End Feels and Contraindications Flashcards
Endfeels
The sensation that is imparted to the examiner by the resisting tissues at the end of the available range
Capsular Endfeel
Limitation caused by capsule or ligamentous tissues
Solid (well defined end point- described as leathery)
Feels as though if you pushed harder on it, something would tear
Capsular Endfeel Examples
Normal
Abnormal
Normal: wrist flexion (soft capsular endfeel)
knee extension (a hard capsular endfeel)
Abnormal: too soft- hypermobility
too hard- arthrosis
end point is too early or late in the range
Bony Endfeel
Limitation caused by bone to bone approximation
Feels quick, abrupt and unyielding
Push on it further- something will break or dislocate
Boy Endfeel Examples
Normal
Abnormal
Normal: elbow extension
Abnormal: jt with osteophytes
Soft Tissue Approximation Endfeel
Limitation caused by the contact of 2 muscle bellies
Feels soft and yielding
Push on it further, there is aome initial give
Soft Tissue Approximation Endfeel
Normal
Normal: knee flexion, elbow flexion
Elastic Endfeel
Limitation caused by soft tissue stretch by adaptive shortening of the muscle tendon unit
Feels stretchy and recoils when the tension is taken off it
Push further it feels like something will snap
Elastic Endfeel Examples
Normal
Abnormal
Normal: wrist flexion with fingers flexed
Abnormal: adaptively shortened jt, like an ankle out of a cast
Springy Endfeel
Limitation caused by the articular surface rebounding from contact and compression of an intra-articular meniscus or disc
Feels like pushing up against a rubber pad-block movement
Push farther something will get pinched or it will collapse
Springy Endfeel Examples
Normal
Abnormal
Normal: compression of the cervical spine
Abnormal: knee flexion or compression with damaged meniscus
Spasm Endfeel
Abnormal endfeel
Limitation caused by a reflexive reactive muscle contraction initiated by irritation of articular or muscular nociceptors
Feels very abrupt, twang, end to the mov’t- often speed dependent
Push father nothing will give
CANNOT get a true endfeel in the presence of spasm
Boggy Endfeel
Abnormal
Abnormal: Limitation produced by fluid within the joint
Feels squishy sensation at the limitation of the mov’t
Keep pushing on it it will feel like something will burst
Empty Endfeel
Abnormal
Patient limits the mov’t due to pain and there is no discernible endfeel approached yet
No feel yet- haven’t reached the end
Not to be confused with the patient being apprehensive, when they RROM an empty endfeel is caused by serious pathology
Contraindication
Findings that will make it difficult to defend Some findings will make it difficult to defend a mob in front of a group of your peers if anything goes wrong
Hard 3 Contraindications
Inappropriate endfeel
No time to assess the condition
The patient doesn’t want you to do it
Other Contraindications
Malignancy, anticoagulant or steroid use Fx, dislocation, sign of buttock spinal cord lesions, congenital abnormalities Cauda Equin lesions, VT artery disease Multiple nerve root involvement Rheumatoid collagen necrosis Active bone disease, CV lig instability Acute Inflam or infective process Fully closed pack position Supra cervical problems (cant make decision)
Precautions- Go Gently
Neurological signs Mod-severe radiating P Constant or continuous undiagnosed pain Acute signs or acute capsular pattern Severe mov't loss, Severe recent trauma Severe headache, dizzy, noncardinal signs Hypermobility Prolonged immobilization RA, OP, Spondylosis (listhesis) Pregnancy Hx of maligancy Past steroid, anticoagulant use
Mandatory Q’s
Drop attacks (indicate VT artery occlusion, heart issues, vestibular or cerebellar disease)
Dizziness (can indicate VT artery occulsion, vestibular or cerebellar disease
URTI (can affect stability of upper jts- acute hyperaemic lig laxity ~2 weeks)
RA (affects CV lig instibiliy- 40% of RA have neck involved often on steroids)
Anticoagulants (manual tecq can cause lesions be gentle)- associated with OP
Steroid use (affect the strength of CT, also cause OP)
Bladder and Bowl Function (bladder is more sensitive question as it supplied by S3,S4)
Saddle Paraesthesia (S3,S4 indicates caua equina involvement= possible massive tumor)
Night Pain (constant and unrelenting- tumor? unable to get comfortable)
The Masquraders
AT 1st line of defense
Patient appropriate for our therapy?
Do not cause mass panic
Neoplasm Characteristics
Constant unrelenting P worse @ night Severe guarding spasm Expanding P Empty endfeel Signs worse than symptoms Upper limb radiation with coughing 1 or 2nd lumbar nerve root palsy 1 or 2 C-roots affected 3+ Lumbar roots affected bilateral signs weakness of hand intrinsic M causless lower thoracic P in elderly (stress Fx) bilateral severe P with limited side flexion (T-Fx)
Coxal joint end feel
Flexion: tissue approximation
Extension: tissue stretch
Abduction: tissue stretch
Adduction: tissue approximation
Lateral rotation: tissue stretch or capsular
Medial rotation: tissue stretch or capsular
Tibiofemoral end feel
Flexion: tissue approximation
Extension: tissue stretch
Medial rotation: tissue stretch
Lateral rotation: tissue stretch
Talocrual end feel
Dorsiflexion: tissue stretch
Plantarflexion: tissue stretch
Subtalar end feel
Supination: tissue stretch
Pronation: tissue stretch
Metaphalangeal, Interphalangeal end feel
Tissue stretch in all directions
Shoulder complex end feel
Flexion: tissue stretch
Abduction: bone to bone or tissue stretch
Lateral rotation: tissue stretch
Medial rotation: tissue stretch
Extension of the arm: tissue stretch
Adduction of the arm: tissue approximation
Cross flexion: tissue stretch or approximation
Abduction of the arm: tissue stretch
Scapulohumeral rhythm
Phase 1: humerus 30 abduction, scapula minimal movement, clavicle 0-5 elevation
Phase 2: humerus 40 abduction, scapula 20 rotation with minimal protraction or elevation, clavicle 15 elevation
Phase 3: humerus 60 abduction with 90 lateral rotation, scapula 30 rotation, clavicle 30-50 posterior rotation with up to 15 elevation
