Summary McTimoney College of Chiropractic - Clinic Entrance & Exit Exam (ALL Conditions)
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Course
McTimoney Chiropractic - Clinic Exam
Institution
University Of Ulster
This master summary contains every condition you will need to know for your clinic entry and exit exam. This document includes everything from Neuroscience, Clinical Neurology, MSM and CM2 (Systems). Combined with the testing this is everything you need to know to pass clinic entrance and exit.
Differential Diagnosis List
Clinical Neurology, Year 3
Musculoskeletal Medicine (MSM), Year 3
Clinical Medicine I, Year 4
DDx Tool ➔ VINDICATES
Flashcard for each condition
• What is it?
o Definition as if you were explaining it to Granny
• Who gets it?
o Major epidemiology
o E.g. only geriatrics, paediatrics, age groups etc.
▪ NOT 2:1 males to females
o Would also include major risk factors.
• Hallmark symptoms
o What really has to be there for you to consider this condition present
• Hallmark signs
o Physical exam first
o Then any investigations like imaging/labs
o Know the abnormal
,DDx Process
1. Case history (DOC) = 90%
• Primary complaint ➔ Biomechanical pain, Neurological pain, Stiffness, Instability,
Weakness/Fatigue, Dizziness, Immunocompromise, Headache, Inflammation, Organ
referral, Systemic problem
• WHO is the Px (epidemiology)
W Where is the pain
W When did it start
W When does it occur / How often
W What do you think caused it
Q Quality - how does it feel + type of feeling
Q Quantity - how severe is it (scale 1-10 + PSB + @worst)
H How long does it last?
A Aggravates - what makes it worse
A Alleviates - what makes it better
A Associates - other symptoms
P Progression - is it getting worse
R Repetitive - have you had this before
I Insomnia – does it wake you at night or prevents you from sleeping
C Changes to bowl & bladder
H Handicap - does it prevent you from doing something
Been to GP? Diagnosis?
Past medical Hx / illnesses / trauma
Family Hx
Medications taken
Occupation
2. DDx list RELEVANT 5-7 ➔ inclusion/exclusion criteria + VINDICATES
• VINDICATES = include multiple categories to confirm your WD
• Inclusion = 3-4 hallmarks & epidemiology that match
• Exclusion = 3-4 missing hallmarks & confounders (Sx present that don’t make sense)
o What you expect vs not expect to see
3. Physical exam = 10% ➔ support/exclude differentials
• Base the testing on the presenting signs
• Be methodical
a) Observation
b) Palpation
c) ROM ➔ active, passive, resisted
d) Screens, Ortho
e) Neuro
f) Systemic (Vitals, Cardiovascular, Respiratory, Abdominal)
• Include negative testing ➔ i.e. proof it is not biomechanical to support vascular
4. Create working Dx ➔ leads to prognosis, could be combination of conditions
• Keep 1-2 alternative DDx if outcome is not as expected
, 1 – Shoulder
Vascular Avascular Necrosis (AVN)
Intoxication (w/ Steroid)
What Blood supply to the humeral head is disrupted, leading to joint deterioration
Who Age 30-60
RF: repetitive steroid injections
Symptoms Deep achy shoulder pain, progressive
Worse with activity, interferes with sleep
Signs OP – atrophy, tenderness
ROM – all limited, stiffness, weakness
Infective/Inflammatory Septic / Infectious Arthritis
What Painful infection of the shoulder joint
Who Infants & young children, older adults
RF: IV drug users, RA, DM, immunosuppression
Symptoms Sharp or severe joint pain & swelling combined with fever and malaise
Signs Fever
OP – swelling, tenderness, warmth, redness, malaise
ROM – limited in all planes
Infective/Inflammatory Subacromial Bursitis
What Inflammation of the subacromial bursa which results in an increase in synovial fluid
production
Who RF: overuse injury to supraspinatus (overhead movements)
Symptoms Gradual onset deep superior shoulder pain
Unable to lay on affected side
Signs OP – severe localised bursa tenderness, swelling
ROM – painful, abduction & flexion limited
Infective/Inflammatory Scapulothoracic Bursitis
What Inflammation of the scapulothoracic bursitis which results in painful snapping of the
scapula
Who RF: overuse injury (athletes, manual work)
Symptoms Pain during overhead activities, crepitus with shoulder movement
Signs OP – crepitus, tenderness, audible snap, winging scapula
ROM – normal with audible snapping/crepitus
Infective/Inflammatory Biceps Tendonitis
What Inflammation of the long head of the biceps tendon
Who Age >40
RF: repetitive overhead activities, throwing sports (baseball), lifting
Symptoms Achy anterior shoulder pain
Aggravated by lifting or overhead activities
Signs OP – bicipital groove tenderness, Popeye sign (with complete rupture)
ROM – painful/weak resisted flexion
Ortho – Speed’s, Yergason’s, Neer's
, Infective/Inflammatory Adhesive Capsulitis / Frozen Shoulder
What Inflammation of the shoulder capsule significantly restricting ROM
Who Females age >40
Symptoms Slow onset to severe shoulder pain in 3 progression phases, may take 2 years:
1. Freezing – gradually more & more severe pain, reducing ROM
2. Frozen – pain may reduce, stiffness remains
3. Thawing – ROM slowly improves
Unable to sleep on affected side
Signs OP – guarding shoulder, tenderness
ROM – reduced in every A/PROM (= Dx)
Ortho – Apley Scratch, Painful Arc, SITS (hugely restricted or impossible)
Infective/Inflammatory Polymyalgia Rheumatica (PMR)
What Inflammatory condition that causes muscle pain & stiffness, esp. shoulders/hips
Who Females age 65+
Symptoms Proximal muscle pain of the shoulder +/- Hip girdles
Morning stiffness >1hr
Can be unilateral but becomes bilateral after a few weeks
Signs Vitals – low-grade fever
OP – tenderness, atrophy
ROM – limited
Neoplastic/Neurological Pancoast Tumour
What Lung cancer at the top of the lung compressing the brachial plexus
Who RF: age, smoking, carcinogens, genetics
Symptoms Severe persistent shoulder pain radiating down the arm
Potentially chest pain
May start as TOS Sx ➔ diffuse achy with ulnar neuro progressing into wider neuro pain
Signs OP – atrophy, lumps, masses
ROM – may be limited, arm weakness
Imaging = Dx
Neoplastic/Neurological Cervical Disc Herniation (C5)
What Age-related disc degeneration causes it to bulge/break hereby compressing/irritating 1
or more nerve roots
Who Men age 25-50
RF: repetitive injury (Valsalva, trauma, lifting), flexion/rotation injury, LBP Hx
Symptoms Unilateral deep aching/burning pain in (central spinal neck/)arm ➔ follows dermatome
Weakness in hand/arm
Consistent severe pain (7-8), no alleviation at rest
Signs OP - head/neck tilt away from injury, Bakody's sign, paraspinal tenderness, spasm
Bakody's sign: symptoms reduced with the painful arm placed on top of head
ROM – reduced overall & painful flexion, IL lateral flexion and rotation
Ortho - Valsalva, compression, distraction, shoulder depression, brachial plexus stretch
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