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NMI > Assessing Joint Range, Muscle Length & Muscle Strength > Flashcards

Assessing Joint Range, Muscle Length & Muscle Strength Flashcards

1
Q

What are the indications for physical assessment?

A
  • Difficulty with movement/function
  • Client consent
  • Symptoms appear mechanically based
  • Likely neuromuscular issues
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2
Q

What are the contraindications for physical assessment?

A
  • 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
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3
Q

What are the precautions for physical assessment?

A
  • High level of pain/irritability
  • Significant inflammation
  • Osteoporosis
  • Hypermobility
  • Newly united fracture
  • Following prolonged immobilisation
  • Haemophilia
  • Haematoma
  • Myositis ossification
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4
Q

What should you do when there are precautions for physical assessment?

A
  • Assess AROM & PROM to P1 only
  • Be wary of applying overpressure
  • Be careful when assessing ROM in vulnerable positions
  • Assess strength to P1 only
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5
Q

What are the 3 key elements of determining irritability of symptoms?

A
  • Amount
  • Severity
  • Duration
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6
Q

What should you do for high irritability?

A
  • Active ROM to onset of pain
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7
Q

What should you do for low irritability?

A
  • Active ROM to as far as they can
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8
Q

What are the features of active ROM (AROM)?

A
  • Client produces movement by themselves
  • Reflects joint range & muscle strength
  • Assessed against/across gravity
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9
Q

What are the features of passive ROM (PROM)?

A
  • Client relaxes, therapist performs movement
  • Reflects joint range but not strength
  • Gives info about resistance during movement and end feel
  • Gravity irrelevant
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10
Q

What is active-assisted ROM?

A
  • 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
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11
Q

What are the principles of assessing ROM?

A
  • 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
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12
Q

What are the normal end feels?

A
  • Hard (bony)
  • Soft (soft tissue apposition)
  • Firm (soft tissue stretch)
  • Capsular stretch
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13
Q

What are the abnormal end feels?

A
  • Hard (bone on bone)
  • Soft (boggy sensation)
  • Firm
  • Springy block (internal derangement)
  • Empty (no sensation felt)
  • Spasm (hard sudden stop)
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14
Q

What normally limits ROM?

A
  • Joint surfaces
  • Labrum
  • Capsule
  • Ligaments
  • Muscle length
  • Soft tissue apposition (e.g. calf hitting thigh)
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15
Q

What abnormalities limit normal ROM?

A
  • Pain
  • Swelling
  • Joint stiffness
  • Tight muscles
  • Weak muscles
  • Ligament laxity (excessive ROM)
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16
Q

What is stiffness?

A

Extent to which an object resists deformation in response to force

17
Q

What can stiff joints and tight muscles result from?

A
  • Injury/disease
  • Disuse
  • Immobilisation
  • Poor posture
  • Inadequate movement/stretching
18
Q

How are stiff joints and tight muscles similar?

A

Both present with limited AROM & PROM

19
Q

How are stiff joints detected?

A
  • Palpation

- Passive accessory movements

20
Q

How are tight muscles detected?

A
  • Palpation

- Muscle length tests (stabilise one end of muscle, move other)

21
Q

What joint structures can cause pain due to injury, inflammation or disease?

A
  • Joint capsule
  • Ligaments
  • Entheses
  • Synovium
  • Bursa
  • Periosteum
  • Subchondral bone
22
Q

Why do muscles become tight?

A

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

23
Q

What is spasticity?

A

Velocity-dependent restriction of movement due to increased tendon reflex in response to stretching

24
Q

What is spasticity usually present with?

A

Excess muscle tone (hypertonia)

25
Q

How is spasticity assessed?

A

Tardieu scale - assess range at 3 different velocities

26
Q

What are P1, P2, R1 & R2?

A

P1: First sign of pain/discomfort
P2: Final limiting pain
R1: First sign of resistance
R2: Final limiting resistance

27
Q

What are the principles for assessing muscle length?

A
  • 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
28
Q

What level of pain should you move the patient to if they are highly irritable?

A

P1

29
Q

What is an isokinetic contraction?

A

Concentric/eccentric contraction with constant velocity

30
Q

What factors affect muscle strength?

A
  • Fibre type
  • Fibre diameter
  • Muscle size
  • Force-velocity relationship
  • Length-tension relationship
  • Muscle architecture
31
Q

Why can muscles become weak?

A
  • Neurological injury/disease
  • Pain/injury to muscle/tendon
  • Joint pain/stiffness
  • Immobilisation/atrophy
  • Overuse of muscle
  • Prolonged elongation
32
Q

How can muscle weakness be identified?

A
  • AROM
33
Q

How is isometric muscle strength assessed?

A
  • Hold joint in mid range
  • Ask patient not to let you move them
  • Try and move joint into range, gauge level of resistance
34
Q

How is isotonic muscle strength assessed?

A
  • 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
35
Q

What are the Oxford grades of muscle strength?

A
  1. No movement/activation
  2. Flicker of movement
  3. Full ROM without gravity
  4. Full ROM against gravity
  5. Full ROM against resistance
  6. Full ROM against strong resistance

NMI (9 decks)

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