Assessing Joint Range, Muscle Length & Muscle Strength Flashcards
What are the indications for physical assessment?
- Difficulty with movement/function
- Client consent
- Symptoms appear mechanically based
- Likely neuromuscular issues
What are the contraindications for physical assessment?
- Medical red flags, e.g. severe unrelenting night main, morning stiffness >1hr
- Active bone disease
- Joint dislocation/fracture
- Immediately after surgery
- Acute inflammation
- Infection
- Cauda equina syndrome
- Signs of vertebra-basilar insufficiency
What are the precautions for physical assessment?
- High level of pain/irritability
- Significant inflammation
- Osteoporosis
- Hypermobility
- Newly united fracture
- Following prolonged immobilisation
- Haemophilia
- Haematoma
- Myositis ossification
What should you do when there are precautions for physical assessment?
- Assess AROM & PROM to P1 only
- Be wary of applying overpressure
- Be careful when assessing ROM in vulnerable positions
- Assess strength to P1 only
What are the 3 key elements of determining irritability of symptoms?
- Amount
- Severity
- Duration
What should you do for high irritability?
- Active ROM to onset of pain
What should you do for low irritability?
- Active ROM to as far as they can
What are the features of active ROM (AROM)?
- Client produces movement by themselves
- Reflects joint range & muscle strength
- Assessed against/across gravity
What are the features of passive ROM (PROM)?
- Client relaxes, therapist performs movement
- Reflects joint range but not strength
- Gives info about resistance during movement and end feel
- Gravity irrelevant
What is active-assisted ROM?
- Client produces movement, then therapist assists to maximal range
- Reflects joint range and non-quantifiable muscle strength
- Assessed against/across gravity
- Doesn’t give info about resistance
What are the principles of assessing ROM?
- Explain purpose/procedure, gain consent
- Check resting pain/discomfort
- Screen unaffected side first, then affected pain
- Use sensitive handling to apply overpressure to AROM and assess PROM
- Measure ROM, describe quality of movement and end feel
- Repeat with other limb and compare
What are the normal end feels?
- Hard (bony)
- Soft (soft tissue apposition)
- Firm (soft tissue stretch)
- Capsular stretch
What are the abnormal end feels?
- Hard (bone on bone)
- Soft (boggy sensation)
- Firm
- Springy block (internal derangement)
- Empty (no sensation felt)
- Spasm (hard sudden stop)
What normally limits ROM?
- Joint surfaces
- Labrum
- Capsule
- Ligaments
- Muscle length
- Soft tissue apposition (e.g. calf hitting thigh)
What abnormalities limit normal ROM?
- Pain
- Swelling
- Joint stiffness
- Tight muscles
- Weak muscles
- Ligament laxity (excessive ROM)
What is stiffness?
Extent to which an object resists deformation in response to force
What can stiff joints and tight muscles result from?
- Injury/disease
- Disuse
- Immobilisation
- Poor posture
- Inadequate movement/stretching
How are stiff joints and tight muscles similar?
Both present with limited AROM & PROM
How are stiff joints detected?
- Palpation
- Passive accessory movements
How are tight muscles detected?
- Palpation
- Muscle length tests (stabilise one end of muscle, move other)
What joint structures can cause pain due to injury, inflammation or disease?
- Joint capsule
- Ligaments
- Entheses
- Synovium
- Bursa
- Periosteum
- Subchondral bone
Why do muscles become tight?
Being held in shortened position for a period of time due to
- Pain
- Weakness
- Poor posture
- Repeated activities
Muscle/tendon injury, inflammation or disease causing scar tissue, disuse and adaptive shortening
What is spasticity?
Velocity-dependent restriction of movement due to increased tendon reflex in response to stretching
What is spasticity usually present with?
Excess muscle tone (hypertonia)
How is spasticity assessed?
Tardieu scale - assess range at 3 different velocities
What are P1, P2, R1 & R2?
P1: First sign of pain/discomfort
P2: Final limiting pain
R1: First sign of resistance
R2: Final limiting resistance
What are the principles for assessing muscle length?
- Explain, warnings, consent
- Check resting pain and P1
- Screen unaffected side first then affected side
- Use sensitive handling, slowly lengthen muscles
- Remind client to relax during passive movement
- Stabilise muscle at origin
- Assess end feel
What level of pain should you move the patient to if they are highly irritable?
P1
What is an isokinetic contraction?
Concentric/eccentric contraction with constant velocity
What factors affect muscle strength?
- Fibre type
- Fibre diameter
- Muscle size
- Force-velocity relationship
- Length-tension relationship
- Muscle architecture
Why can muscles become weak?
- Neurological injury/disease
- Pain/injury to muscle/tendon
- Joint pain/stiffness
- Immobilisation/atrophy
- Overuse of muscle
- Prolonged elongation
How can muscle weakness be identified?
- AROM
How is isometric muscle strength assessed?
- Hold joint in mid range
- Ask patient not to let you move them
- Try and move joint into range, gauge level of resistance
How is isotonic muscle strength assessed?
- Ask patient to perform muscle action, palpate muscle activity
- Ask patient to notify you of P1 and describe location/level of pain
- Note number, length of hold, load, strength/quality of contractions
What are the Oxford grades of muscle strength?
- No movement/activation
- Flicker of movement
- Full ROM without gravity
- Full ROM against gravity
- Full ROM against resistance
- Full ROM against strong resistance
