Clinical Assessment (palpation) Flashcards
palpation is
skillful art of assessing the quality @ structural characteristics of the human body.
Anatomical palpation
Sensory palpation
4 Ts of palpation
temperature
texture
tone
tenderness
what can temperature indicate
increased circulation
what are some causes of increased temperature
increased circulation – INFLAMMATION as a result of IMMUNE response
by Fever – (IMMUNE response)
texture
E.g.
ropey, bumping (E.g. TRIGGER POINTS)
spongey, hard (can refer to tonicity)
“stuck together” texture of scar tissue & restricted fascia
tone?
how does muscle respond to stretch?
Does it lengthen easily or not?
does the muscle resist pressure
E.g.
Hypertone
Hypotone
tenderness
guest/patient’s sensitivity to touch/pressure
some have higher tolerance
pain? soreness? tenderness?
E.g. of informed consent for palpation
Case scenario: soreness in right lower back
“Based on the information you provided in this interview, I would like to do an assessment called Palpation. This is where I would palpate, meaning touch, your lower back. I like to compare the unaffected side and the affected. I would be feeling the tone, the temperature of your skin, texture, and the tenderness of your lower back.”
Pain scale
Do you have any questions?
Do I have your consent
palpation assessment – things to note
compare bilaterally
start on unaffected side
use flat hand firmly on unaffected tissue
feel for 4 Ts
Compare to affected side
patient position during palpation assessment
seated/supine/prone – depends on area palpated
remember to ____
always get feedback from patient – ask if there is pain/tension/discomfort/pressure, etc.
remember to also ____ at the end
document your clinical findings
MOVEMENT
A-ROM
P-ROM (& POP-ROM)
R-ROM
note the relationship between range of motion – and contractile vs. Non-contractile tissue
AROM is assessing contractile & non-contractile tissue
PROM is assessing non-contractile tissue
RROM is assessing contractile tissue only
definition of RANGE OF MOTION
end-to-end distance of a specific joint movement which is structurally possible
“The term Range of Motion refers to the degree of motion that is present in a joint.”
Note 5th type of ROM (Not covered in this course)
AA-ROM
active assisted range of motion
AROM
active contraction of muscle crossing the joint
unaffected then affected
what is the therapist looking for during AROM assessment?
is action/movement correct?
can patient complete full ROM?
is there visible compensation w/ other muscles? (???)
FACIAL EXPRESSION OF GUEST
quality of movement? smooth? consistent? gradual? choppy? etc.
Very important note about ROM assessments. Always pay attention to patient’s _____.
facial expressions
other things to watch for during AROM assessment
When and where during each of the movements the onset of pain occurs
Whether the movement increases the intensity and quality of the pain
The reaction of the patient to pain
The amount of observable restriction and its nature
The pattern of movement
The rhythm and quality of movement
The movement of associated joints
The willingness of the patient to move the part
AROM vs PROM – which produces more movement?
PROM
what is the primary limiting factor of P-ROM (& POP-ROM) ?
PROM & POPROM are primarily limited by PAIN
what to observe during PROM assessment?
when/where does pain begin?
does movement increase intensity?
pattern of movement limitation?
ROM available?
END FEEL?
(NOTE THAT POPROM IS ESP EFFECTIVE FOR ASSESSING END FEEL)
note hypo/hypermobility during PROM assessment
PROM can be performed if there is hypo/hyper-mobility
avoid overstretching hypermobility
avoid trying to push past limited ROM w/ hypomobility
different types of END feels for passive ROM
Normal ROM – typical tissue approximation
Boggy – soft/swollen, w/ edema (?)
leathery – feeling of “stretching leather belt”
firm – hard/dense tissue, w/ poor movement
bony – bone on bone feeling
normal vs abnormal/pathological JOINT END FEELS
bone to bone = elbow extension
soft tissue approximation = knee flexion
tissue stretch = ankle dorsiflexion, finger extension, shoulder LR
abnormal/pathological JOINT END FEELS
early muscle spasm (protective spasm following injury)
late muscle spasm (spasm via instability/pain)
“Mushy” tissue stretch (tissue stretch)
spasticity (upper motor neuron lesion)
hard capsular (frozen shoulder)
soft capsular (synovitis)
bone to bone (osteophyte)
empty (PAIN. E.g. acute subacromial bursitis)
springy block (meniscus tear)
POPROM
only if painless PROM
RROM assessment uses
isometric contraction
RROM 2 protocols
protocol 1 = Magee (test @ neutral position)
protocol 2 = Kendall (test @ mid-range)
RROM purpose
to test the general strength of all the muscles that cross the joint in general
(ALSO TESTING FOR PAIN)
(in contrast to MMT which tests a specific muscle)
(or MYOTOME TESTING – which tests CNS)
(or MUSCLE SETTING – which is for the purpose of realigning the fibres of a muscle or muscle group)
observations during RROM
quality of RROM
patient weak or strong?
compensating muscles detected?
PAIN?
can the patient complete RROM (or give in?)
–> if give in, consider myotome testing (???)
And again – MONITOR FACIAL EXPRESSION
AAROM (?)
rehabilitation for MVA, sports trauma, falls, etc.
patient requires assistance regaining full ROM
A VERY IMPORTANT NOTE ABOUT EXPLAINING THE PROCEDURE
MAKE SURE TO EXPLAIN THE PROCEDURE OF AROM, PROM, RROM to the patient, so they understand what the procedure consists of (and purpose?)
another important thing the patient should be reminded of
(PAIN FREE RANGE)
ALL MOVEMENT SHOULD BE DONE IN PAIN-FREE ZONE
Instruct patient/guest to not move to/past the point of pain
something else to be observant of
(BASELINE OF MEASUREMENTS)
note starting on unaffected side
Not JUST for preparing nervous system on affected side
But also – OBSERVE movement of unaffected side, and COMPARE the movement on the affected side to the movement on the unaffected side
Be sure to reference charts demonstrating NORMAL ROM in order to know when a particular ROM is not within normal limits
.
on charting (star diagram) what notation is used for different types of ROM?
AROM with squiggly line
PROM with straight line
