 108 | ||
| TYPES OF PAIN | 109 | ||
| Tension Pain | 109 | ||
| Inflammatory Pain | 110 | ||
| Ischemic Pain | 110 | ||
| Myofascial Pain | 110 | ||
| Muscle Tension | 110 | ||
| Muscle Spasm | 110 | ||
| Muscle Trauma | 111 | ||
| Muscle Deficiency | 111 | ||
| Trigger Points | 111 | ||
| Joint Pain | 112 | ||
| Drug-Induced | 113 | ||
| Chemical Exposure | 113 | ||
| Inflammatory Bowel Disease | 113 | ||
| Arthritis | 114 | ||
| Infectious Arthritis. Joint pain can be a local response to an infection. This is called infectious, septic, or bacterial arthri... | 114 | ||
| Reactive Arthritis. Reactive arthritis is sometimes used synonymously with Reiter’s syndrome, a triad of nongonococcal urethriti... | 117 | ||
| Radicular Pain | 117 | ||
| Arterial, Pleural, and Tracheal Pain | 118 | ||
| Gastrointestinal Pain | 118 | ||
| Pain at Rest | 119 | ||
| Night Pain | 119 | ||
| Night Pain and Cancer | 119 | ||
| Pain with Activity | 120 | ||
| Diffuse Pain | 120 | ||
| Chronic Pain | 120 | ||
| Risk Factors | 121 | ||
| Fear-Avoidance Behavior | 121 | ||
| Differentiating Chronic Pain from Systemic Disease | 122 | ||
| Aging and Chronic Pain | 122 | ||
| COMPARISON OF SYSTEMIC VERSUS MUSCULOSKELETAL PAIN PATTERNS | 123 | ||
| CHARACTERISTICS OF VISCEROGENIC PAIN | 124 | ||
| Gradual, Progressive, and Cyclical Pain Patterns | 125 | ||
| Constant Pain | 125 | ||
| Physical Therapy Intervention “Fails” | 125 | ||
| Bone Pain and Aspirin | 125 | ||
| Pain Does Not Fit the Expected Pattern | 126 | ||
| SCREENING FOR EMOTIONAL AND PSYCHOLOGIC OVERLAY | 126 | ||
| Anxiety, Depression, and Panic Disorder | 127 | ||
| Anxiety | 127 | ||
| Depression | 127 | ||
| Symptoms of Depression. About one third of the clinically depressed clients treated do not feel sad or blue. Instead, they repor... | 130 | ||
| Drugs, Depression, Dementia, or Delirium?. The older adult often presents with such a mixed clinical presentation, it is difficu... | 131 | ||
| Panic Disorder | 131 | ||
| Psychoneuroimmunology | 132 | ||
| SCREENING FOR SYSTEMIC VERSUS PSYCHOGENIC SYMPTOMS | 133 | ||
| Screening Tools for Emotional Overlay | 133 | ||
| Pain Catastrophizing Scale | 133 | ||
| McGill Pain Questionnaire | 134 | ||
| Illness Behavior Syndrome and Symptom Magnification | 135 | ||
| Waddell’s Nonorganic Signs | 136 | ||
| Conversion Symptoms | 136 | ||
| Screening Questions for Psychogenic Source of Symptoms\b | 137 | ||
| PHYSICIAN REFERRAL | 137 | ||
| Guidelines for Immediate Physician Referral | 137 | ||
| Guidelines for Physician Referral Required | 138 | ||
| Clues to Screening for Viscerogenic Sources of Pain | 138 | ||
| Show me exactly where your pain is located | 140 | ||
| What does it feel like? | 140 | ||
| How long do the symptoms last? | 140 | ||
| Tell me about the pattern of your pain/symptoms | 140 | ||
| REFERENCES | 143 | ||
| 4 - Physical Assessment as a Screening Tool | 147 | ||
| GENERAL SURVEY | 147 | ||
| Mental Status | 148 | ||
| Risk Factors for Delirium | 148 | ||
| Nutritional Status | 150 | ||
| Body and Breath Odors | 151 | ||
| Vital Signs | 151 | ||
| Pulse Rate | 151 | ||
| Respirations | 152 | ||
| Pulse Oximetry | 153 | ||
| Blood Pressure | 154 | ||
| Assessing Blood Pressure. BP should be taken in the same arm and in the same position (supine or sitting) each time it is measur... | 155 | ||
| Pulse Pressure. The difference between the systolic and diastolic pressure readings (SBP − DBP) is called pulse pressure normall... | 157 | ||
| Variations in Blood Pressure. There can be some normal variation in SBP from side to side (right extremity compared with left ex... | 157 | ||
| Blood Pressure Changes with Exercise. As previously mentioned, the SBP increases with an increasing level of activity and exerci... | 157 | ||
| Hypertension. In recent years, an unexpected increase in illness and death caused by hypertension has prompted the National Inst... | 158 | ||
| Hypertension in African Americans. Nearly 40% of African Americans suffer from heart disease and 13% have diabetes. Hypertension... | 158 | ||
| Hypertension in Hispanics. The Hispanic population in the United States is the largest minority group in the nation. Research on... | 159 | ||
| Hypertension in Children and Adolescents.47 Up to 3.6% of children under the age of 18 years also have hypertension. Guidelines ... | 159 | ||
| Hypotension. Hypotension is a systolic pressure below 90 mm Hg or a diastolic pressure below 60 mm Hg. A BP level that is border... | 159 | ||
| Postural (Orthostatic) Hypotension. A common cause of low BP is postural (orthostatic) hypotension, defined as a sudden drop in ... | 159 | ||
| Core Body Temperature | 160 | ||
| Walking Speed: The Sixth Vital Sign | 162 | ||
| TECHNIQUES OF PHYSICAL EXAMINATION | 162 | ||
| Inspection | 162 | ||
| Palpation | 162 | ||
| Percussion | 162 | ||
| Auscultation | 163 | ||
| INTEGUMENTARY SCREENING EXAMINATION | 163 | ||
| Skin Assessment | 164 | ||
| Change in Skin Temperature | 166 | ||
| Change in Skin Color | 166 | ||
| Assessing Dark Skin | 166 | ||
| Examining a Mass or Skin Lesion | 167 | ||
| Assess Surgical Scars | 169 | ||
| Common Skin Lesions | 170 | ||
| Vitiligo | 170 | ||
| Café-au-lait | 170 | ||
| Skin Rash | 171 | ||
| Hemorrhagic Rash | 171 | ||
| Dermatitis | 171 | ||
| Rosacea | 171 | ||
| Thrombocytopenia | 172 | ||
| Xanthomas | 172 | ||
| Rheumatologic Diseases | 172 | ||
| Steroid Skin and Steroid Rosacea | 173 | ||
| Erythema Chronicum Migrans | 174 | ||
| Effects of Radiation | 174 | ||
| Sexually Transmitted Diseases/Infections | 175 | ||
| Herpes Virus. Several herpes viruses are accompanied by characteristic skin lesions. Herpes simplex virus (HSV)-1 and -2 are the... | 176 | ||
| Herpetic Whitlow. Herpetic whitlow, an intense painful infection of the terminal phalanx of the fingers, is caused by HSV-1 (60%... | 176 | ||
| Herpes Zoster. Varicella-zoster virus (VZV), or herpes zoster or “shingles,” is another herpes virus with skin lesions character... | 177 | ||
| Cutaneous Manifestations of Abuse | 177 | ||
| Mongolian Spots. Discoloration of the skin in newborn infants, called a Mongolian spot (Fig. 4.25), can be mistaken for a sign o... | 178 | ||
| Cancer-Related Skin Lesions | 178 | ||
| Kaposi’s Sarcoma | 179 | ||
| Lymphomas | 179 | ||
| NAIL BED ASSESSMENT | 180 | ||
| Nail Bed Changes | 180 | ||
| Onycholysis | 181 | ||
| Koilonychia | 181 | ||
| Beau’s lines | 181 | ||
| Splinter Hemorrhages | 182 | ||
| Leukonychia | 182 | ||
| Paronychia | 182 | ||
| Clubbing | 183 | ||
| Nail Patella Syndrome | 183 | ||
| LYMPH NODE PALPATION | 186 | ||
| MUSCULOSKELETAL SCREENING EXAMINATION | 187 | ||
| NEUROLOGIC SCREENING EXAMINATION | 188 | ||
| Mental Status | 189 | ||
| Cranial Nerves | 189 | ||
| Motor Function | 190 | ||
| Sensory Function | 190 | ||
| Reflexes | 191 | ||
| Neural Tension | 191 | ||
| REGIONAL SCREENING EXAMINATION | 192 | ||
| Head and Neck | 192 | ||
| Upper and Lower Extremities | 192 | ||
| Peripheral Vascular Disease | 192 | ||
| Venous Thromboembolism | 194 | ||
| The Chest and Back (Thorax) | 194 | ||
| Chest and Back: Inspection30 | 194 | ||
| Chest and Back: Palpation | 195 | ||
| Chest and Back: Percussion | 196 | ||
| Chest and Back: Lung Auscultation | 196 | ||
| Chest and Back: Heart Auscultation | 197 | ||
| Screening for Early Detection of Breast Cancer. The goal of screening is early detection of breast cancer. Breast cancers that a... | 197 | ||
| Abdomen | 198 | ||
| Abdomen: Inspection | 198 | ||
| Abdomen: Auscultation | 199 | ||
| Abdomen: Percussion and Palpation | 199 | ||
| Liver. Liver percussion to determine its size and identify its edges is a skill beyond the scope of a physical therapist for the... | 199 | ||
| Spleen. As with other organs, the spleen is difficult to percuss, even more so than the liver, and is not part of the physical t... | 200 | ||
| Gallbladder and Pancreas. Likewise, the gallbladder tucked up under the liver (see Figs. 9.1 and 9.2) is not palpable unless gro... | 200 | ||
| Kidneys. The kidneys are located deep in the retroperitoneal space in both upper quadrants of the abdomen. Each kidney extends f... | 200 | ||
| Bladder. The bladder lies below the symphysis pubis and is not palpable unless it becomes distended and rises above the pubic bo... | 201 | ||
| Aortic Bifurcation. It may be necessary to assess for an abdominal aneurysm, especially in the older client with back pain and/o... | 201 | ||
| SYSTEMS REVIEW … OR … REVIEW OF SYSTEMS? | 201 | ||
| PHYSICIAN REFERRAL | 205 | ||
| Vital Signs | 205 | ||
| Precautions/Contraindications to Therapy | 205 | ||
| Guidelines for Immediate Physician Referral | 206 | ||
| REFERENCES | 210 | ||
| II -\rViscerogenic Causes of Neuromusculoskeletal Pain and Dysfunction | 213 | ||
| 5 - Screening for Hematologic Disease | 213 | ||
| SIGNS AND SYMPTOMS OF HEMATOLOGIC DISORDERS | 213 | ||
| CLASSIFICATION OF BLOOD DISORDERS | 213 | ||
| Erythrocyte Disorders | 213 | ||
| Anemia | 214 | ||
| Clinical Signs and Symptoms. Decreased capacity of the blood to carry oxygen may result in disturbances in the function of many ... | 214 | ||
| Polycythemia | 215 | ||
| Clinical Signs and Symptoms. The symptoms of this disease are often insidious in onset with vague complaints. The most common fi... | 215 | ||
| Sickle Cell Anemia | 216 | ||
| Clinical Signs and Symptoms. A series of “crises,” or acute manifestations of symptoms, characterize sickle cell disease. The se... | 216 | ||
| Leukocyte Disorders | 216 | ||
| Leukocytosis | 217 | ||
| Leukopenia | 217 | ||
| Leukemia | 218 | ||
| Platelet Disorders | 218 | ||
| Thrombocytosis | 218 | ||
| Thrombocytopenia | 218 | ||
| Clinical Signs and Symptoms. Severe thrombocytopenia results in the appearance of multiple petechiae (small, purple, pinpoint he... | 218 | ||
| Coagulation Disorders | 219 | ||
| Hemophilia | 219 | ||
| Clinical Signs and Symptoms. Bleeding into the joint spaces (hemarthrosis) is one of the most common clinical manifestations of ... | 219 | ||
| PHYSICIAN REFERRAL | 220 | ||
| Guidelines for Immediate Medical Attention | 220 | ||
| Guidelines for Physician Referral | 220 | ||
| Clues to Screening for Hematologic Disease | 220 | ||
| REFERENCES | 223 | ||
| 6 - Screening for Cardiovascular Disease | 224 | ||
| SIGNS AND SYMPTOMS OF CARDIOVASCULAR DISEASE | 225 | ||
| Chest Pain or Discomfort | 225 | ||
| Palpitation | 226 | ||
| Dyspnea | 226 | ||
| Cardiac Syncope | 227 | ||
| Fatigue | 227 | ||
| Cough | 227 | ||
| Cyanosis | 227 | ||
| Edema | 227 | ||
| Claudication | 228 | ||
| Vital Signs | 228 | ||
| CARDIAC PATHOPHYSIOLOGY | 228 | ||
| Conditions Affecting the Heart Muscle | 228 | ||
| Hyperlipidemia | 228 | ||
| Screening for Side Effects of Statins. Statin associated muscle symptoms (SAMS) are the most common myotoxic events associated w... | 229 | ||
| Coronary Artery Disease | 231 | ||
| Atherosclerosis. Atherosclerosis is the disease process often called arteriosclerosis or hardening of the arteries. It is a prog... | 231 | ||
| Thrombus. When plaque builds up on the artery walls, the blood flow is slowed and a clot (thrombus) may form on the plaque. When... | 231 | ||
| Spasm. Sudden constriction of a coronary artery is called a spasm; blood flow to that part of the heart is cut off or decreased.... | 232 | ||
| Risk Factors. In 1948 the United States government decided to investigate the etiology, incidence, and pathology of CAD by study... | 232 | ||
| Women and Heart Disease. Many women know about the risk of breast cancer, but in truth, they are 10 times more likely to die of ... | 232 | ||
| Clinical Signs and Symptoms. Atherosclerosis, by itself, does not necessarily produce symptoms. For manifestations to develop, t... | 233 | ||
| Angina | 233 | ||
| Types of Anginal Pain. There are a number of types of anginal pain, including chronic stable angina (also referred to as walk-th... | 234 | ||
| Clinical Signs and Symptoms. The client may indicate the location of the symptoms by placing a clenched fist against the sternum... | 234 | ||
| Myocardial Infarction | 235 | ||
| Clinical Signs and Symptoms. There are some well-known pain patterns specific to the heart and cardiac system. Sudden death can ... | 236 | ||
| Cardiac Arrest. Researchers expect the number of Americans living with angina to grow as new treatments improve survival after a... | 236 | ||
| Classic Warning Signs of Myocardial Infarction. Those who do have warning signs of MI may have severe unrelenting chest pain des... | 236 | ||
| Warning Signs of Myocardial Infarction in Women. For women, symptoms can be more subtle or “atypical.” Chest pain or discomfort ... | 236 | ||
| Pericarditis | 237 | ||
| Clinical Signs and Symptoms. At first, pericarditis may have no external signs or symptoms. The symptoms of acute pericarditis v... | 237 | ||
| Congestive Heart Failure or Heart Failure | 238 | ||
| Clinical Signs and Symptoms. The incidence of CHF increases with advancing age. Because of the increasing age of the U.S. popula... | 239 | ||
| Left Ventricular Failure. Failure of the left ventricle causes either pulmonary congestion or a disturbance in the respiratory c... | 239 | ||
| Right Ventricular Failure. Failure of the right ventricle may occur in response to left-sided CHF or as a result of pulmonary em... | 240 | ||
| Diastolic Heart Failure. Diastolic heart failure describes a condition in which the left ventricle stiffens and hypertrophies. O... | 240 | ||
| Aneurysm46 | 241 | ||
| Thoracic and Peripheral Arterial Aneurysms. A dissecting aneurysm (most often a thoracic aneurysm) occurs when a tear develops i... | 241 | ||
| Abdominal Aortic Aneurysms. An aneurysm is an abnormal dilation in a weak or diseased arterial wall causing a sac-like protrusio... | 241 | ||
| Risk Factors. The therapist should look for a history of smoking,47-49 known congenital heart disease (e.g., bicuspid aortic val... | 241 | ||
| Clinical Signs and Symptoms. Most AAAs are asymptomatic52; discovery occurs during physical or radiographic examination of the a... | 242 | ||
| Conditions Affecting the Heart Valves | 243 | ||
| Rheumatic Fever | 243 | ||
| Clinical Signs and Symptoms. The most typical clinical profile of a child or young adult with acute rheumatic fever is an initia... | 244 | ||
| Endocarditis | 244 | ||
| Risk Factors. In addition to clients with previous valvular damage, injection drug users and postcardiac surgical clients are at... | 244 | ||
| Clinical Signs and Symptoms. A significant number of clients (up to 45%) with bacterial endocarditis initially have musculoskele... | 244 | ||
| Lupus Carditis | 245 | ||
| Congenital Valvular Defects | 245 | ||
| Mitral Valve Prolapse. Echocardiographic studies have advanced our knowledge of mitral valve prolapse (MVP) in the last two deca... | 245 | ||
| Risk Factors. MVP is a benign condition in isolation; however, it can be associated with a number of other conditions, especiall... | 246 | ||
| Clinical Signs and Symptoms. Two thirds of the individuals with MVP experience no symptoms. Approximately one third experience o... | 246 | ||
| Conditions Affecting the Cardiac Nervous System | 247 | ||
| Fibrillation | 248 | ||
| Risk Factors. Persons at risk for fibrillation who require screening include those who have had a previous heart attack or a his... | 249 | ||
| Clinical Signs and Symptoms. Symptoms of fibrillation vary, depending on the functional state of the heart and the location of t... | 249 | ||
| Sinus Tachycardia | 250 | ||
| Clinical Signs and Symptoms. The symptoms of tachycardia vary from one person to another and may range from an increased pulse t... | 250 | ||
| Sinus Bradycardia | 250 | ||
| Clinical Signs and Symptoms. Syncope may be preceded by sudden onset of weakness, sweating, nausea, pallor, vomiting, and distor... | 250 | ||
| CARDIOVASCULAR DISORDERS | 250 | ||
| Hypertension | 250 | ||
| Pulse Pressure | 251 | ||
| Blood Pressure Classification | 251 | ||
| Risk Factors | 251 | ||
| Clinical Signs and Symptoms | 252 | ||
| Transient Ischemic Attack | 252 | ||
| Orthostatic Hypotension (See also discussion on Hypotension in Chapter 4) | 252 | ||
| Peripheral Vascular Disorders | 253 | ||
| Arterial (Occlusive) Disease | 254 | ||
| Risk Factors. Diabetes mellitus increases the susceptibility to CHD. People with diabetes have abnormalities that affect a numbe... | 254 | ||
| Clinical Signs and Symptoms. The first sign of vascular occlusive disease may be the loss of hair on the toes. The most importan... | 254 | ||
| Raynaud’s Phenomenon and Disease | 255 | ||
| Clinical Signs and Symptoms. The typical progression of Raynaud’s phenomenon is pallor in the digits, followed by cyanosis accom... | 255 | ||
| Venous Disorders | 255 | ||
| Acute Venous Disorders. Acute venous disorders are caused by the formation of thrombi (clots), which obstruct venous flow. Block... | 255 | ||
| Risk Factors. Deep venous thrombosis (DVT) defined as blood clots in the pelvis, leg, or major upper extremity veins is a common... | 255 | ||
| Clinical Signs and Symptoms. Superficial thrombophlebitis appears as a local, raised, red, slightly indurated (hard), warm, tend... | 256 | ||
| Chronic Venous Disorders. Chronic venous insufficiency, also known as postphlebitic syndrome, is identified by chronic swollen l... | 258 | ||
| Lymphedema | 258 | ||
| LABORATORY VALUES | 258 | ||
| Serum Electrolytes | 258 | ||
| Potassium | 258 | ||
| Sodium | 258 | ||
| Calcium | 258 | ||
| Magnesium | 259 | ||
| SCREENING FOR THE EFFECTS OF CARDIOVASCULAR MEDICATIONS | 259 | ||
| Diuretics | 259 | ||
| Beta-Blockers | 259 | ||
| Alpha-1 Blockers | 259 | ||
| ACE Inhibitors | 260 | ||
| Calcium Channel Blockers | 260 | ||
| Nitrates | 260 | ||
| PHYSICIAN REFERRAL | 260 | ||
| Guidelines for Immediate Medical Attention | 261 | ||
| Guidelines for Physician Referral | 261 | ||
| Clues to Screening for Cardiovascular Signs and Symptoms | 261 | ||
| NONCARDIAC CHEST PAIN PATTERNS | 265 | ||
| REFERENCES | 269 | ||
| 7 - Screening for Pulmonary Disease | 272 | ||
| SIGNS AND SYMPTOMS OF PULMONARY DISORDERS | 272 | ||
| Cough | 272 | ||
| Dyspnea | 272 | ||
| Cyanosis | 273 | ||
| Clubbing (see Chapter 4) | 273 | ||
| Altered Breathing Patterns | 273 | ||
| Pulmonary Pain Patterns | 274 | ||
| Tracheobronchial Pain | 274 | ||
| Pleural Pain | 274 | ||
| Diaphragmatic Pleural Pain | 275 | ||
| Pulmonary Physiology | 275 | ||
| Acid-Base Regulation | 275 | ||
| Pulmonary Pathophysiology | 276 | ||
| Respiratory Acidosis | 276 | ||
| Respiratory Alkalosis | 276 | ||
| Chronic Obstructive Pulmonary Disease | 277 | ||
| Acute. Acute bronchitis is an inflammation of the trachea and bronchi (tracheobronchial tree) that is self-limiting and of short... | 277 | ||
| Chronic. Chronic bronchitis is a condition associated with prolonged exposure to nonspecific bronchial irritants and is accompan... | 278 | ||
| Bronchiectasis. Bronchiectasis is a form of obstructive lung disease that is actually a type of bronchitis. It is a progressive ... | 278 | ||
| Emphysema. Emphysema may develop in a person after a long history of chronic bronchitis in which the alveolar walls are destroye... | 279 | ||
| Types of Emphysema. There are three types of emphysema. Centrilobular emphysema (Fig. 7.4), the most common type, destroys the b... | 279 | ||
| Clinical Signs and Symptoms. The irreversible destruction reduces elasticity of the lung and increases the effort to exhale trap... | 279 | ||
| INFLAMMATORY/INFECTIOUS DISEASE | 280 | ||
| Asthma | 280 | ||
| Immune Sensitization and Inflammation | 280 | ||
| Clinical Signs and Symptoms | 281 | ||
| Complications. Status asthmaticus is a severe, life-threatening complication of asthma. With severe bronchospasm the workload of... | 281 | ||
| Pneumonia | 281 | ||
| Risk Factors | 281 | ||
| Clinical Signs and Symptoms | 282 | ||
| Tuberculosis | 283 | ||
| Risk Factors | 283 | ||
| Clinical Signs and Symptoms | 283 | ||
| Systemic Sclerosis Lung Disease | 284 | ||
| Clinical Signs and Symptoms | 284 | ||
| Neoplastic Disease | 284 | ||
| Lung Cancer (Bronchogenic Carcinoma) | 284 | ||
| Risk Factors. Smoking is the major risk factor for lung cancer, accounting for 82% of deaths caused by lung cancer.22 Other risk... | 284 | ||
| Metastases. Metastatic spread of pulmonary tumors is usually to the long bones, vertebral column (especially the thoracic verteb... | 285 | ||
| Clinical Signs and Symptoms. Clinical signs and symptoms of lung cancer often remain silent until the disease process is at an a... | 285 | ||
| GENETIC DISEASE OF THE LUNG | 288 | ||
| Cystic Fibrosis | 288 | ||
| Clinical Signs and Symptoms | 288 | ||
| OCCUPATIONAL LUNG DISEASES | 289 | ||
| Home Remodeling | 289 | ||
| Clinical Signs and Symptoms | 289 | ||
| PLEUROPULMONARY DISORDERS | 290 | ||
| Pulmonary Embolism and Deep Venous Thrombosis | 290 | ||
| Risk Factors | 290 | ||
| Prevention | 290 | ||
| Deep Venous Thrombosis (see also Chapter 6) | 290 | ||
| Pulmonary Embolism | 290 | ||
| Cor Pulmonale | 291 | ||
| Pulmonary Arterial Hypertension | 291 | ||
| Clinical Signs and Symptoms | 291 | ||
| Pleurisy | 292 | ||
| Clinical Signs and Symptoms | 292 | ||
| Pneumothorax | 292 | ||
| Clinical Signs and Symptoms | 293 | ||
| PHYSICIAN REFERRAL | 293 | ||
| Guidelines for Immediate Medical Attention | 294 | ||
| Guidelines for Physician Referral | 294 | ||
| Clues to Screening for Pulmonary Disease | 294 | ||
| Environmental and Work History | 298 | ||
| REFERENCES | 300 | ||
| 8 - Screening for Gastrointestinal Disease | 302 | ||
| SIGNS AND SYMPTOMS OF GASTROINTESTINAL DISORDERS | 302 | ||
| Abdominal Pain | 303 | ||
| Primary Gastrointestinal Visceral Pain Patterns. Visceral pain (internal organs) occurs in the midline because the digestive org... | 303 | ||
| Referred Gastrointestinal Pain Patterns. Sometimes visceral pain from a digestive organ is felt in a location remote from the us... | 304 | ||
| Dysphagia | 305 | ||
| Odynophagia | 306 | ||
| Gastrointestinal Bleeding | 306 | ||
| Epigastric Pain with Radiation | 306 | ||
| Symptoms Affected by Food | 307 | ||
| Early Satiety | 307 | ||
| Constipation | 307 | ||
| Diarrhea | 307 | ||
| Fecal Incontinence | 310 | ||
| Arthralgia | 311 | ||
| Shoulder Pain | 311 | ||
| Obturator or Psoas Abscess | 311 | ||
| Neuropathy | 314 | ||
| GASTROINTESTINAL DISORDERS | 314 | ||
| Gastroesophageal Reflux Disease | 314 | ||
| Clinical Signs and Symptoms | 314 | ||
| Peptic Ulcer | 315 | ||
| Clinical Signs and Symptoms | 315 | ||
| Gastrointestinal Complications of Nonsteroidal Antiinflammatory Drugs | 316 | ||
| Diverticular Disease | 318 | ||
| Appendicitis | 319 | ||
| Clinical Signs and Symptoms | 319 | ||
| McBurney’s Point | 319 | ||
| Pancreatitis | 321 | ||
| Clinical Signs and Symptoms | 321 | ||
| Pancreatic Carcinoma | 322 | ||
| Clinical Signs and Symptoms | 322 | ||
| Inflammatory Bowel Disease | 322 | ||
| Crohn’s Disease | 323 | ||
| III: Systemic Origins of Neuromusculoskeletal Pain and Dysfunction | 521 | ||
| 14 - Screening the Head, Neck, and Back | 521 | ||
| USING THE SCREENING MODEL TO EVALUATE THE HEAD, NECK, OR BACK | 521 | ||
| Past Medical History | 521 | ||
| Risk Factor Assessment | 523 | ||
| Clinical Presentation | 525 | ||
| Effect of Position | 525 | ||
| Night Pain | 525 | ||
| Associated Signs and Symptoms | 525 | ||
| Review of Systems | 525 | ||
| Yellow Flag Findings | 526 | ||
| Work. In particular, belief that pain is harmful resulting in fear-avoidance behavior and belief that all pain must be gone befo... | 526 | ||
| Beliefs. People with chronic LBP who demonstrate yellow flag beliefs also have an increased risk for poor prognosis. This catego... | 526 | ||
| Behaviors. Beliefs extend into behaviors such as passive attitude toward rehabilitation, use of extended rest, reduced activity,... | 526 | ||
| Affective. Depressed mood, irritability, and heightened awareness of bodily sensations along with anxiety represent affective ps... | 526 | ||
| Red-Flag Signs and Symptoms | 526 | ||
| LOCATION OF PAIN AND SYMPTOMS | 528 | ||
| Head | 528 | ||
| Causes of Headaches | 528 | ||
| Cancer. The greatest concern is always whether or not there is a brain tumor causing the headaches. Only a minority of individua... | 529 | ||
| Migraines. Migraine headaches are often accompanied by nausea, vomiting, and visual disturbances, but the pain pattern is also o... | 530 | ||
| Cervical Spine | 531 | ||
| Thoracic Spine | 532 | ||
| Scapula | 532 | ||
| Lumbar Spine | 534 | ||
| Sacrum/Sacroiliac | 534 | ||
| SOURCES OF PAIN AND SYMPTOMS | 535 | ||
| Viscerogenic | 535 | ||
| Neurogenic | 536 | ||
| Vasculogenic | 537 | ||
| Spondylogenic | 538 | ||
| Psychogenic | 539 | ||
| SCREENING FOR ONCOLOGIC CAUSES OF BACK PAIN | 539 | ||
| Past Medical History | 540 | ||
| Red Flags and Risk Factors | 540 | ||
| Clinical Presentation | 542 | ||
| Associated Signs and Symptoms | 542 | ||
| SCREENING FOR CARDIAC CAUSES OF NECK AND BACK PAIN | 542 | ||
| Angina | 543 | ||
| Myocardial Ischemia | 543 | ||
| Abdominal Aortic Aneurysm | 543 | ||
| Risk Factors | 543 | ||
| Clinical Presentation | 544 | ||
| SCREENING FOR PERIPHERAL VASCULAR CAUSES OF BACK PAIN | 545 | ||
| Back Pain: Vascular or Neurogenic? | 545 | ||
| The Bicycle Test | 547 | ||
| SCREENING FOR PULMONARY CAUSES OF NECK AND BACK PAIN | 548 | ||
| Past Medical History | 549 | ||
| Clinical Presentation | 549 | ||
| Associated Signs and Symptoms | 549 | ||
| SCREENING FOR RENAL AND UROLOGIC CAUSES OF BACK PAIN | 550 | ||
| Origin of Pain Patterns | 550 | ||
| Past Medical History | 550 | ||
| Clinical Presentation | 550 | ||
| Screening Questions: Renal and Urologic System | 550 | ||
| Pseudorenal Pain | 552 | ||
| History | 552 | ||
| Risk Factors | 552 | ||
| Clinical Presentation | 552 | ||
| Associated Signs and Symptoms | 552 | ||
| SCREENING FOR GASTROINTESTINAL CAUSES OF BACK PAIN | 552 | ||
| Past Medical History and Risk Factors | 553 | ||
| Signs and Symptoms of Gastrointestinal Dysfunction | 553 | ||
| Esophagus | 555 | ||
| Stomach and Duodenum | 555 | ||
| Small Intestine | 555 | ||
| SCREENING FOR LIVER AND BILIARY CAUSES OF BACK PAIN | 556 | ||
| The Pancreas | 557 | ||
| SCREENING FOR GYNECOLOGIC CAUSES OF BACK PAIN | 557 | ||
| Past Medical History | 557 | ||
| Risk Factors | 557 | ||
| Multiple Pregnancies and Births | 557 | ||
| Endometriosis | 558 | ||
| Ovarian Cysts and Uterine Fibroids | 560 | ||
| Ectopic Pregnancy | 560 | ||
| Intrauterine Contraceptive Device | 560 | ||
| Clinical Presentation | 560 | ||
| Associated Signs and Symptoms | 561 | ||
| SCREENING FOR MALE REPRODUCTIVE CAUSES OF BACK PAIN | 561 | ||
| Risk Factors | 561 | ||
| Clinical Presentation | 561 | ||
| Associated Signs and Symptoms | 562 | ||
| SCREENING FOR INFECTIOUS CAUSES OF BACK PAIN | 562 | ||
| Vertebral Osteomyelitis | 562 | ||
| Disk Space Infection | 563 | ||
| Bacterial Endocarditis | 563 | ||
| PHYSICIAN REFERRAL | 564 | ||
| Guidelines for Immediate Medical Attention | 564 | ||
| Guidelines for Physician Referral | 564 | ||
| Clues to Screening Head, Neck, or Back Pain | 565 | ||
| General | 565 | ||
| Past Medical History | 565 | ||
| Oncologic | 565 | ||
| Cardiovascular | 565 | ||
| Pulmonary | 565 | ||
| Renal/Urologic | 566 | ||
| Gastrointestinal | 566 | ||
| Gynecologic | 566 | ||
| Nonorganic (Psychogenic) (see discussion in Chapter 3) | 566 | ||
| Infectious | 566 | ||
| Pediatrics | 566 | ||
| 15 - Screening the Sacrum, Sacroiliac, and Pelvis | 579 | ||
| THE SACRUM AND SACROILIAC JOINT | 579 | ||
| Using the Screening Model to Evaluate Sacral/Sacroiliac Symptoms | 579 | ||
| Clinical Presentation | 579 | ||
| Sacroiliac Joint Pain Pattern. Whether from a mechanical or a systemic origin, the patient usually experiences pain over the pos... | 582 | ||
| Screening for Infectious/Inflammatory Causes of Sacroiliac Pain | 582 | ||
| Rheumatic Diseases as a Cause of Sacral or Sacroiliac Pain | 582 | ||
| Screening for Spondylogenic Causes of Sacral/Sacroiliac Pain | 583 | ||
| Metabolic Bone Disease | 583 | ||
| Osteoporosis. Osteoporosis can cause insufficiency fractures of the sacrum. The therapist must assess for risk factors (see Boxe... | 583 | ||
| Paget’s Disease. Paget’s disease as a cause of lumbar, sacral, SI, or pelvic pain occurs most commonly in men over 70 years of a... | 583 | ||
| Fracture | 583 | ||
| Screening for Gynecologic Causes of Sacral Pain | 584 | ||
| Screening for Gastrointestinal Causes of Sacral/Sacroiliac Pain | 584 | ||
| Screening for Tumors as a Cause of Sacral/Sacroiliac Pain | 584 | ||
| THE COCCYX | 584 | ||
| Coccygodynia | 584 | ||
| THE PELVIS | 585 | ||
| Using the Screening Model to Evaluate the Pelvis | 585 | ||
| History Associated With Pelvic Pain | 585 | ||
| Clinical Presentation | 588 | ||
| Associated Signs and Symptoms | 588 | ||
| Anterior Pelvic Pain | 590 | ||
| Posterior Pelvic Pain | 590 | ||
| Screening for Gynecologic Causes of Pelvic Pain | 590 | ||
| Ectopic Pregnancy | 591 | ||
| Prolapsed Conditions | 591 | ||
| Uterine Prolapse. Uterine prolapse occurs most often after childbirth (Fig. 15.7). Secondary prolapse may occur with prolonged p... | 592 | ||
| Cystocele and Rectocele. Cystocele is the protrusion of the anterior vaginal wall against the wall of the vagina. Rectocele is a... | 592 | ||
| Endometriosis | 592 | ||
| Chronic Pelvic Pain | 593 | ||
| Screening for Infectious Causes of Pelvic Girdle Pain | 593 | ||
| Pelvic Inflammatory Disease | 594 | ||
| Screening for Vascular Causes of Pelvic Girdle Pain | 595 | ||
| Peripheral Vascular Disease | 595 | ||
| Pelvic Congestion Syndrome | 596 | ||
| Screening for Cancer as a Cause of Pelvic Pain | 596 | ||
| Using the Screening Model for Cancer | 597 | ||
| Gynecologic Cancers | 598 | ||
| Endometrial (Uterine) Cancer. Cancer of the uterine endometrium, or lining of the uterus, is the most common gynecologic cancer,... | 598 | ||
| Clinical Signs and Symptoms. Seventy-five percent of all cases of endometrial cancer occur in postmenopausal women. The most com... | 598 | ||
| Ovarian Cancer. Ovarian cancer is the second most common reproductive cancer in women and the leading cause of death from gyneco... | 599 | ||
| Risk Factors. Risk increases with advancing age, and the incidence of ovarian cancer peaks between the ages of 40 and 70 years. ... | 599 | ||
| Extraovarian Primary Peritoneal Carcinoma. Extraovarian primary peritoneal carcinoma (EOPPC) is an abdominal cancer (peritoneal ... | 599 | ||
| Cervical Cancer. Cancer of the cervix is the third most common gynecologic malignancy in the United States. It is the most commo... | 600 | ||
| Risk Factors. Risk factors associated with the development of cervical cancer are many, and varied, and include the following | 600 | ||
| Clinical Signs and Symptoms. Early cervical cancer has no symptoms. Clinical symptoms related to advanced disease include painfu... | 600 | ||
| Screening for Gastrointestinal Causes of Pelvic Pain | 600 | ||
| Screening for Urogenital Causes of Pelvic Pain | 602 | ||
| Screening for Other Conditions as a Cause of Pelvic Girdle Pain | 602 | ||
| PHYSICIAN REFERRAL | 602 | ||
| Guidelines for Immediate Medical Attention | 602 | ||
| Guidelines for Physician Referral | 603 | ||
| Clues to Screening the Sacrum/Sacroiliac | 603 | ||
| Past Medical History | 603 | ||
| APPENDICES | 713 | ||
| APPENDIX A: SCREENING SUMMARY | 713 | ||
| APPENDIX B: SPECIAL QUESTIONS TO ASK (SCREENING FOR) | 713 | ||
| APPENDIX C: SPECIAL FORMS TO USE | 714 | ||
| APPENDIX D: SPECIAL TESTS TO PERFORM | 714 | ||
| A-2 - RED FLAGS | 714.e3 | ||
| PAST MEDICAL HISTORY (PERSONAL OR FAMILY) | 714.e3 | ||
| RISK FACTORS | 714.e3 | ||
| CLINICAL PRESENTATION | 714.e3 | ||
| Pain Pattern | 714.e3 | ||
| Neurologic Signs and Symptoms | 714.e4 | ||
| General | 714.e4 | ||
| Cauda Equina Syndrome | 714.e4 | ||
| Cervical Myelopathy | 714.e4 | ||
| ASSOCIATED SIGNS AND SYMPTOMS | 714.e4 | ||
| FOLLOW-UP QUESTIONS | 714.e4 | ||
| A-3 SYSTEMIC CAUSESOF JOINT PAIN | 714.e5 | ||
| A-4 - THE REFERRAL PROCESS | 714.e6 | ||
| B-1 - SCREENING FOR | 714.e7 | ||
| AUDIT QUESTIONNAIRE | 714.e7 | ||
| KEY | 714.e7 | ||
| B-2 - SCREENING FOR ALCOHOL ABUSE: CAGE QUESTIONNAIRE | 714.e8 | ||
| B-3 - ASSAULT, INTIMATE PARTNER ABUSE, OR DOMESTIC VIOLENCE | 714.e9 | ||
| INDIRECT QUESTIONS (APTA, 2005) | 714.e9 | ||
| FOLLOW-UP QUESTIONS (APTA, 2005) | 714.e9 | ||
| B-4 SCREENINGBILATERAL CARPAL TUNNEL SYNDROME | 714.e10 | ||
| TO THE THERAPIST | 714.e10 | ||
| B-5 - SCREENING BLADDER FUNCTION | 714.e11 | ||
| CHANGES IN BLADDER FUNCTION | 714.e11 | ||
| FOR WOMEN | 714.e11 | ||
| FOR MEN (SEE ALSO APPENDIX: SPECIAL QUESTIONS PROSTATE) | 714.e11 | ||
| B-6 SCREENINGBOWEL FUNCTION | 714.e13 | ||
| B-7 SCREENINGTHE BREAST | 714.e14 | ||
| B-8 - SCREENING FOR CHEST/THORAX | 714.e15 | ||
| MUSCULOSKELETAL | 714.e15 | ||
| NEUROLOGIC | 714.e15 | ||
| PULMONARY | 714.e15 | ||
| CARDIAC | 714.e15 | ||
| EPIGASTRIC | 714.e16 | ||
| B-9 SCREENING FOR DEPRESSION/ANXIETY (SEE ALSO APPENDIX B-10, SCREENING FOR DEPRESSION IN OLDER ADULTS) | 714.e17 | ||
| FOR THE ASIAN CLIENT | 714.e17 | ||
| B-10 SCREENING FOR DEPRESSIONIN OLDER ADULTS | 714.e18 | ||
| GERIATRIC DEPRESSION SCALE (Short Form) | 714.e18 | ||
| B-11 SCREENING FOR DIZZINESS | 714.e19 | ||
| FOR THE THERAPIST | 714.e19 | ||
| B-12 SCREENING FOR DYSPNEA (SHORTNESS OF BREATH [SOB]; DYSPNEA ONEXERTION [DOE]) | 714.e20 | ||
| FOR THE THERAPIST | 714.e20 | ||
| B-13A SCREENING FOR EATING DISORDERS | 714.e21 | ||
| B-13B RESOURCES FOR SCREENING FOR EATINGDISORDERS | 714.e22 | ||
| B-14 - SCREENING ENVIRONMENTAL AND WORK HISTORY | 714.e23 | ||
| WHEN TO SURVEY | 714.e23 | ||
| QUICK SURVEY | 714.e23 | ||
| FOLLOW-UP | 714.e23 | ||
| B-15 SCREENING FOR FIBROMYALGIASYNDROME (FMS) | 714.e24 | ||
| B-16 SCREENINGFOR GASTROINTESTINAL (GI)PROBLEMS | 714.e25 | ||
| B-17 - SCREENING HEADACHES | 714.e26 | ||
| HISTORY | 714.e26 | ||
| SITE | 714.e26 | ||
| ONSET | 714.e26 | ||
| FREQUENCY | 714.e26 | ||
| INTENSITY | 714.e26 | ||
| DURATION | 714.e26 | ||
| DESCRIPTION | 714.e26 | ||
| PATTERN | 714.e26 | ||
| AGGRAVATING FACTORS | 714.e26 | ||
| RELIEVING FACTORS | 714.e26 | ||
| ASSOCIATED SYMPTOMS | 714.e26 | ||
| FOR THE THERAPIST | 714.e27 | ||
| B-18 - SCREENING JOINT PAIN (SEE ALSO APPENDIX A-3: SYSTEMIC CAUSES OF JOINT PAIN) | 714.e28 | ||
| FOR THE CLIENT WITH SUDDEN ONSET OF JOINT PAIN | 714.e28 | ||
| TO THE THERAPIST | 714.e28 | ||
| QUICK OCCUPATIONAL/WORK SURVEY | 714.e28 | ||
| B-19 SCREENINGQUESTIONS FOR KIDNEY ANDURINARY TRACT IMPAIRMENT | 714.e29 | ||
| OBSERVATIONS | 714.e29 | ||
| B-20 SCREENING FORLIVER (HEPATIC) IMPAIRMENT | 714.e30 | ||
| TO THE THERAPIST | 714.e30 | ||
| B-21 SCREENING SOFT TISSUE LUMPS OR SKIN LESIONS | 714.e31 | ||
| B-22 SCREENINGLYMPH NODES | 714.e32 | ||
| B-23 SCREENINGMEDICATIONS | 714.e33 | ||
| B-24 SCREENING MEN EXPERIENCING BACK, HIP, PELVIC, GROIN, OR SACROILIAC PAIN | 714.e34 | ||
| B-25 SCREENINGNIGHT PAIN | 714.e35 | ||
| B-26 SCREENING FOR SIDE EFFECTS OF NONSTEROIDALANTI-INFLAMMATORIES (NSAIDS) | 714.e36 | ||
| ASK ABOUT THE PRESENCE OF GASTROINTESTINAL SIGNS AND SYMPTOMS | 714.e36 | ||
| TIMING OF SYMPTOMS | 714.e36 | ||
| BLOOD PRESSURE (BP) | 714.e36 | ||
| VISUAL INSPECTION | 714.e36 | ||
| B-27 - SCREENING UNUSUAL ODORS | 714.e37 | ||
| IF YOU SUSPECT URINARY INCONTINENCE | 714.e37 | ||
| IF YOU SUSPECT FECAL INCONTINENCE | 714.e37 | ||
| IF YOU DETECT BREATH ODOR | 714.e37 | ||
| B-28 - SCREENING PAIN | 714.e38 | ||
| LOCATION OF PAIN | 714.e38 | ||
| DESCRIPTION OF PAIN | 714.e38 | ||
| FREQUENCY AND DURATION OF PAIN | 714.e38 | ||
| PATTERN OF PAIN | 714.e38 | ||
| AGGRAVATING AND RELIEVING FACTORS | 714.e38 | ||
| ASSOCIATED SYMPTOMS | 714.e38 | ||
| ARE YOU HAVING ANY PAIN ANYWHERE ELSE IN YOUR BODY? | 714.e38 | ||
| ANXIETY/DEPRESSION (SEE TABLE 3.11) | 714.e38 | ||
| FOR THE CLIENT WHO FOLLOWS EASTERN MEDICINE PRACTICES | 714.e39 | ||
| JOINT PAIN | 714.e39 | ||
| NIGHT PAIN | 714.e39 | ||
| PSYCHOGENIC SOURCE OF SYMPTOMS | 714.e39 | ||
| B-29 PALPITATIONS (CHEST OR HEART) | 714.e40 | ||
| TO THE THERAPIST | 714.e40 | ||
| B-30 - SCREENING FOR PROSTATE PROBLEMS | 714.e41 | ||
| ENLARGED PROSTATE | 714.e41 | ||
| 0 1 2 3 4 5 | 714.e41 | ||
| B-31 SCREENING FOR PSYCHOGENIC SOURCE OF SYMPTOMS | 714.e42 | ||
| FOR THE THERAPIST | 714.e42 | ||
| B-32A TAKING A SEXUAL HISTORY | 714.e43 | ||
| REFERENCES | 714.e43 | ||
| B-32B TAKING A SEXUAL HISTORY | 714.e44 | ||
| B-33 - SEXUALLY TRANSMITTED DISEASES | 714.e45 | ||
| SPECIAL QUESTIONS TO ASK | 714.e45 | ||
| PHYSICIAN REFERRAL | 714.e45 | ||
| B-34 - SPECIAL QUESTIONS TO ASK: SHOULDER AND UPPER EXTREMITY | 714.e46 | ||
| GENERAL SYSTEMIC | 714.e46 | ||
| CARDIAC | 714.e46 | ||
| PULMONARY | 714.e46 | ||
| GASTROINTESTINAL | 714.e46 | ||
| GYNECOLOGIC | 714.e46 | ||
| UROLOGIC | 714.e47 | ||
| TRAUMA | 714.e47 | ||
| B-35 SCREENING SLEEP PATTERNS | 714.e48 | ||
| B-36 SCREENING FOR SUBSTANCE USE/ABUSE | 714.e49 | ||
| B-37 - WOMEN EXPERIENCING BACK, HIP, PELVIC, GROIN, SACROILIAC (SI), OR SACRAL PAIN | 714.e50 | ||
| PAST MEDICAL HISTORY | 714.e50 | ||
| MENSTRUAL HISTORY | 714.e50 | ||
| FOR THE YOUNG FEMALE ADOLESCENT/ATHLETE | 714.e50 | ||
| REPRODUCTIVE HISTORY | 714.e50 | ||
| C-1 FAMILY/PERSONAL HISTORY (SAMPLE) | 714.e52 | ||
| C-2 INTAKE FORM(SAMPLE) | 714.e55 | ||
| C-3 PATIENT ENTRYQUESTIONNAIRE | 714.e58 | ||
| C-4 - CHECKLIST FOR RED/YELLOW FLAGS | 714.e62 | ||
| BOGDUK’S CHECKLIST FORYELLOW FLAGS | 714.e62 | ||
| Work | 714.e62 | ||
| Beliefs | 714.e62 | ||
| Behaviors | 714.e62 | ||
| Affective | 714.e62 | ||
| C-5A SIMPLIFIED WELLS’ CLINICAL DECISION RULE FOR DVT | 714.e63 | ||
| C-5B SIMPLIFIED WELLS’ CRITERIA FOR THE CLINICAL ASSESSMENT OF PULMONARY EMBOLISM | 714.e64 | ||
| C-5C UPPEREXTREMITY DVT SCALE | 714.e65 | ||
| C-6 OSTEOPOROSIS SCREENING EVALUATION | 714.e66 | ||
| C-7 PATIENT ASSESSMENTRECORD FORM | 714.e67 | ||
| C-8 RISK FACTORASSESSMENT FOR SKIN CANCER | 714.e69 | ||
| C-9 EXAMINING A SKIN LESION OR MASS | 714.e70 | ||
| D-1 GUIDE TOPHYSICAL ASSESSMENT DURING A SCREENING EXAMINATION | 714.e71 | ||
| D-2 EXTREMITYEXAMINATION CHECKLIST | 714.e72 | ||
| D-3 - HAND AND NAIL BED ASSESSMENT | 714.e73 | ||
| OBSERVE THE HANDS FOR | 714.e73 | ||
| OBSERVE THE FINGERS AND TOENAILS FOR | 714.e73 | ||
| D-4 - PERIPHERAL VASCULAR ASSESSMENT | 714.e74 | ||
| INSPECTION | 714.e74 | ||
| PALPATION | 714.e74 | ||
| Pulses (see Fig. 4.1) | 714.e74 | ||
| Characteristics of Pulses | 714.e74 | ||
| ARTERIAL INSUFFICIENCY OF EXTREMITIES | 714.e74 | ||
| VENOUS INSUFFICIENCY OF EXTREMITIES | 714.e74 | ||
| SPECIAL (QUICK SCREENING) TESTS | 714.e74 | ||
| D-5 - REVIEW OF SYSTEMS* | 714.e75 | ||
| GENERAL QUESTIONS | 714.e75 | ||
| INTEGUMENTARY (INCLUDE SKIN, HAIR, AND NAILS) | 714.e75 | ||
| MUSCULOSKELETAL/NEUROLOGIC | 714.e75 | ||
| RHEUMATOLOGIC | 714.e75 | ||
| CARDIOVASCULAR | 714.e75 | ||
| PULMONARY | 714.e75 | ||
| PSYCHOLOGIC | 714.e75 | ||
| GASTROINTESTINAL | 714.e76 | ||
| HEPATIC/BILIARY | 714.e76 | ||
| HEMATOLOGIC | 714.e76 | ||
| GENITOURINARY | 714.e76 | ||
| GYNECOLOGIC | 714.e76 | ||
| ENDOCRINE | 714.e76 | ||
| CANCER | 714.e76 | ||
| IMMUNOLOGIC | 714.e76 | ||
| D-6 SELF-BREASTEXAMINATION (SBE) | 714.e77 | ||
| D-7 TESTICULARSELF-EXAMINATION | 714.e79 | ||
| INDEX | 715 | ||
| A | 715 | ||
| B | 718 | ||
| C | 721 | ||
| D | 727 | ||
| E | 728 | ||
| F | 730 | ||
| G | 731 | ||
| H | 732 | ||
| I | 735 | ||
| J | 736 | ||
| K | 736 | ||
| L | 737 | ||
| M | 739 | ||
| N | 741 | ||
| O | 742 | ||
| P | 744 | ||
| Q | 749 | ||
| R | 749 | ||
| S | 751 | ||
| T | 756 | ||
| U | 757 | ||
| V | 759 | ||
| W | 760 | ||
| X | 760 | ||
| Y | 760 | ||
| Z | 760 | ||
| IBC | ES3 |