Clinical Assessment (palpation)

Question 1

palpation is

Answer 1

skillful art of assessing the quality @ structural characteristics of the human body.

Anatomical palpation
Sensory palpation

Question 2

4 Ts of palpation

Answer 2

temperature
texture
tone

tenderness

Question 3

what can temperature indicate

Answer 3

increased circulation

Question 4

what are some causes of increased temperature

Answer 4

increased circulation – INFLAMMATION as a result of IMMUNE response

by Fever – (IMMUNE response)

Question 5

texture

Answer 5

E.g.
ropey, bumping (E.g. TRIGGER POINTS)
spongey, hard (can refer to tonicity)

“stuck together” texture of scar tissue & restricted fascia

Question 6

tone?

Answer 6

how does muscle respond to stretch?

Does it lengthen easily or not?

does the muscle resist pressure

E.g.
Hypertone
Hypotone

Question 7

tenderness

Answer 7

guest/patient’s sensitivity to touch/pressure

some have higher tolerance

pain? soreness? tenderness?

Question 8

E.g. of informed consent for palpation

Answer 8

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

Question 9

palpation assessment – things to note

Answer 9

compare bilaterally

start on unaffected side

use flat hand firmly on unaffected tissue

feel for 4 Ts

Compare to affected side

Question 10

patient position during palpation assessment

Answer 10

seated/supine/prone – depends on area palpated

Question 11

remember to ____

Answer 11

always get feedback from patient – ask if there is pain/tension/discomfort/pressure, etc.

Question 12

remember to also ____ at the end

Answer 12

document your clinical findings

Question 13

MOVEMENT

Answer 13

A-ROM
P-ROM (& POP-ROM)
R-ROM

Question 14

note the relationship between range of motion – and contractile vs. Non-contractile tissue

Answer 14

AROM is assessing contractile & non-contractile tissue

PROM is assessing non-contractile tissue

RROM is assessing contractile tissue only

Question 15

definition of RANGE OF MOTION

Answer 15

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.”

Question 16

Note 5th type of ROM (Not covered in this course)

Answer 16

AA-ROM

active assisted range of motion

Question 17

AROM

Answer 17

active contraction of muscle crossing the joint

unaffected then affected

Question 18

what is the therapist looking for during AROM assessment?

Answer 18

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.

Question 19

Very important note about ROM assessments. Always pay attention to patient’s _____.

Answer 19

facial expressions

Question 20

other things to watch for during AROM assessment

Answer 20

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

Question 21

AROM vs PROM – which produces more movement?

Answer 21

PROM

Question 22

what is the primary limiting factor of P-ROM (& POP-ROM) ?

Answer 22

PROM & POPROM are primarily limited by PAIN

Question 23

what to observe during PROM assessment?

Answer 23

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)

Question 24

note hypo/hypermobility during PROM assessment

Answer 24

PROM can be performed if there is hypo/hyper-mobility

avoid overstretching hypermobility

avoid trying to push past limited ROM w/ hypomobility

Question 25

different types of END feels for passive ROM

Answer 25

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

Question 26

normal vs abnormal/pathological JOINT END FEELS

Answer 26

bone to bone = elbow extension

soft tissue approximation = knee flexion

tissue stretch = ankle dorsiflexion, finger extension, shoulder LR

Question 27

abnormal/pathological JOINT END FEELS

Answer 27

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)

Question 28

POPROM

Answer 28

only if painless PROM

Question 29

RROM assessment uses

Answer 29

isometric contraction

Question 30

RROM 2 protocols

Answer 30

protocol 1 = Magee (test @ neutral position)

protocol 2 = Kendall (test @ mid-range)

Question 31

RROM purpose

Answer 31

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)

Question 32

observations during RROM

Answer 32

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

Question 33

AAROM (?)

Answer 33

rehabilitation for MVA, sports trauma, falls, etc.

patient requires assistance regaining full ROM

Question 34

A VERY IMPORTANT NOTE ABOUT EXPLAINING THE PROCEDURE

Answer 34

MAKE SURE TO EXPLAIN THE PROCEDURE OF AROM, PROM, RROM to the patient, so they understand what the procedure consists of (and purpose?)

Question 35

another important thing the patient should be reminded of

(PAIN FREE RANGE)

Answer 35

ALL MOVEMENT SHOULD BE DONE IN PAIN-FREE ZONE

Instruct patient/guest to not move to/past the point of pain

Question 36

something else to be observant of

(BASELINE OF MEASUREMENTS)

Answer 36

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

Question 37

Be sure to reference charts demonstrating NORMAL ROM in order to know when a particular ROM is not within normal limits

Answer 37

.

Question 38

on charting (star diagram) what notation is used for different types of ROM?

Answer 38

AROM with squiggly line

PROM with straight line