Assessment Skills Flashcards
What is Muscle Insufficiency?
When a muscle cannot exert normal force or bring normal movement of the part to which it is attached.
Active Insufficiency vs. Passive Insufficiency
- Active Insufficiency = When a prime mover (agonist) becomes shortened to the point that it cannot generate or maintain active tension.
When a two joint muscle cannot shorten enough to move through full ROM at all joints crossed simultaneously.
(Ex: Maximally extend your knee, then flex your hip / Maximally flex your wrist, then make a fist).
- Passive Insufficiency = When a two-joint muscle cannot lengthen to the extent required to allow full ROM of all joints it crosses simultaneously.
(**Ex: **Unable to achieve normal ankle dorsiflexion with full knee extension (passive gastroc insufficiency / unable to flex trunk without bending knees (passive hamstring insufficiency)
Two options for Muscle Strength Testing?
- Manual Muscle Testing (MMT) = Easy and efficient way to assess strength.
- Dynamometry = More objective, Takes more time, Requires equipment
How to Perform a Manual Muscle Test?
- Put the patient in the appropriate test position. Think about what the muscle does.
- Position yourself to maximize force.
- Instruct your patient to go through full AROM. ***If **patient has full AROM, place the limb in mid range and apply resistance. **If **patient does not have full AROM, put the patient in gravity-reduced position and assess how much they can actively move.
- Grade the test
Grading Strength:
Grade = ?
Description = No palpable muscle contraction
Grade = 0/5 (zero)
Grading Strength:
Grade = ?
Description = Palpable muscle contraction
Grade = 1/5 (Trace)
Grading Strength:
Grade = ?
Description = Partial ROM in gravity-reduced position
Grade = 2-/5
Grading Strength:
Grade = ?
Description = Completes ROM in a gravity-reduced position / Partial ROM in gravity.
Grade = 2/5 (Poor)
Grading Strength:
Grade = ?
Description = Able to move through > 50% ROM against gravity
Grade = 3- /5 (Fair Minus)
Grading Strength:
Grade = ?
Description = Completes movement against gravity; no resistance
Grade = 3/5 (Fair)
Grading Strength:
Grade = ?
Description = Full anti-gravity ROM and able to hold minimal resistance
Grade = 3+/5 (Fair Plus)
Grading Strength:
Grade = ?
Description = Full anti-gravity ROM and breaks between minimal and moderate resistance.
Grade = 4- /5
Grading Strength:
Grade = ?
Description = Full anti-gravity ROM and able to hold moderate resistance
Grade = 4/5 (Good)
Grading Strength:
Grade = ?
Description = Full anti-gravity ROM and breaks between moderate and maximum resistance
Grade = 4+/5
Grading Strength:
Grade = ?
Description = Full anti-gravity ROM and able to hold maximum resistance
Grade = 5/5 (Normal)
3 Normal End-Feels
**End Feel **= Type of resistance you encounter when passively moving a joint through ROM
- Firm or Capsular (stretch), ( when in doubt = firm) - Finger extension
- Hard (bone to bone) - Elbow extension
- Soft (soft tissue approximation) - Elbow flexion
Abnormal End-Feels
- Empty (cannot reach end feel, usually because of pain) / Ex: Joint inflammation, Fracture, Bursitis
- Firm / Ex: Increased tone, Tightening of the capsule, Ligament shortening
- Hard (elbow ext / supination) Fracture / Ex: OA or osteophyte formation
- Soft / Ex: Edema, Synovitis, Ligament instability or tear
Grading Joint Play
- 0 = ankylosed - fused
- 1 = significant hypomobility
- 2 = hypomobility
- 3 = normal
- 4 = hypermobility
- 5 = significant hypermobility
- 6 = subluxation
M.R.S.
- M = Myotomes
- R = Reflexes
- S = Sensation
Assessing M.R.S.
Myotome Testing
- Myotome = A set of muscles innervated by a single spinal nerve
- We do not grade like with MMT
- We compare right to left:
- Absent
- diminished
- symmetrical (WNL),
- asymmetrical
Assessing M.R.S.
Reflexe Testing
- Observe the excursion of the distal segment
- Grading Scale:
- 0 = No response, always abnormal
- 1+ = A slight but present response; may or may not be normal
- 2+ = A brisk response; normal
- 3+ = A very brisk response; may or may not be normal
- 4+ = A tap elicits a repeating reflex (clonus); always abnormal; always abnormal.
- Clonus = repetitive movement
Sensation
How to test Dermatomes
- Show patient what it feels like in an area you aren’t formally testing (Select an area that is NOT compromised).
- Have the patient close his/her eyes
- Using equal pressure L and R, gently touch the area one side at a time (Use consistent cues and questions, Ex: “Does this feel the same on both sides?”).
Dermatome = An area of skin that a single nerve innervates.
Gives information about a spinal level that may have a lesion: Absent, diminished, symmetrical (WNL), asymmetrical.
Summary of Grading:
Reflexes
Summary of Grading:
MMT
Summary of Grading:
Sensation
Summary of Grading:
Myotomes
Summary of Grading:
ROM
Summary of Grading:
Joint Play
