The condition scripts highlight the key subjective and objective information used to create your initial hypothesis. These are the typical presentations for each condition and work well with non complex cases.
2-3 focused questions and the 2 tests are used to rule in the diagnosis. Ideally one test that is sensitive and one test that is specific would be the best option but the validity of many special tests are questionable. In this part of the process general questions may confound the reasoning process so keep the questions focused on the condition scripts. Followup questions and examination will be focused and serve as bias correction to further rule out competing differentials and to identify contributing etiologies.
Segmental Dysfunction
Subjective Questions
- Pain quality. Moderate pain in most common with segmental dysfunction compared to disc herniation which is severe. Pain is also likely to be unilateral and not banding pain across the back.
- Have you has these episodes in the past? Commonly these episodes occur couple times a year and may last a few days to a week.
- Have you been able to do your regular daily activity? We are looking for non obligate loss of function. They can go to work and do regular daily activity. They may cancel golfing or stop running as these are optional and not obligate activities but in may cases they may still exercising.
Assessment
- ROM: likely mild restriction or pain in one direction. Unlike an acute disc herniation where there is typically severe loss of range of motion. All planes are likely to be limited with acute disc herniation.
- PA’s: screening for pain reproduction, limited motion ect. The biomechanical exam will later be used to identify if we have a subluxed joint, pericapsular restriction, hypermobility, capsular pattern or muscular guarding.
Biomechanical Exam
When performing the biomechanical assessment with a subluxed joint or precapsular restriction we will have a restricted passive physiological intervertebral motion(PPIVM). We will then proceed to check the end feel with the passive arthrokinematic intervertebral motion(PPAVIM) to determine if the end feel is pericapsular restriction(hard capsular) or a subluxed pathomechanical end feel.
In the presence of a normal, muscle hypertonicity or hypermobile end feel the PAIVM is not required since we already know there is not a restricted end feel. The links below are to the biomechanical assessment and manipulation for the jammed(subluxed end feel).