Screening for Head, Neck, and Shoulder Pathology in Patients with Upper Extremity Signs and Symptoms

Narrative Review: Conditions of the head, neck, thorax, and shoulder may occur simultaneously with arm pathology or produce symptoms perceived by the patient to originate in the elbow, wrist, or hand. Identification of the tissue disorder and associated impairments, followed by matching the rehabilitative intervention to address these issues, leads to optimal outcomes. With this goal in mind, the hand therapist needs to recognize clinical findings that signal potentially serious medical conditions of the brain, cervical region, chest, or shoulder. Additionally, less serious but potentially debilitating, musculoskeletal or neurogenic pain from proximal sources must also be differentiated from somatic pain originating in the elbow, wrist, or hand so that the clinician can decide to further examine and intervene or refer to an appropriate health care provider. This article describes clinical findings that suggest the presence of serious medical pathology in the head, neck, or thorax and presents a screening algorithm to assist in discriminating pain derived from local structures in the distal arm from referred pain originating in the more proximal regions of the shoulder, thorax, neck, or brain

CPG Implementation: Differential Diagnosis Decision Tree

Clinical practice guideline recommendations can only influence practice and impact society if they are implemented. The Academy of Orthopaedic Physical Therapy and Journal of Orthopaedic and Sports Physical Therapy have used decision trees, or clinical algorithms, to facilitate CPG implementation by clinicians. The soon-to-be-published CPG on differential diagnosis and need for referral will be best implemented if it is integrated into a clinical reasoning model for managing common musculoskeletal conditions. Speakers will present an “integration over isolation” decision tree model for evaluation and management of individuals presenting with common musculoskeletal disorders where the individual’s clinical findings suggest the presence of a medical condition, in which referral to a medical practitioner is the CPG recommended best practice. Attendees will learn how to use the CPG implementation tool in everyday practice as presenters take them on a digital walk-through of integrating essential evaluation and intervention components for differential diagnosis of common musculoskeletal disorders and sinister pathology that can mimic common musculoskeletal disorders

Ankle stability and Movement Coordination Impairment: Ankle Ligament Sprains. Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization\u27s International Classification of Functioning, Disability, and Health (ICF). The purpose of these clinical practice guidelines is to describe the peer-reviewed literature and make recommendations related to ankle ligament sprain

A CPG to Recognize Health Conditions That May Necessitate Referral

Physical therapists increasingly play the role of front-line providers. It is incumbent upon us to ensure intervention provided by a physical therapist is the most appropriate form of care for our patients and clients. Some conditions that may necessitate referral may mimic symptoms associated with musculoskeletal or movement disorders commonly treated by physical therapists. The Academy of Orthopaedic Physical Therapy and Federal Physical Therapy Section have partnered to create a clinical practice guideline to provide physical therapists with a synthesis of evidence-based information on conditions that may present as typical musculoskeletal concerns but require careful differential diagnosis for identification and appropriate management. Members of the guideline development team will present a summary of the systematic review process, methods, and recommendations for selected health conditions that warrant further medical workup and/or referral. Emphasis will be placed on actionable clinical recommendations and supporting evidence to provide attendees with critically appraised information and clinical pearls that can be used to appropriately manage patients and clients