Diagnosis for Physical Therapists: A Symptom-Based Approach

Description

Demonstrates how to organize the history and examination interview, and to interpret the findings using a 'process' that helps to determine what is the most likely type and source of the pathology. Organizes the content by the presenting primary symptom. Uses outlines, lists, and tables within each symptom chapter to make reference easy. Follows a standard format throughout each symptom chapter that includes… A brief description of the symptom and its variations. Red flags indicating the need for special concern Tables of possible conditions, organized by how common or rare they are. Identifies conditions that might require emergency or urgent attention. Describes the differential diagnosis of each symptom, with careful attention to the findings in the history and examination. Discusses each of the conditions listed in the table of possible diagnoses, focusing on the key findings that would rule a condition more or less likely. Lists tests that might be needed to reach a definitive differential diagnosis. Facilitates decision making regarding whether physical therapy is…not indicated, indicated after referral or consultation with another healthcare practitioner, or appropriate without additional referral or consultation. Copyright Preface Contributors Reviewers Manuscript Support Acknowledgments and Dedication Contents in Brief Contents Section I: Foundations Chapter 1: Why Should Physical Therapists Know About Diagnosis? Introduction Five Critical Issues Frame the Topic of Diagnosis by Physical Therapists Critical Issue 1: What is a Diagnosis? Critical Issue 2: Should Physical Therapists Diagnose Pathology? Critical Issue 3: Should Physical Therapists Adopt a Different Definition for Diagnosis Than Other Health Professionals Use? Critical Issue 4: Should Physical Therapists be Expected to Diagnose Given the Current Legal Environment? Critical Issue 5: What Information Should Physical Therapists Use to Make Decisions About Treatment and Prognosis? Conclusion Chapter 2: Beyond the Diagnosis: The Search for Underlying Etiology Introduction Physical Therapists Use the Diagnostic Label Physical Therapists Elaborate on the Diagnostic Label The Diagnostic Label Alone is Insufficient to Guide Physical Therapists A Process Guides Physical Therapists’ Search for an Underlying Etiology Physical Therapists Identify the Functional Chief Concern Physical Therapists Perform Task and Movement Analyses Physical Therapists Create and Test Hypothetical Relationships The Search for an Underlying Etiology is Dynamic and Ongoing Conclusion Chapter 3: Diagnostic Reasoning Introduction Both Diagnosis and Medical Screening Have Roles in Physical Therapy Diagnosis is a Unique Combination of Reasoning Patterns Backward Reasoning Involves Creation and Testing of Clinical Hypotheses Forward Reasoning Involves the Attempt to Recognize Patterns in Clinical Presentation Experts Create “Small Worlds” of Information to Use in Diagnostic Reasoning Preferred Diagnostic Reasoning Processes Depend on the Clinician and the Case Conclusion Chapter 4: How to Use This Book Introduction Principle of “Economy of Diagnoses” The Diagnostic Process Barriers to Communication The Starting Point: Identify the Patient’s Chief Concern Symptoms Versus Signs Special Concerns TIM VaDeTuCoNe: A Database of Possible Causes Remote Versus Local Source of Pain What Follows the Making of a TIM VaDeTuCoNe List? Conclusion Chapter 5: Case Demonstration: Shoulder Case Description Case Outcome Section II: Adult Pain Chapter 6: Diagnostic Considerations of Pain Introduction All People Share Common Nociceptive Processes Nociceptors Respond to Various Forms of Tissue Injury Nociceptors Transmit Pain Signals Along Organized Neural Pathways The Perception of Pain Severity Depends on Anatomical, Physiological, and Cognitive Factors A “Gate” Controls the Transmission of Pain Signals at the Spinal Cord and Elsewhere Input from the Cerebral Cortex and Midbrain Also Plays a Role in the Gate’s Function Emotional, Anticipatory, and Previously Learned Responses Also Modulate Pain Severity Timing of Pain Suggests the Etiology of Underlying Pathology Factors in the History and Physical Examination Can Implicate Affected Tissues Descriptions of Pain May Relate to Either Injured Tissues or Emotional Features Locations of Pain and Its Underlying Cause May Differ Misinterpretation by the Central Nervous System Causes Referred Pain Long-Term Pain Causes Cyclic Anatomical, Physiological, and Cognitive-Behavioral Changes Prolonged Activation of Nociceptive Pathways Causes Maladaptations Throughout the Nervous System The Sympathetic Nervous System Can Contribute to the Perception of Pain Psychological and Social Factors Perpetuate Pain Through Behavior Reinforcement Conclusion Chapter 7: Headaches Description of the Symptom Overview of Headache Description of Conditions That May Lead to Headache Remote Local Chapter 8: Temporomandibular Joint and Facial Pain Description of the Symptom Overview of Temporomandibular Joint and Facial Pain Description of Conditions That May Lead to Temporomandibular Joint and Facial Pain Remote Local Chapter 9: Case Demonstration: Jaw Pain Case Description Case Outcome Chapter 10: Neck Pain Description of the Symptom Overview of Neck Pain Description of Conditions That May Lead to Neck Pain Remote Local Description of the Symptom Chapter 11: Shoulder Pain Overview of Shoulder Pain Description of Conditions That May Lead to Shoulder Pain Remote Local Chapter 12: Elbow Pain Description of the Symptom Overview of Elbow Pain Description of Conditions That May Lead to Elbow Pain Remote Local Chapter 13: Wrist and Hand Pain Description of the Symptom Overview of Wrist and Hand Pain Description of Conditions That May Lead to Wrist and Hand Pain Remote Local Chapter 14: Anterior Thorax Pain Description of the Symptom Overview of Anterior Thorax Pain Description of Conditions That May Lead to Anterior Thorax Pain Remote Local Chapter 15: Case Demonstration: Chest Pain Case Description Case Outcome Chapter 16: Posterior Thorax Pain Description of the Symptom Overview of Posterior Thorax Pain Description of Conditions That May Lead to Posterior Thorax Pain Remote Local Chapter 17: Case Demonstration: Infrascapular Pain Case Description Case Outcome Chapter 18: Lumbar Pain Description of the Symptom Overview of Lumbar Pain Description of Conditions That May Lead to Lumbar Pain Remote Local Chapter 19: Hip Pain Description of the Symptom Overview of Hip Pain Description of Conditions That May Lead to Hip Pain Remote Local Chapter 20: Case Demonstration: Hip Pain Case Description Case Outcome Chapter 21: Knee Pain Description of the Symptom Overview of Knee Pain Description of Conditions That May Lead to Knee Pain Remote Local Chapter 22: Lower Leg Pain Description of the Symptom Overview of Lower Leg Pain Description of Conditions That May Lead to Lower Leg Pain Remote Local Chapter 23: Ankle Pain Description of the Symptom Overview of Ankle Pain Description of Conditions That May Lead to Ankle Pain Remote Local Chapter 24: Foot Pain Description of the Symptom Overview of Foot Pain Description of Conditions That May Lead to Foot Pain Remote Local Section III: Adult Non-Pain Chapter 25: Foundations of Neurological Differential Diagnosis Introduction Nervous System Pathology is Important to Consider in Diagnostic Reasoning Summary of Neurological Differential Diagnosis Chart Review History/Subjective Examination Objective Examination Clinical Neurological Tests Diagnostic Impression Linking Examination Findings to Neuroanatomy Anatomy and Functions of the Nervous System Neurological Impairments and Associated Anatomical Regions Conclusion Chapter 26: Cardiovascular and Pulmonary Clues from Examination Introduction General Observation is an Important Initial Basis for Diagnosing Cardiovascular and Pulmonary Pathologies Assessment of Skin Provides Clues Regarding the Status of Cardiac and Pulmonary Function Color May Indicate the Presence of Impaired Blood Oxygenation Surface Temperature Reflects the Rate of Underlying Tissue Metabolism Mobility and Turgor Suggest the Status of Nutrition, Hydration, and Vascular Competence Lesions and Marks can Provide Clues to the Presence of Important Medical Comorbidities Examination of the Thorax Provides Diagnostic Information Regarding the Cardiovascular and Pulmonary Systems Configuration of the Chest Wall May Indicate the Presence of Chronic Pulmonary Pathology Chest Wall Excursion Reflects the Status of Ventilatory Mechanics Palpation of the Thorax Provides Information Regarding the Physical Composition and Orientation of Thoracic Organs Tonal Quality of Sound Transmitted Through the Thorax Provides Information Regarding the Composition of the Lungs Vital Signs Provide Direct Information Regarding Various Aspects of Cardiovascular and Pulmonary Functioning Heart Rate Indicates the Cardiovascular System’s Response to Different Levels of Activity Pulse Rhythm Suggests the Status of Electrical Conduction and Cardiac Output Pulse Quality Provides Information Regarding the Status of Contractile Force and Cardiac Output Blood Pressure Responds to Changes in Position and Activity in a Predictable Fashion and Provides Important Clues to Organ Perfu Respiratory Rate Suggests the Status of Ventilatory Mechanics and Blood Oxygenation Heart and Lung Sounds Reveal Clues About Cardiac and Pulmonary Pathology Cardiac Auscultation Pulmonary Auscultation Conclusion Chapter 27: Dizziness Description of the Symptom Overview of Dizziness Description of Conditions That May Lead to Dizziness Chapter 28: Loss of Balance and Falls Description of the Symptom Overview of Loss of Balance and Falls Description of Conditions That May Lead to Loss of Balance and Falls Chapter 29: Sensory Abnormalities Description of the Symptom Overview of Sensory Abnormalities Auditory Abnormalities Gustatory Abnormalities Olfactory Abnormalities Proprioceptive Abnormalities Tactile Abnormalities Visual Abnormalities Description of Conditions That May Lead to Sensory Abnormalities Chapter 30: Abnormal Movement Description of the Symptom Overview of Abnormal Movement Description of Conditions That May Lead to Abnormal Movement Chapter 31: Problems of Cognition, Communication, and Behavior Description of the Symptom Description of Conditions That May Lead to Problems with Cognition, Communication, and Behavior Overview of Problems with Cognition, Communication, and Behavior Chapter 32: Stiffness Description of the Symptom Overview of Stiffness Description of Conditions That May Lead to Stiffness Chapter 33: Weakness Description of the Symptom Overview of Weakness Description of Conditions That May Lead to Weakness Chapter 34: Case Demonstration: Inability to Stand Case Description Case Outcome Chapter 35: Palpitations Description of the Symptom Overview of Palpitations Description of Conditions That May Lead to Palpitations Chapter 36: Persistent Cough Description of the Symptom Overview of Persistent Cough Description of Conditions That May Lead to Persistent Cough Chapter 37: Dyspnea Description of the Symptom Overview of Dyspnea Description of Conditions That May Lead to Dyspnea Chapter 38: Edema Description of the Symptom Overview of Edema Description of Conditions That May Lead to Edema Chapter 39: Case Demonstration: Edema and Shoulder Pain Case Description Case Outcome Chapter 40: Failure of Wounds to Heal Description of the Symptom Overview of Wounds That Fail to Heal Description of Conditions That May Lead to Failure of Wounds to Heal Chapter 41: Case Demonstration: Fatigue Case Description Case Outcome Section IV: Children Chapter 42: Special Diagnostic Issues in Children Introduction Special Features of History Taking in Children The Age of a Child is the Defining Feature in Differential Diagnosis The History is Generally Obtained Secondhand Through the Parent Obtaining Information About a Child’s Development Some Pitfalls Never Forget the Possibility of Child Abuse Special Features of the Physical Examination of a Child Get to the Child’s Level Watch While the Child is Waiting to Be Seen Potential Problems with Disrobing Examine the Painful Area Last Confirmation of Discrepancies Examining the Child to Obtain Information About the Child’s Development Differences in Fractures Between Children and Adults Epiphyseal Fractures Issues Related to Growth of Bones in Children Growth of the Long Bones Growth Disturbances Due to Abnormal Muscle Activity Leg-Length Discrepancy Physiological Differences Mechanical Differences Other Considerations Conclusion Chapter 43: Elbow Pain in a Child Description of the Symptom Overview of Elbow Pain in a Child Description of Conditions That May Lead to Elbow Pain in a Child Remote Local Chapter 44: Back Pain in a Child Description of the Symptom Overview of Back Pain in a Child Description of Conditions That May Lead to Back Pain in a Child Remote Local Chapter 45: Hip Pain in a Child Description of the Symptom Overview of Hip Pain in a Child Description of Conditions That May Lead to Hip Pain in a Child Remote Local Chapter 46: Case Demonstration: Hip Pain in a Child Case Description Case Outcome Chapter 47: Knee Pain in a Child Description of the Symptom Overview of Knee Pain in a Child Description of Conditions That May Lead to Knee Pain in a Child Remote Local Chapter 48: Case Demonstration: Knee Pain and Limping in a Child Case Description Case Outcome Chapter 49: Shin Pain in a Child Description of the Symptom Overview of Shin Pain in a Child Description of Conditions That May Lead to Shin Pain in a Child Remote Local Chapter 50: Ankle and Foot Pain in a Child Description of the Symptom Overview of Ankle and Foot Pain in a Child Description of Conditions That May Lead to Ankle and Foot Pain in a Child Remote Local Chapter 51: Case Demonstration: Foot Pain in a Child Case Description Case Outcome Chapter 52: Delayed Mobility (Crawling and Walking), Failure to Thrive, and Psychomotor Delay in a Child Description of the Symptom Description of Conditions That May Lead to Delayed Mobility, Failure to Thrive, and Psychomotor Delay in a Child Overview of Delayed Mobility, Failure to Thrive, and Psychomotor Delay in a Child Chapter 53: The Child With a Painless Limp Description of the Symptom Overview of a Painless Limp in a Child Causes of Limping Reduce Pain Compensate for Muscle Weakness Accommodate a Deformity Central Nervous System Dysfunction Descriptions of Conditions That May Lead to a Painless Limp in a Child Chapter 54: Tripping and Falling in a Child Description of the Symptom Overview of Tripping and Falling in a Child Description of Conditions That May Lead to Tripping and Falling in a Child Description of the Symptom Chapter 55: Toe Walking in a Child Overview of Toe Walking in a Child Description of Conditions That May Lead to Toe Walking in a Child Chapter 56: Joint Contractures in a Child Description of the Symptom Overview of Joint Contractures in a Child Description of Conditions That May Lead to Joint Contractures in a Child Chapter 57: Torticollis in a Child Description of the Symptom Overview of Torticollis in a Child Description of Conditions That May Lead to Torticollis in a Child Chapter 58: Case Demonstration: Torticollis in a Child Case Description Case Outcome Chapter 59: Poor Posture and Scoliosis, Kyphosis, and Lordosis in a Child Description of the Symptom Overview of Poor Posture and Scoliosis, Kyphosis, and Lordosis in a Child Scoliosis Structural Kyphosis Lordosis Description of Conditions That May Lead to Poor Posture and Scoliosis, Kyphosis, and Lordosis in a Child Chapter 60: Bowed Legs and Knock Knees in a Child Description of the Symptom Overview of Bowed Legs and Knock Knees in a Child Description of Conditions That May Lead to Bowed Legs in a Child Description of Conditions That May Lead to Knock Knees in a Child Chapter 61: In-Toeing and Out-Toeing in a Child Description of the Symptom Overview of In-Toeing and Out-Toeing in a Child Description of Conditions That May Lead to In-Toeing in a Child Description of Conditions That May Lead to Out-Toeing in a Child Chapter 62: Flat Feet in a Child Description of the Symptom Overview of Flat Feet in a Child Description of Conditions That May Lead to Flat Feet in a Child Chapter 63: Weakness and Hypotonia in a Child Description of the Symptom Overview of Weakness and Hypotonia in a Child Description of Conditions That May Lead to Weakness and Hypotonia in a Child Index