![]() inability to bear weight both immediately after injury and for 4 steps during the initial evaluation.bony tenderness at the base of 5th metatarsal.bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus.bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus.There is a high sensitivity, and therefore helps the clinician determine to rule out a potential fracture. The Ottawa Ankle and Foot Rules allow clinician to determine the probability of ruling out an ankle or foot fracture. Inability to bear weight immediately after injury and in the emergency department (4 steps) regardless of limping.inability to flex the knee to 90 degrees,.isolated tenderness without other bone tenderness.6 Criteria for radiographs include the following: 4 There is a high degree of sensitivity, 100%. The Ottawa Knee Rules is way determine the need for further radiographic imaging after sustaining an injury to the knee. 3 The sensitivity of the CCR was 99.4%, which means the decision-making tool is very beneficial for ruling out fractures. ![]() The Canadian C-Spine Rules (CCR) are a helpful guide for practitioners to detect clinically important cervical spine injuries including fracture, or ligamentous instability. Here are a few common instruments that are used by practitioners. There are several rules that are designed for specific body regions. Diagnostic instruments are a helpful way for clinicians to recognize and appropriately refer to the right medical professional. As clinicians, we have a responsibility to be able to triage our patients, and direct them for further medical assessment when indicated. The use of algorithms and diagnostic instruments may be helpful to understand when a referral is needed for further medical assessment.ĭiagnostic instruments are utilized by practitioners to determine if patients need a referral for radiographic imaging. Thankfully, there are ways to help guide clinical decision making when you are in these situations. Appropriate referral patterns and examination led to a speedy resolution of the problem and unnecessary physical therapy visits.Diagnosing potentially sinister pathologies can seem a little daunting and ambiguous.I have never previously considered Gout as a condition that would cause pain in this way, but clinical findings did suggest that patient condition required additional follow up with the physician. The tuning fork test resulted in a false positive for a fracture.A complete physical therapy exam, in collaboration with other medical providers, lead to correct interventions for an atypical presentation of gout.He was prescribed medications and his symptoms began to significantly improve. However, they did diagnose him with Gout, a metabolic disease in which crystals form in the joints. He had Xrays of his foot and it had shown no fracture. ![]() I called his primary care physician and explained to him my results. I explained to him that there is some evidence to suggest that he may have fractured his foot. He was also quite tender with stretching his foot. The patient jumped off the table when I put the tuning fork on the base of the outside of his foot. The theory is that the vibration causes the two end of a fracture to vibrate and thus causing a severe pain response. Tuning forks (a two-pronged steel device used by musicians, which vibrates when struck to give a note of specific pitch) can be quite useful at identifying fractures and/or problems with the bone. His ankle was quite swollen and tender on the outside of his foot. He came to the office stating that his left ankle pain was really bothering him and he would like us to start physical therapy treatments. He was diagnosed with peroneal tendinitis and responded well to care very quickly. His right ankle was initially treated because it very painful and debilitating. This patient inspects roofs for an insurance company and spends a great deal of time walking on sloped surfaces. A male in his late 20’s stopped by the clinic with bilateral ankle pain.
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