Introduction and

orthopedic sheet

Introduction to orthopedic physical therapy

• Orthopedic physical therapy is deal with musculoskeletal disorders and its surgeries

• The patients may be inpatients or outpatients and the dealing with each stage is completely different

• The musculoskeletal disorders may be bone or soft tissues injuries

Principles of success in physical therapy

• The health from gad• do you want really to help and treat the patients• Study hard the basic sciences and have up to-date

knowledge in physical therapy sciences.• The atmosphere should be suitable for patients’

recovery • The patients should follow the therapist instructions• Then wait till the time of recovery .

Should you use examinationsheets or not?

• There are obviously clear advantages for using examination sheets (e.g. neatness, speed, consistency, easy transferability).

• The disadvantages are all the patients going to the same kind of questioning/approach?

• Or would it be possible to branch off much earlier

into a more acute or chronic part of the interview and assessment? This will depend largely on the experience or lack of it of the examiner.

• The assessment sheets should therefore be used in a flexible way and the motives for using them must be clear to the user

• The assessments sheets can surely be regarded as a standardized way of documenting a baseline and subsequent change and therefore might be regarded by the team members as a useful and necessary tool.

• a patient-centred problem-solving approach will be impossible and this could therefore be regarded as poor practice if the sheet is used only for documentations

• We must, however, at all times be aware of the limitations of what we record. The validity and especially specificity of our tests.

How should you go about assessinga patient?

Paris (1985), committed to symptoms rather than syndromes, divides his evaluation into the following15 points:

1. Interview with receptionist2. Pain assessment3. Initial observation4. History and interview with physio5. Structural observation6. Active movements7. Upper/lower extremity evaluation8. Neurological assessment

9. Palpation for condition10. Palpation for position11. Palpation for mobility12. X-rays and other medical findings13. Summary of objective findings14. Plan of treatment for objective findings15. Prognosis.

• The physiotherapy assessment has so far been firmly linked to problem solving. Is it therefore possible to predict who is going to be a good problem solver and who is not?

• Problem solving approach in assessments needs to be linked to the very specific knowledge of the theories underpinning the area of muscular skeletal problems and recognition of the specificity of that particular context.

What Is needed for a good assessment?

• The function of the assessment is to make sense of the examination findings. Grieve (1981) defines the role of the examination as 'to understand fully how the patient is troubled and then to seek a physical basis for these symptoms in terms of objective signs'.

• This makes it very clear that the assessor needs very specific knowledge, but she/he also needs specific skills, and it seems that the interdependence of these two ingredients, knowledge and skills, is the vital ingredient.

• Skills and knowledge are enhanced by experience. The less experience the assessor has the more the therapist will have to stick to clearly signposted routes

• Physiotherapists have to come to their opinion by evaluating, first, purely subjective data offered by the patient plus, second, objective data elicited by a clinical examination.

• The actual sequence of your assessment plan will depend a lot on the setting you work in.

1- Do you work in an outpatients' department with independent patients coming for a well-defined problem

2- Or do you work on a ward with bedbound patients who have undergone surgery or experienced the diagnosis of a progressive disease?

3- Or perhaps you work in the community with patients in their own home coping with a chronic and perhaps disabling disease.

Results of the subjective examination

At the end of this first part of the assessment you should now have gained a thorough insight into:

• the patient's problem and how he views it• the patient's expectations of you and himself• the history, nature and behavior of the problem• its degree of irritability

• possible contraindications to treatment • a working hypothesis of which structures

might be involved• a sound theoretical reason for planning

certain investigations• a list of factors that might indicate a slower

progression to treatment avenues, Kendall et al (1997) described them as:

• Attitudes and beliefs (e.g. pain is harmful and an indication of harm and damage)

• Behaviors (avoidance of 'normal' activities and roles)

• Compensation• Diagnosis and treatment issues (is there any

test that has not yet been done?)• Emotions (fear of increased pain with activity)

• Family (overprotective spouse/partner)• Work (history of manual labour; repetitive,

boring work).

The message of the yellow flags is on the one hand a signal for slower than anticipated progress and on the other an indication that other professionals should be involved with this patient's care.

• An extensive objective examination will include aspects of:

1. observation2. active movements3. passive movements4. resisted or repeated movements

5. palpation of the area

6. neural tension testing

7. neurological testing (if indicated)

8. muscle patterning.

9. Measurements

10.Special tests

N.B• Clearly, only the most potent tests are going to

be employed and only those that are going to shed most light on the problem.