Physical Therapy Examination and Evaluation
Oncologic examination adapts standard tests to altered tissue and systemic status. Components: history (primary, treatment, current phase, red flags), systems review (cardiopulmonary, integumentary, neurologic, musculoskeletal), impairment measures (range of motion, strength, sensation, edema), functional measures (gait, transfers, endurance), and patient-reported outcomes. Use standardized, validated tools where possible: goniometry, manual muscle testing (caution with fracture risk), circumferential or volumetric limb measures for lymphedema, 6-minute walk test or 2-minute step test for endurance, and balance tests for neuropathy.
Key concepts: baseline documentation before and after treatment, outcome measure selection matched to the construct, and modification of testing when fatigue, pain, or counts limit performance. Know that shoulder range of motion after breast cancer surgery is a frequent impairment, and that cervical and shoulder screening after head and neck treatment must account for fibrosis and lymphedema.
Traps
- Using maximal manual muscle testing in a patient with known bone metastases without considering fracture risk.
- Measuring limb girth at inconsistent landmarks, making comparison invalid.
- Failing to document which arm is at risk for lymphedema and why.
Rule of thumb
Choose the measure that matches the construct you will treat, and standardize the landmark and procedure every time.
Worked example
For a patient post axillary dissection, record bilateral circumferential measures at a fixed landmark, shoulder range of motion, and a validated function score at baseline so change can be judged later.