The aim of the objective assessment is to determine what factors and structures are responsible for producing the patient’s symptoms. It is important that this procedure is conducted in order to find confirmatory signs, to prove or disprove the structures identified in the subjective are sources of the symptoms. It is important that the physiotherapist keeps an open mind, not quickly jumping to conclusions based on subjective information (Petty 2001). To be able to identify the source of the pain, thorough knowledge of functional and applied anatomy is essential, along with a clear understanding of the behavior of pain and its ability to be referred from site of origin. It’s widely known that other influences can affect perception of pain. (Atkins & Kesson 2005)
From the subjective assessment it is seen that this patient, a 53 year old male painter, is suffering from pain in the cervical neck region that brings on a burning pain in the lateral aspect of his right arm. He noticed the pain after a work related incident 2 months ago, and the condition has deteriorated in the last 2 weeks. One must also into consideration that this patient sustained whiplash injury 2 years ago.
People with whiplash complain of an achy discomfort in the posterior cervical region radiating out over the trapezius muscles and shoulders, and down the arm. (Vernon 2001). As the soft tissue in the shoulder region is still tender and prone to damage, the patient may be suffering from a reoccurrence of the injury. Evidence suggests possible tears in the upper fibres of the shoulder, due to his accident at work. The stiffness in the morning could indicate presents of inflammation. Inflammation in a muscle produces swelling that may lead to impingement on the nervous system, which is causing the referred pain in the elbow. Nerve root irritation in C5 is also a possibility as C5 dermatome covers the lateral aspect of the arm.
This essay will discuss the specific components for an objective examination of this patient. Main Body A general observation begins as the patient is met for the first time and carries on throughout both the subjective and objective assessment of the patients face, posture and gait and can alert the clinician to abnormalities. Before any movements are performed, the state of rest is established to provide a baseline for subsequent comparison in the next treatment (Atkins & Kesson 2005)
Posture can be examined in both sitting and standing. The patient’s symptoms are aggravated while sitting for long periods of time. It is well recognized that prolonged positioning in “poor” posture can lead to mechanical problems, dysfunction and pain, from structures that are mechanically stressed (Macy 2000). An informal examination is assessed while taking the subjective, as the patient is unaware that they are being observed and is in a more natural state and position. Neck position, muscle wasting and spinal curvatures are noted as well as postural compensation. If the symptoms change by altering an asymmetrical posture, this suggests that the posture is related to the problem. (Petty 2001)
Poor posture may be the cause of this patient’s pain due to muscles being over or under worked. The patient describes pain A as a constant toothache, initially suggesting musculoskeletal involvement, a problematic muscle. He complains that his symptoms appear after half an hour of painting, but when he paints overhead, with arm in n elevated position, pain appears after only 10 minutes. The physiotherapist may consider damage to upper trapezius, as it is involve in this movement. This muscle also originates from the upper cervical region, there by strengthening the suspicion for a connection (Kenyon J & Kenyon K 2004).
Range of movement A detailed examination is made of the quality and range of active and passive physiological joint movement. A comparison of both sides is made to distinguish between ‘normal’ movements. As a physiotherapist, it is good practice to clear all joints above and below the problematic joint (Atkins & Kesson 2005). In this case the cervical spine, shoulder, elbow and wrist would be assessed. Abnormalities i.e. joint stiffness, pain, decreased range would be highlighted and give an indication what movements and structures were producing symptoms. The clinician must look out for the patient using trick movements due to pain caused during normal movements. If this is not noted then an inaccurate reading could be made and the origin of the pain not identified (Clarkson 2000).