MS 1 hip misc 1

nerve

joint or muscle or vascular

soft tissue or muscular

• tissues that connect, support, or surround other structures and organs of the body, not being bone
• includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes (which are connective tissue), and muscles, nerves and blood vessels (which are not connective tissue)

inflammation, joint, vascular

compression of a nerve

• good signs, like sleeping thru the night if pt was initially waking hourly
• or activity level increasing

• heart attack --> left arm pain
• kidney issue --> back pain
• gall stones --> thoracic pain

• heart - slower to contract
• HR - slow
• BP - lower

• antibiotics --> tendonopathies
• steroids --> they eat bone and soft tissue -> osteoporosis

• pt's willingness or unwillingness to move
• ROM
• muscular power
• quality of movement (smooth, jittery, stuck)
• contractile vs noncontractile tissues

anything that can't volitionally move is inert/noncontractile

• do it when the AROM is painfree at the end of range
• indicates the joint is clear
• no need to do PROM at this point bc it would give no new info

• firm arrest of movement w slight creep, leathery
• ex: shoulder ER, knee ext

order of restriction:IR >> ext>abd>flex

inert or noncontractile tissues

hard

soft tissue

lat head flex

ligamentous - it feels abrupt, firm, tighter than a muscular end feel)

bounces back  this is always pathological

any joint w meniscus - TMJ, knee

• diff from hardbony end feel,this ill feel abrupt, hard, limiting the ROM
• seen w bone chips, osteophytes

any aberration from the normal end feel for that joint

• soft, squishy feel bc of synovitis
• seen in RA
• no healthy joint has this

hypermobile

no end feel - pt won't let you go that far bc of pain

• similarto crepitus
• see when jnt is eroding
• rough, unpleasant for pt and PT

• contractile tissues: muscles, tendons, attachments
• put joint in resting pos and have pt push against your hands to see if you can elicit the symptomatic pain
• must be applied so only one muscle group is tested at a time

in a joint - they're a component of arthrokinematics

• happen inside a joint - so a component of osteokinematics
• involuntary
• accompany and are necessary for full ROM
• ex: depression of humeral head during flexion

• a kind of arthrokinematic
• involuntary
• refers to the amount of movement created under force
• ex: in dorsiflexion the head of the talus rotates post and tib/fib spread
• ex: PT pulling on a joint to creat movement inside a capsule

• 0-ankylosed-none
• 6-unstable (prob due to torn lig)- surgery

• cap - progress to next level of care
• hard - treat as if acute

• a non-capsular pattern
• restricts movement in one direction

• non-capsular pattern
• a loose fragment of cartilage or bone causes a localized block --> springy rebound or bony block

• disproportionate limitaton, ie muscle shortening, spasm -- shortening, loss of ROM in 1 dir
• constant-length phenomenon - limitation at one joint related to the position in which another joint is held (blockage in 1 joint limits ROM in another) - only in 2 joint muscles

• if painful/limited in opp dir - contractile structure at fault (muscle, tendon, attachment)
• if restricted in same dir - noncontractile or arthrogenic lesion

• pain and strong: small lesion/tear
• pain and weak: big lesion/tear
• painless and strong: get some ice cream
• painless and weak: neuropathy
• painful on repetition: vascular supply troubles

• pain appears near mid range, but there are painless areas on either side of it
• pain elicited by internal squeezing
• may be due to pinch and release of bursa, tendon, etc, or arthritis in one region

• diff from pain caused by squeezing
• impingement (prob of a tendon)

a passive movemen to a joint requiring tx

• sustained stretch (~7 sec)
• oscillatory (1-2/sec)
• grades of movement (increasing the ROM)
• progressive ossilations (I-IV)

• aka thrust
• small amplitude, high velocity (classic chiro move)

• recent fracture
• osteoporosis, metastatic bone disease (grades I and II are ok)
• pregnancy (bc ladies get hypermobile. but can do Grades I and II)
• RA (leads to laxity, edema, sinovitis in joints)
• prolonged steroid use
• hypermobility
• bleeding disorders or cumadine
• hemophilia
• blood thinners

• in fibrous capsule of joint - mainly in superficial layers btwen collagen fibers
• small myelinated fibers
• static and dynamic mechanoreceptors w low threshold, slowly adapting

so, like type II, they're good for pain inhibition, and can be activated at beginning and middle of range (grades I and II)

• found in fibrous capsule of joint, mainly in deep layers,
• medium myelinated
• dynamic mechanoreceptors, low threshold, rapidly adapting

so, like type II, they're good for pain inhibition, and can be activated at beginning and middle of range (grades I and II)

• found in joint ligaments and facet joints in spin
• large myelinated fibers
• dynamec mechanoreceptors, high threshold, very slow adapting

• we know them as GTOs
• responsive at end of range - grade III and IV, so they're good for stretching

• found in fibrous capsule, articular fat pads, ligaments, walls of blood vessels, posterior longitudinal ligament, ant long lig
• very small and unmyelinated
• pain receptors, high threshold, non-adapting, nociereceptors-C-fibers, slow conducting, respond to temp and pressure, give a burning feeling when they react

• direct tauma
• long term immob
• inflam condition

(in ankle leads to repeated sprains bc ankle is no longer telling were it is)