SUBJECTIVE ASSESSMENT: HYPOTHESIS SETTING. Msc Manual Therapy The Knee.

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Presentation transcript:

SUBJECTIVE ASSESSMENT: HYPOTHESIS SETTING. Msc Manual Therapy The Knee

History Mechanism of injury: when, how, sudden, gradual, trauma, activity, footwear, equipment. Diurnal pattern: am, daily, sleep. Special questions: swelling, locking, clicking, giving way, bruising. Management: post injury, investigations, physio. DH: analgesia, anti-inflam, steriods, anticoags, etc. PMH: prev injury/treatment, cardiovascular health, Ep, Dm, Ca. GH: physical and psychological well being, weight. SH: Work, family, hobbies, sports, usual level of activity.

Site of pain Medial: Meniscus, pes, medial retinaculum, MCL, post oblique popliteal ligament, saphenous nerve. Lateral: Peroneal nerve, fibula head, LCL, arcuate ligament, biceps femoris, ITB. Posterior: popliteus, arcuate ligament, posterior capsule, PCL, tibial nerve, plantaris, semimembranosus, biceps femoris. Anterior: Patellofemoral, patella tendon, tibial tuberosity, tibial plateau.

Severity of Symptoms VAS, NPS, mild/mod/sev. Analgesia: what? How many? How often? Effect? Sleep disturbance. Effect on function/work/hobbies.

Irritability of symptoms Aggravating factors and length of time. Easing factors and length of time. Example 1: agg= step down, 3-4 steps. ease= rest, imed. Example 2: agg= twist when running, imed. ease= 3 hours.

Nature of Pain Description. Constant/intermittent. Pins and needles/numbness. Psychosocial factors. Arthrogenic vs myogenic vs neurogenic vs psychogenic.

Hypothesis Setting Thorough and logical subjective assessment is vital to produce a working hypothesis/es to test in the objective assessment. Objective testing procedures alone are not accurate enough to produce a definitive diagnosis. Combination of subjective and objective assessments will improve diagnostic accuracy. Information gained in the subjective assessment will aid treatment selection, prognosis setting and assess management outcome.