4 vital signs of physical examination
1.
2.
3.
4.
body temperature BT
blood pressure BP
pulse (heart rate) HR
breathing rate (respiratory rate) RR
Average / normal
1.
2.
3.
4.
37°C
120/80 mm Hg (millimeter of mercury) 120 systolic 80 diastolic
60 to 100 bpm
12 to 16 breaths per minute
Stroke
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medical emergency
when the blood supply to part of your brain is interrupted or reduced, preventing brain
tissue from getting oxygen and nutrients.
brain cells begin to die in minutes.
treatment is crucial.
Symptoms
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Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
Sudden confusion, trouble speaking, or difficulty understanding speech.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
types
1. Ischemic stroke.
2. Hemorrhagic stroke.
3. Transient ischemic attack (a warning or “mini-stroke”).
ischemic stroke is when blood vessels to the brain become clogged.
A hemorrhagic stroke is when bleeding interferes with the brain's ability to function
A transient ischemic attack (TIA) is a stroke that lasts only a few minutes. It happens when
the blood supply to part of the brain is briefly blocked.
Adhesive capsulitis OR Frozen shoulder

This inflammatory condition initially painful and later progressively restricted active
and passive glenohumeral (GH) joint range of motion
Symptoms
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pain and stiffness
dull or achy pain causes you to limit your movement
Reaching for an item on a high shelf becomes difficult
difficult dressing
worsens at night
Cause
This inflammatory condition causes fibrosis of the GH joint capsule, is accompanied by
gradually progressive stiffness and significant restriction of range of motion (typically
external rotation).
Phases
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Acute/freezing/painful phase: Gradual onset of shoulder pain at rest with sharp pain at
extremes of motion, and pain at night with sleep interruption which may last anywhere
from 2-9 months.
Adhesive/frozen/stiffening phase: Pain starts to subside, progressive loss of GH motion
in capsular pattern. Pain is apparent only at extremes of movement. This phase may
occur at around 4 months and last till about 12 months.
Resolution/thawing phase: Spontaneous, progressive improvement in functional range
of motion which can last anywhere from 5 to 24 months.
Assessment Subjective Assessment
1. Patient History
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patient’s past medical history (PMHx), to rule out red flags and guide the examination.
History of presenting condition (Hx PC).
Pain distribution and severity: Strong component of night pain, pain with rapid or
unguarded movement, discomfort lying on the affected shoulder, pain easily aggravated
by movement. Pain can be anywhere from the base of the skull, from down the arm into
the hand.
Aggravating activities - limited reaching, particularly during overhead (e.g., hanging
clothes) or to-the-side (e.g., fasten one's seat belt) activities. Patients also suffer from
restricted shoulder rotations, resulting in difficulties in personal hygiene, clothing and
brushing their hair. Another common concomitant condition with frozen shoulder is
neck pain, mostly derived from overuse of cervical muscles to compensate the loss of
shoulder motion [11]
2. Observation of Posture and Positioning

Scapular winging of the involved shoulder may be observed from the posterior and/or
lateral views.
3. Range of Movement Assessment - Active/Passive/Overpressure
Pain pattern
represents how the individual's pain changes with time.
Median nerve pathology
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caused by compression of the median nerve in the elbow or forearm or wrist
affects movement of or sensation in the hand.
Hernia
A hernia occurs when an internal organ or other body part protrudes abnormally through the wall of
muscle or tissue
causes
by a combination of pressure and an opening or weakness of muscle or fascia; the pressure
pushes an organ or tissue through the opening or weak spot.
common types
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inguinal (inner groin)
incisional (resulting from an incision)
femoral (outer groin)
umbilical (belly button)
hiatal (upper stomach).
Sciatica
pain that radiates along the path of the sciatic nerve, which branches from your lower back
through your hips and buttocks and down each leg. Typically, sciatica affects only one side of
your body.
Diagnosis
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
MRI
muscle strength and reflexes.

For example, you may be asked to walk on your toes or heels, rise from a squatting
position and, while lying on your back, lift your legs one at a time. Pain that results
from sciatica will usually worsen during these activities.
Osteoarthritis (OA)
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most common form of arthritis in females
degenerative joint disease or “wear and tear” arthritis.
It occurs most frequently in the hands, hips, and knees.
the cartilage within a joint begins to break down and the underlying bone begins to
change.
Diagnosis
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Xray
Pmh
Blood test
Bradycardia
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Low heart rate
under 60 beats BPM
trachycarida
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high heart rate
over 100 BPM
spontaneous vaginal delivery SVD
patients gives birth in normal manner through vagina
Caesarean section C-section
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surgical delivery of a baby.
surgical procedure by which a baby is delivered through an incision in the mother's
abdomen,
https://www.slideshare.net/ktpeterson11/muscle-14972614
ACL reconstruction - is surgery to replace a torn ACL

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Male OPD
Abdul Nafay
PMH of ACL operation on left side 7 months ago with c/o pain while walking and using
stairs
 Post surgery pain
 Goal: regain ROM, strength, proprioception, strengthening of the quadriceps and
hamstrings and stability.
 Treatment:
 RICE - Rest, Ice, Compression, Elevation should be used in order to reduce swelling
and pain, to attempt full range of motion.
 SLR
 Ankle DF/PF/circumduction
 Stretching exercise
 Knee flexion/extension in sitting
 Patellar mobilisations
 Glutes medius work in side lying
 Gluteal exercises in prone
 Knee flexion in prone (gentle kicking exercises)
 Weight transfers in standing (forwards/backwards, side/side)
Adhesive capsulitis or Frozen Shoulder

Inflammatory, painful, stiffness, restricted active and passive glenohumeral joint
range of motion (typically external rotation).
 causes fibrosis of the GH joint capsule.
 Symptoms
 insidious onset with a progressive increase in pain
 gradual decrease in active and passive range of motion.
 night pain
 radiating pain from the base of the skull, from down the arm into the hand.
 loss of external rotation (ER)
 difficulty with grooming
 performing overhead activities
 dressing
 fastening items behind the back
 Disturbed Sleep
 Types
 Acute/freezing/painful phase: Gradual onset of shoulder pain at rest with sharp pain
at extremes of motion, and pain at night with sleep interruption which may last
anywhere from 2-9 months.
 Adhesive/frozen/stiffening phase: Pain starts to subside, progressive loss of GH
motion in capsular pattern. Pain is apparent only at extremes of movement. This
phase may occur at around 4 months and last till about 12 months.

Resolution/thawing phase: Spontaneous, progressive improvement in functional
range of motion which can last anywhere from 5 to 24 months.
Observation of Posture and Positioning
Scapular winging of the involved shoulder may be observed from the posterior and/or lateral
views.
Reduced forward flexion, abduction, external rotation, and internal rotation range of motion
are key clinical signs of adhesive capsulitis.
Shoulder Shrug Sign
Initial Phase: Painful, Freezing
Pain relief and the exclusion of other potential causes of your frozen shoulder is the focus
during this phase.
Very gentle shoulder mobilization
muscle releases
acupuncture
dry needling
TENS
hot packs, can be applied before or during treatment
any activities that cause pain should be avoided
A pulley may be used to assist range of motion and stretch,
Core exercises include pendulum exercise, passive supine forward elevation, passive
external rotation
active assisted range of motion in extension, horizontal adduction, and internal rotation. [5]
Second Phase: Decreased Range of Movement
Gentle and specific shoulder joint mobilisation
Stretches
muscle release techniques
acupuncture
dry needling
MULLIGAN mobilisation with movement (MWM) style techniques appears the most
effective.
movement with mobilisation and end range mobilisations are recommended. [14]
Third Phase: Resolution
Provide you with exercise progressions including strengthening exercises to control and
maintain increased range of movement.
Progressed primarily by increasing stretch frequency and duration
As the patient’s irritability level reduces, more intense stretching and exercises using a
device, such as a pulley, can be performed to influence tissue remodelling. [5]
Paraumbilical hernia
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
Laproscopy
keyhole surgery to repair a hernia that has appeared at or around your belly button.
Pneumonia is swelling (inflammation) of the tissue in one or both lungs.
x-ray in pneumonia shows white spots in the lungs (called infiltrates) that identify an infection.
Chest physiotherapy includes
Postural drainage
Postural drainage involves positioning a person with the assistance of gravity to aid the
normal airway clearance mechanism. Positions should generally be held for 3 to 15 minutes
Percussion
Percussion is also referred to as cupping, clapping, and tapotement. The purpose of
percussion is to intermittently apply kinetic energy to the chest wall and lungs. This is
accomplished by rhythmically striking the thorax with a cupped hand or mechanical device
directly over the lung segment(s) being drained. [6]
Vibration
Vibration involves the application of a fine tremorous action (manually performed by
pressing in the direction that the ribs and soft tissue of the chest move during expiration)
over the draining area. In this technique, a rapid vibratory impulse is transmitted through
the chest wall from the flattened hands of the therapist by isometric alternate contraction of
forearm flexor and extensor muscles, to loosen and dislodge the airway secretions. [6]
Cerebral palsy (CP) affect ability to move and maintain balance and posture. CP is the most
common motor disability in childhood.
Low back pain assessment
Movement Patterns
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How does the patient enter the room?
A posture deformity
deformity with a lateral pelvic tilt,
How does the patient sit down and how comfortably/ uncomfortably does he or she sit?
How does the patient get up from the chair? A patient with low back pain may splint the
spine in order to avoid painful movements.
Posture
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Scoliosis (static, sciatic, idiopathic)
Lordosis (excessive, flattened)
Kyphosis (thoracic)
Functional Tests
1. Functional Demonstration of pain provoking movements
2. Squat test - to highlight lower limb pathologies. Not be done with patients suspected
of having arthritis or pathology in the lower limb joints, pregnant patients, or older
patients who exhibit weakness and hypomobility. If this test is negative, there is no
need to test the peripheral joints (peripheral joint scan) with the patient in the lyin g
position[11].
Movement Testing
Rom
Myotomes and dermatomes
Tests for low back pain SLR and slump test