End Feels and Contraindications

Question 1

Endfeels

Answer 1

The sensation that is imparted to the examiner by the resisting tissues at the end of the available range

Question 2

Capsular Endfeel

Answer 2

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

Question 3

Capsular Endfeel Examples
Normal
Abnormal

Answer 3

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

Question 4

Bony Endfeel

Answer 4

Limitation caused by bone to bone approximation
Feels quick, abrupt and unyielding
Push on it further- something will break or dislocate

Question 5

Boy Endfeel Examples
Normal
Abnormal

Answer 5

Normal: elbow extension
Abnormal: jt with osteophytes

Question 6

Soft Tissue Approximation Endfeel

Answer 6

Limitation caused by the contact of 2 muscle bellies
Feels soft and yielding
Push on it further, there is aome initial give

Question 7

Soft Tissue Approximation Endfeel

Normal

Answer 7

Normal: knee flexion, elbow flexion

Question 8

Elastic Endfeel

Answer 8

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

Question 9

Elastic Endfeel Examples
Normal
Abnormal

Answer 9

Normal: wrist flexion with fingers flexed
Abnormal: adaptively shortened jt, like an ankle out of a cast

Question 10

Springy Endfeel

Answer 10

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

Question 11

Springy Endfeel Examples
Normal
Abnormal

Answer 11

Normal: compression of the cervical spine
Abnormal: knee flexion or compression with damaged meniscus

Question 12

Spasm Endfeel

Answer 12

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

Question 13

Boggy Endfeel

Abnormal

Answer 13

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

Question 14

Empty Endfeel

Abnormal

Answer 14

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

Question 15

Contraindication

Answer 15

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

Question 16

Hard 3 Contraindications

Answer 16

Inappropriate endfeel
No time to assess the condition
The patient doesn’t want you to do it

Question 17

Other Contraindications

Answer 17

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)

Question 18

Precautions- Go Gently

Answer 18

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

Question 19

Mandatory Q’s

Answer 19

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)

Question 20

The Masquraders

Answer 20

AT 1st line of defense
Patient appropriate for our therapy?
Do not cause mass panic

Question 21

Neoplasm Characteristics

Answer 21

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)

Question 22

Coxal joint end feel

Answer 22

Flexion: tissue approximation
Extension: tissue stretch
Abduction: tissue stretch
Adduction: tissue approximation
Lateral rotation: tissue stretch or capsular
Medial rotation: tissue stretch or capsular

Question 23

Tibiofemoral end feel

Answer 23

Flexion: tissue approximation
Extension: tissue stretch
Medial rotation: tissue stretch
Lateral rotation: tissue stretch

Question 24

Talocrual end feel

Answer 24

Dorsiflexion: tissue stretch
Plantarflexion: tissue stretch

Question 25

Subtalar end feel

Answer 25

Supination: tissue stretch
Pronation: tissue stretch

Question 26

Metaphalangeal, Interphalangeal end feel

Answer 26

Tissue stretch in all directions

Question 27

Shoulder complex end feel

Answer 27

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

Question 28

Scapulohumeral rhythm

Answer 28

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