《肌肉骨骼物理治疗评定的原则》由会员分享，可在线阅读，更多相关《肌肉骨骼物理治疗评定的原则（41页珍藏版）》请在金锄头文库上搜索。
1、Peripheral Joints subjective examination肌肉骨骼物理治疗评定的原则肌肉骨骼物理治疗评定的原则Principles of Musculoskeletal Physiotherapy AssessmentPrinciples of Musculoskeletal Physiotherapy Assessment第一部分:主观检查和客观检查Part I:Subjective & Objective ExaminationDr. Grace Szeto Contributions by Dr Ella Yeung Department of Rehabilita
2、tion Sciences The Hong Kong Polytechnic University Kunming, July 2009Peripheral Joints subjective examination完整的肌肉骨骼评定完整的肌肉骨骼评定Total musculoskeletal assessmentTotal musculoskeletal assessment病史Patient history 观察Observation运动检查（主动和被动）Examination of movements (active and passive) 附属运动（关节摆弄）Accessory m
3、ovements (joint play) 肌力检查Muscle tests 特殊检查Special tests 神经系统检查Neurological examination 触诊Palpation 诊断性检查结果（影像学、血检等）Diagnostic test results(imaging, blood test etc)Peripheral Joints subjective examination资料收集资料收集 Data Gathering资料收集资料收集资料收集资料收集 Data GatheringData Gathering资料分析资料分析 Data Analysis资料分析资料
4、分析资料分析资料分析 Data AnalysisData Analysis确定问题确定问题 Problem Identification确定问题确定问题确定问题确定问题 Problem IdentificationProblem Identification目标目标 Aims & Objectives目标目标目标目标 Aims & ObjectivesAims & Objectives物理治疗计划物理治疗计划 Physiotherapy Plan物理治疗计划物理治疗计划物理治疗计划物理治疗计划 Physiotherapy Physiotherapy PlanPlan治疗方法治疗方法 Inter
5、vention治疗方法治疗方法治疗方法治疗方法 InterventionIntervention评估评估 Evaluation评估评估评估评估 EvaluationEvaluation物理治疗过程物理治疗过程物理治疗过程物理治疗过程Physiotherapy ProcessPhysiotherapy ProcessPeripheral Joints subjective examination诊断程序DiagnosticProcess做一个益智拼图游戏 Putting together a jigsaw puzzle 将小片信息拼在一起构建成一个整体病人的图片Piecing together
6、small bits of information to build an overall picture of the patientPeripheral Joints subjective examination主观和客观检查的目标Aims of S/E 症状的来源Source(s) of the symptoms 原因Contributing factors (causes) 严重性和激惹性Severity and Irritability 物理检查和治疗的慎用症和禁忌症Precautions and contraindications to physical examination a
7、nd treatment 预后Prognosis 处理Management 进步 - 再次评估标记Progress Reassessment asterisk (*)Peripheral Joints subjective examination主观检查的组成主观检查的组成Components of S/EComponents of S/E 主要问题和身体图Main problem and Body chart 症状表现Behavior of symptoms 加剧症状的活动/姿势aggravating activities/positions 缓解症状的活动和姿势relieving acti
8、vities/positions 24小时变化情况24-hour picture 特殊问题Special Questions 病史History 现病史present history 过去史past history 社会史Social HistoryPeripheral Joints subjective examination主要问题主要问题& & 身体图身体图Main Problem & Body ChartMain Problem & Body Chart 主要问题-与症状相关的、与功能相关的、或与病理相关的Main problem symptom related or function
9、 related or pathology related 如果是近期创伤-首先了解近期病史If recent trauma take recent history first “现阶段，你的主要问题是什么” “At this stage, what is your main problem?” 如果答案是不能做一些活动，例如“不能下蹲” ，确定为什么？疼痛、僵硬、肌力减弱？If, answer, unable to do some activity, e.g. “unable to squat ”, clarify why? Pain, stiffness, weakness?Periphe
10、ral Joints subjective examination身体图身体图Body ChartBody Chart所有症状 ALLsymptoms 严重性严重性Severity 区域区域Area 性质性质Nature 深度深度DepthPeripheral Joints subjective examination身体图身体图Body Chart Body Chart - -S.A.N.DS.A.N.D. . 严重性严重性 如如VAS量表，量表，10分之几分之几(注：老年病人有时比较困难)Severity in terms of VAS scale, out of 10. (note: s
11、ometimes difficult for elderly patient) 区域区域 准确位置，用手指指出并确定准确位置，用手指指出并确定Area exact area, use fingers to identify and clarify 性质性质 - 疼痛的类型疼痛的类型(钝痛,尖锐疼痛,烧灼痛) 、持续性 (持续痛或间歇痛)Nature type of pain (dull ache, sharp pain, burning pain ) & constancy (is the pain constant or intermittent?) 深度深度 - 深的或是表浅的深的或是表浅
12、的Depth deep or superficialPeripheral Joints subjective examination身体图身体图Body ChartBody Chart 记录最严重的区域Record Worst Area 如果有多个区域，如果有多个区域，编号编号Number if multiple areas 不同症状之间的不同症状之间的关系关系Relationship between different symptoms 相邻关节如果正常， 打上 Joints above and below if clear 针刺和麻木针刺和麻木P + Ns and numbPeripher
13、al Joints subjective examination症状表现症状表现Behavior of SymptomsBehavior of Symptoms 选择1或2个使症状加剧的活动Select 1 or 2 activities which aggravate 确定严重性和激惹性Establish severity and irritability 多少How much 多严重How severe 持续时间How long lasting 按轻、中、重度或0-10分Grade mild, moderate, severe or 0 10 scale 分析运动分析运动ANALYSE T
14、HE MOVEMENTPeripheral Joints subjective examination症状表现症状表现Behavior of SymptomsBehavior of Symptoms你可以问You can ask: 因为，你不能做什么？What are you unable to do because of? 阻碍你做什么？What does . prevent you from doing? 你什么时候会出现/感到? When do you experience / feel your ? 你做多少(活动)会引起疼痛出现？How much of (activity) can
15、you do before you experience pain? 你做时会出现多严重的疼痛？How much pain did you get when you do? 做什么可以减轻你的疼痛？（活动、姿势、药物）What can you do to ease your pain? (activity, position, medication) 疼痛会持续多长时间？How long does the pain last for?Peripheral Joints subjective examination症状之间的关系症状之间的关系Relationship between sympto
16、msRelationship between symptoms你可以问：You can ask: 你觉得X和Y之间有关联吗？为什么？Do you feel that x and y are related? Why? 当X加重时，Y怎么样？When x is worse, what happens to y? 当Y加重时，X怎么样？When y is worse, what happens to x?Peripheral Joints subjective examination症状表现症状表现Behavior of SymptomsBehavior of Symptoms举例Example 行走60分钟诱发髋部疼痛，VAS2
