Chapter 1 Purpose, Definitions and Rules (page 2) Flashcards
Identify the purpose(s) of assessment.
- To identify the physical structures responsible for the client’s symptoms. With orthopedic conditions, the examiner aims to perform a physical test (or tests) that duplicates exactly the symptoms of which the patient complains. It is not always possible to identify a primary lesion.
- To assess the function of all related tissues and structures. (This includes those resulting from and predisposing to the primary complaint.)
- To assess the ability of the client to perform daily activities.
________________ is where the distance between the origin and insertion of the muscle increases.
ECCENTRIC contraction
_______________ is where the distance between the origin and insertion of the muscle decreases.
CONCENTRIC contraction
________________ is the type muscle contraction without change in the force of contraction.
ISOTONIC
This is the type of muscle contraction without a change in distance in the length of the muscle.
Isometric Contraction
_________: A group of muscles innervated from a single spinal nerve root.
Myotome
_____________ involves resisting the action of the specific muscle innervated by a particular nerve root.
Myotome Testing
____________: an area of bone, joint, or ligament innervated from a single spinal nerve root.
Sclerotome
____________ refers to the area of skin supplied with afferent nerve fibres by a single posterior spinal root.
Dermatome
Dermatomal sensory testing is performed with a _________, ________ or _____________ to assess the patency of a single spinal nerve.
Cottonball
Pinwheel
Reflex Hammer
__________________: a reflected action or movement, where a stimulus is sent to the spinal cord and relayed back to a muscle via a lower motor nerve, used to evaluate the integrity of the nerve supply of specific nerve roots in the area being tested.
DEEP TENDON REFLEX (DTR)
_________________ involves the patient’s movement of a joint through its entire range without assistance.
ACTIVE RANGE OF MOTION TESTING
(AROM or AF-Mobility)
___________________ involves the therapist attempting to move the joint through its entire range of motion without assistance from the patient.
PASSIVE RANGE OF MOTION TESTING
(PROM or PR-Passive Relaxed)
Identify 3 things that a therapist should observe during the movement (AROM).
- The patient’s willingness to move the joint.
- Where, in the range there is onset of pain or restriction.
- How the affected side’s range, compares to the unaffected side.
Identify 3 things that a therapist should observe during the movement (PROM).
- Where in the range there is onset of pain or restriction.
- How the point of onset of pain or restriction compares to ACTIVE range.
- How the affected side’s range compares to the unaffected side.
_____________ is a type of range of motion that challenges soft tissues and the joint. It is used to assess ___________.
PASSIVE FORCED (PF)
END-FEELS
__________________ involves the contraction of muscle against resistance supplied by the examiner.
RESISTED TESTING (ARROM)
Identify at least 3 rationale for the use of ARROM.
- To assess for lesions in muscle and tendon
- To test nervous innervation of muscle
- To assess strength
________ is a small additional force exerted by the therapist when the AROM and PROM are not full to lengthen muscles, tendons, ligaments, joint capsule.
Stretch
____________ is a force exerted by the therapist at the end of an _____ to take the movement passively through to the normal end of _____; it enables the examiner to assess the “end-feel” of the movement without performing PROM; may only be used on ___________.
OVERPRESSURE
AROM
PROM
PAIN-FREE AROMs
When assessing for lesions in muscle and tendon, the examiner resists an isometric contraction with the joint in a neutral position so as to __________________.
**Slacken the capsule and non-contractile tissue **
As long as no movement occurs across the joint, increased pain associated with isometric testing in neutral can be reasonably attributed to ____________.
Muscle or Tendon
To test for nervous innervation of muscle, longer contractions against resistance are used (5 seconds or longer). Why is this so?
This is because myotomal weakness takes time to develop, and may not be evident with resistance of shorter duration.
What are the guidelines when it comes to performing isotonic testing?
- Maintain uniform resistance.
- Test through complete range.
- Speed of movement must be constant.
- Resistance is opposite to direction of motion.
- Limit movement to, and apply resistance across, one joint.
- Fix proximal structures firmly.
- Don’t press on muscle, belly or tendon.
________________ are used to test many conditions, orthopedists have developed complicated maneuvers which may combine AF, PR and AR. These are all designed to provoke the tissues in order to recreate the signs of symptoms of specific pathologies.
SPECIAL ORTHOPEDIC TESTS
What are the three normal (healthy) end-feels?
Bone to bone
Soft-tissue approximation
Tissue stretch
There are six abnormal end-feels, which indicate problems in tissues in or around the joint. Enumerate them.
Spasm
Boggy (a.k.a. soft capsular)
Capsular
Bony block
Springy block
Empty
This occurs when the movement is stopped due to pain. No mechanical resistance is felt by the examiner.
Empty End-feel
____________: A firm springy resistance with a slight rebound. It occurs in an unusual place in the range and is associated with torn menisci, or loose bodies in the joint.
Springy Block
____________: A hard resistance that feels like bone to bone but occurs earlier in the range than expected.
Bony Block
__________: A firm springy resistance that feels like tissue stretch, but occurs earlier in the range than expected. It is associated with _____________ and is often described as leathery.
Capsular
Chronic capsular conditions
_____________: A soft resistance throughout the range due to edema associated with ___________________.
Boggy (a.k.a. soft capsular)
Acute and sub-acute inflammation
_______: A sudden dramatic stoppage in movement, ‘vibrant twang’. It is usually accompanied with pain, and can occur anywhere in the range.
Spasm
_______________: An unyielding hard sensation that happens quickly in the range.
Bone to bone
_________________: This softer yielding happens over a slightly longer portion of the range.
Soft-tissue approximation
_______________: There is firm springy resistance with a slight permissible movement. Progressively greater force meets greater resistance.
Tissue stretch
The quality of tissue resistance toward passive end range is called _________. It gives information about the health of the tissues being stretched or compressed.
End-feel
During physical examination, the examiner varies the forces by changing:
The amount of ef fort
Duration of application
Speed of application
Frequency
Location
Direction
Type of movement which generates the force.
_______ movement that reproduces symptoms from a muscle lesion often has no effect when done ___________.
Active
Passively
Myotome testing is held for minimum ___ secs. TOS
testing is held for up to ___ secs.
5
60
To elicit pain from low-grade tendonitis, it may be necessary to ____________ contractions as a way to vary force by the examiner.
Repeated Resisted
___________ must be used to carefully provoke the client’s symptoms, but _____________ may cause further damage and must be avoided.
Sufficient force
Excessive force
For both active and passive movements the following responses should be noted:
Where during the range of motion the pain begins.
How the motion affects its quality and intensity.
The pain distribution.
The client’s reaction.
For resisted isometric contractions the therapist would note from the response accordingly:
The positions of resistance which reproduce the pain.
How the strength of contraction affects its quality and intensity.
The pain distribution.
The client’s reaction.
______ evoked in response to the test forces will vary in quality according to the tissue which is inflamed, and may exhibit classic patterns of distribution.
Pain
TRUE or FALSE:
When a lesion affects the entire capsule, most movements will equally be limited eventually.
FALSE.
(It is incorrect to state that all movements are affected
‘equally’ in a capsular pattern of restriction).
In a chronic capsular lesion of the glenohumeral joint, _________________ will be lost first. As the capsule degenerates further, ___________ will be lost. This pattern of limitation constitutes the ‘capsular pattern of restriction’ for the glenohumeral joint.
Lateral Rotation and Abduction
Medial Rotation
When an inflammatory process affects an entire joint capsule, ____________ movements become ___________ in the same pattern.
Active and passive
Restricted (or limited)
All joints have two main positions associated with joint capsule tension. What are the proper terms for these positions?
Closed or tight packed positions
Open or loose packed positions
___________ - any position that is not closed, the joint capsule is the most relaxed, resting position is often a loose packed position and therefore the position that is sought after when there is effusion. Joint play is _________ in this position.
Open-packed position
Increased
____________ position is achieved when articular surfaces are in maximum contact with each other, capsule and most ligaments are taut, joint surfaces are not easily separated.
Closed pack
The two positions (of joint capsule tension) are usually _________________ eg. if flexion creates a tight packed position then extension would create __________________.
Directly opposite of each other
Loose packed position
TRUE or FALSE:
In Testing, always test the NORMAL SIDE FIRST.
TRUE.
Unless simultaneous comparison is required or applicable.
In any region, the order of testing is usually:
______________
______________
______________
______________
______________
ACTIVE
PASSIVE
RESISTED
SPECIAL ORTHOPEDIC TESTS – if required.
NEUROLOGICAL TESTING – if required.
When testing for lesions in contractile tissue RESISTED ISOMETRICS MUST BE DONE WITH THE JOINT IN _________ POSITION.
Neutral
The assessment procedure is performed in four steps. These are _____, ______, ______, and ______.
- *History, Observation, Examination** and
- *Plan**
(The same four steps are sometimes named ‘subjective’, ‘objective’, ‘action’, and ‘plan’ and abbreviated as the acronym SOAP.)
The _______ solicits written/verbal information about the client’s specific complaint(s) and general state of health and therefore is subjective.
History
________ adds information obtained by visual inspection of the client standing (postural analysis) and walking (gait analysis).
Observation
The _______ identifies the etiology of the complaint, proposed methods of treatment and expected outcomes within a time frame and should be explained to the client after the assessment.
Plan
