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1. •Anterior drawer
A positive test strongly suggests a problem but a negative test
test has a low
does not rule out an ACL tear.
sensitivi-
ty and high
specifici- ty for
confirming ACL
pathology, so a
posi- tive test
strongly sug-
gests a problem
but a negative test
does not rule out acute or chronic, articular or nonarticular, inflammatory or
an ACL tear. noninflamma- tory, and localized or systemic in distribution.
Acute (less than 6 weeks duration) or chronic (more than 6 weeks
2. When assessing duration), Flammatory or inflam- matory
the patient with
muscu- loskeletal
problems, it is
important to
deter- mine if the
problem is:
3. Articular structures • synovium, • synovial fluid, • articular cartilage, • intra-articular
ligaments,
• joint capsule, • juxta-articular bone
4. Articular problems are deep or dittuse pain, • deep or dittuse pain, • limited ROM
(passive &
characterized by structures
5. Nonarticular (or 6. Nonarticular disor- ders are
peri- articular) characterized by
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e), • swelling, • crepitation, • overlying skin •
• instability, • 'locking', • Deformity
painful active, but not passive ROM,
• identified as supportive extra- • demonstrated point or focal ternderness in regions distinct
articular ligaments, from artic- ular structures,
• tendons, • bursae, • muscle, • • physical findings far from the joint capsule.
fascia, • bone, • nerve, • Usually do not find crepitus, instability or deformity
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7. History · Chronology of complaint gives important diagnostic clues
·onset, or did it develop over some time
·evolution of the problem, such as chronic, intermittent,
·migratory and duration of the problem.
8. Physical Examination· Distinguish between mechanical problems, soft tissue disease, and
non-
inflammatory and inflammatory joint disease.
·Inspecting the involved site and observe for side to side symmetry
·The uninvolved side should be examined first and compared
with the involved side (this will mean the painful portion of the
exam will be last)
·evaluate for warmth over the joint, joint ettusion, and pain on
joint motion.
You should have the patient perform as much active ROM as
possible during the exam,
9. Low Back Pain · Also called low back strain or lumbar strain
·Injury to paravertebral spinal muscles, ligamentous injuries, disc
herni- ation or leaking of substances from nucleus pulposus
·Back pain associated with neurological deficit, decreased or
absent pulses, or bowel or bladder dysfunction is potentially life
threatening & warrants immediate referral.
·Low back pain is a common complaint seen in primary care.
·Pain may be caused by a herniated disc or from leaking of
substances from the nucleus pulposus that can induce
inflammation and cause irri- tation.
·often diflcult to localize an injury to a specific structure.
10. Chronic low back 11. Symptoms associated with chronic lo
pain is back pain are
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pain that lasts longer than 3 months.
typically recurrent and episodic, but
may be unremitting.
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