-
Contractile tissues include
muscles, their tendons, and their attachments into the bone; may have tension placed on them by stretching or contraction
-
________ tissues: (and their associated sheaths) have tension put on them by stretching and pinching
Nervous
-
Includes all structures not considered contractile or neurological such as joint capsules, ligaments, bursae, blood vessels, cartilage, and dura mater
Inert tissues
-
Myotome
groups of muscles supplied by a single nerve root
-
With passive and ligamentous testing, both the ________ and _______ (end feel) of opening are important
degree; quality
-
“Red Flags” in Exam indicating need for medical consultation:
- Severe unremitting pain
- Pain unaffected by medication or position
- Severe pain with no history of injury
- Severe spasm
- Psychologic overlay
-
The purpose of the musculoskeletal exam is to identify the _______ ______ responsible for the patient’s complaint, pain or functional impairment/limitation and determine the patient’s ________ ____________.
specific lesion; functional ability
-
Five elements of patient/client management:
Examination>Evaluation>Diagnosis> Prognosis>Intervention
-
The procedural intervention
the actual treatment
-
Associated data collection
Tests and Measures!
-
Written and oral
Communication
-
Noted on active movements
- When and where during each of the movements the onset of pain occurs
- Does movement increases the intensity and quality of pain
- Reaction of the patient to pain
- Amount of observable restriction
- Pattern of movement
- Rhythm and quality of movement
- Movement of associated joints
- Willingness of the patient to move the part
- Any limitation and its nature
-
With the joint relaxed, the therapist takes the joint through as full a range as possible
PROM
-
When comparing AROM and PROM- differences may be caused by
muscle contraction or spasm, muscle deficiency, neurological deficit, contractures, or pain
-
Each movement must be compared with the same movement on the opposite joint or _____ ________.
accepted norms
-
Should be noted on passive movements
- When and where during each of the movements the pain begins
- Whether the movement increases the intensity and quality of pain
- The pattern of limitation of movement
- The end feel of movement
- The movement of associated joints
- The range of motion available
-
Three classic normal end feels:
- Bone-to-bone or “Hard”
- Soft tissue approximation or “Soft”
- Tissue stretch or “Firm”
-
Five classic abnormal end feels:
- Muscle spasm
- Capsular
- Bony block
- Empty
- Springy block
- Laxity
-
Capsular pattern:
when the joint capsule is affected there will be pattern of proportional limitation specific to each joint of the body
-
A limitation that exists but does not follow the classic capsular pattern for that particular joint
Noncapsular pattern
-
Pain-free, full ROM:
no lesion
-
Pain and limited ROM in every direction:
entire joint is affected, indicating arthritis or capsulitis▫
-
Pain-free, limited ROM:
often of abnormal bone-on-bone type, usually indicating symptomless arthritis
-
Pain and excessive or limited ROM in some directions:
lesion of inert tissue such as a ligamentous sprain or local capsular pattern lesion
-
Active and Passive combinations: (inert, capsular)
Restricted and painful, same direction: non-contractile tissue affected
-
Active and Passive combinations:(muscle tissue)
Restricted and painful, opposite direction: contractile tissue affected
-
The degree to which an instrument measures what it is purported to measure; the extent to which it fulfills it’s purpose.
Validity
-
Refers to the amount of consistency between successive measurements of the same variable on the same subject under the same conditions
Reliability
-
Intrarater reliability:
the degree to which one person can replicate the measurement he/she obtains
-
The degree to which multiple testers can obtain measurements that agree
Interater reliability:
-
Refers to the measurement of angles
Goniometry
-
-
-
Refers to the movement of joint surfaces such as slides (glides), spins, and rolls
Arthrokinematics
-
Refers to the movement of the shaft of the bone rather than the joint surfaces; ~goniometry measures this type of joint movement
Osteokinematics
-
Refers to the alignment of the arms of the goniometer with the proximal and distal segments of the joint using bony anatomical landmarks
Alignment
-
Measurement instruments: universal goniometer most commonly used
- Body
- Stationary arm or proximal arm
- Moving arm or distal arm
-
The testing position helps to stabilize the patient’s body and proximal joint segment
Stabilization
-
Positioning:
the position of the body during which goniometric measurements are obtained
-
Must provide enough info to allow accurate interpretation of results
Recording
-
Sources of error in measurement of ROM:
- Reading wrong side of the scale
- Expectation for what reading should be
- Change in patient’s motivation to perform
- Measurement procedure error
- Taking successive ROM measurements at different times of the day
-
__________ ___________ is the greatest extensibility of a muscle-tendon unit
Muscle length
-
Purpose of muscle length testing:
to determine whether hypomobility or hypermobility is caused by the length of the inactive antagonist muscle or other structures
-
Muscles can contract more forcefully when slightly __________.
stretched
-
Muscles generate maximum concentric tension when __ times resting length.
1.2
-
Beyond resting length active tension _______ due to insufficient sarcomere overlap
decreases
-
Active insufficiency:
inability for a muscle to exert enough tension to shorten sufficiently to complete ROM in all joints simultaneously
-
Inability for a muscle to stretch enough to complete full ROM in all joints simultaneously
Passive insufficiency
-
MMT Grading System:
- 5…Normal (N)…Max resistance applied by the examiner
- 4…Good (G)…Mod resistance
- 3…Fair (F)…Against gravity- no resistance
- 2…Poor (P)…Gravity minimal
- 1…Trace (T)…Evidence of muscle contraction
- 0…Zero (0)…No contraction
-
When applying resistance during break test, resistance is applied near the
distal end of segment
-
Preferred point of resistance when testing vertebroscapular muscles is the ___ rather than the scapula
arm
-
When grading MMT, use of (+) and (–) is generally discouraged except for _____ ___ _____.
Fair+ and Poor –
-
When any condition limits the ROM a patient can perform, then the MMT is considered to be performed in the “________ ______”
available range
-
Four possible findings on resisted movement
- Strong and painless
- Strong and painful
- Weak and painless
- Weak and painful
-
Strong and painless-
no lesion
-
Strong and painful-
minor lesion
-
interruption of nerve supply or complete rupture of tendon or muscle
Weak and painless
-
partial tendon/muscle rupture or pain inhibition due to serious pathological condition (acute fracture, neoplasm, etc.)
Weak and painful
-
Testing muscle spindles (deep receptors) Reflex grading:
- 0= areflexic (no reflex)
- 1= hyporeflexic (delayed, slow reflex)
- 2= normal (brisk contraction)
- 3= hyperreflexic (exaggerated contraction
- 4= clonus (twitching, continuous contraction)
-
Standardized pain assessment tests:
- McGill Pain Questionnaire (MPQ)
- Dallas Pain Questionnaire
- Wong-Baker Faces Pain Rating Scale
- Owestry Low Back Pain Questionnaire
- Verbal rating scale
- Visual analog scale
- Pain estimate
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