An Accurate Diagnosis At Sydney Muscle & Joint Clinic Penrith
How Our Physios, Exercise Physiologists and Chiropractors Achieve An Accurate Diagnosis
Clinical History & Interview
Acquiring a clinical history and interviewing a patient provides important information for our physios to determine a diagnosis and also establishes a solid foundation for the relationship between our physiotherapists and you-the patient. An appointment begins with an interview, where our physiotherapists compiles a patient’s history of the current injury or complaint as well as past medical history, family history, social history, and other relevant information, such as current medications (prescription and over-the-counter) and dietary supplements.
Pertinent questions our physios and chiros will ask in establishing an accurate diagnosis or what tissue is in lesion includes: what caused the complaint, what makes it worse and better, previous experience, morning pain/stiffness, previous treatment, how would you aggravate it right now, any associated symptoms.
The physical exam is a hands-on observational examination of the patient by the treating physiotherapist. A careful physical exam can help a clinician refine the next steps in the diagnostic process, can prevent unnecessary diagnostic testing, and can aid in building trust with the patient. At Sydney Muscle & Joint Clinic our physiotherapists, exercise physiologists and chiropractors utilise special test to assess provocation of the injury region. Examples of these include:
Lumbar spine: range of motion to P1, KEMPS, slump, SLR, prone instability.
Cervical spine: range of motion to P1, KEMPS, cervical flexion, spurlings, ULTT (median, radial, ulna)
Shoulder: Hawkins-Kennedy, empty can, full can, O'Briens, painful arc, crank test.
Hip: FADIR, FABER, adduction, GTPS point tenderness, FADER, MMT, pubic stress test, squeeze test
Knee: McMurrays, Ege's, Apley's, Thessalys, anterior drawer, Clarke's sign
Ankle: talar tilt, anterior drawer, hop test.
Over the last few years diagnostic testing has become a critical feature of standard medical practice, but due to its overuse, costs and negative implications for the patient the use of diagnostic testing should be avoided unless a red flag is present or if evidence based management is not having a normal clinical benefit. In musculoskeletal clinical practice diagnostic testing may include imaging (x-ray, MRI, ultrasound, CT) and diagnostic injections.
At Sydney Muscle & Joint Clinic Penrith we generally don't use diagnostic testing if the results do not change the intervention, if there are no red flags and if it poses a significant detriment to the patient (anxiety surrounding resulting imaging findings).