Evaluation - 3 Flashcards
objective: observing the sources of the sxs
what do we use to observe the sxs
ROM
tissue characteristics
special tests
ROM
selective tissue tension testing
PROM
AROM
resistive
PROM –> ROM
cardinal planes of movement
accessory movements/joint play
generic options for dx
musculotendinous
capsulo-ligamentous
intra-articular
extra-articular
selective tissue testing includes
resistive, AROM, passive accessory and passive physiologic ROM
what do we consider when assessing ROM
3 Rs
reactivity
range
resistance
reactivity –> 3 Rs
does it hurt
comparable signs
range –> 3 Rs
too much
just right
too little
resistance –> 3 Rs
quality good v. bad
end feel
AROM range
more important is patterns of loss
capsular patterns
AROM reactivity
how easily is it aggravated?
how quickly does it settle down?
does it effect activity/participation?
pain is a –> AROM reactivity
comparable sign
AROM reactivity –> pain location and behavior
painful arc
end range pain
through the range pain
AROM resistance –> quality
smooth at all speeds
antagonists relax
no restraint to movement
no compensations
no joint noise
physiologic ROM
osteokinematic
what is physiologic ROM
bone motion (volitional)
generally rolling of bone
accessory ROM
arthrokinematics
what is accessory ROM
gliding, distraction and spinning
not volitional
assess after physiologic
how do we assess ROM
active
physiologic (PROM)
accessory (PROM)
how is physiologic done
through the range
what does physiologic eliminate
muscle contraction
how is passive physiologic graded
over pressure at end range
grading –> passive physiologic
easy <–> medium <–> hard
end feel (resistance)
reactive
range
big picture –> range
hypo
normal
hyper
big picture –> resistance
normal end feel
abnormal end feel
big picture –> reactivity
No or yes
assessing range
angles can be measures
what needs to be measured
compare with AROM
Passive movement
normal
dysfxnal
normal passive movement
PROM > AROM
no joint noise
all muscles relax
pain free
dysfxnal passive movement
PROM = AROM
joint noise
muscle guarding
painful
reactivity words
pain?
where?
comparable?
assessing reactivity –> pain before resistance
high reactive
assessing reactivity –> pain w/ resistance
moderate reactive
assessing reactivity –> pain after resistance
low reactive
what is reactivity during PROM testing often d/t
tension
assessing location of reactivity
capsulo-ligamentous
musculo-tendinous
extra-articular
intra-articular
assessing resistance quality
types of end feels
types of end feels
normal
pathologic
normal end feels
bony
soft tissue
muscular
capsular
pathologic end feels
muscle spasm
boggy
empty
springy
accessory motion exam
gliding and distraction
gliding and distraction –> accessory motion exam
tx plane
open pack or resting position
pt relaxed (pt should not hold)
external stabilization
force applied close to joint
tx plane –> gliding and distraction –> accessory motion exam
gliding –> parallel
distraction –> perpendicular
quick screen for accessory motion
3 R’s
-range
-resistance
-reactivity
quick screen for accessory motion –> range
less
normal
more
quick screen for accessory motion –> resistance
soft
normal
hard
quick screen for accessory motion –> reactivity
pain
location
comp
assessing range using
descriptive score and paris score
assessing range –> ankylosed
paris score: 0
descriptive score: no movement
assessing range -> considerable limitation
paris score: 1
descriptive score: major motion loss
assessing range –> slight limitation
paris score: 2
descriptive score: minor motion loss
assessing range –> normal
paris score: 3
descriptive score: normal
assessing range –> slight increase
paris score: 4
descriptive score: minor hypermobility
assessing range –> considerable increase
paris score: 5
descriptive score: major hypermobility
assessing range –> pathological increase
paris score: 6
descriptive score: unstable
resistance to movement =
end feel
what is resistive tesing
not an MMT
not intended to score their strength
snapshot strong or weak
snapshot pain or pain free
keys to resistive testing
isolate
isometric
increase (ramp up, light –> max)
where should we isolate –> resistive testings
in mid range
one joint at a time
how should we do resistive tests
in one position
how should we increase resistance
slowly
start easy –> resist harder –> work to maximal contraction
when should we stop the resistive test
until it hurts
once a contraction is painful
STTT helps us identify
the source of the sxs
musculotendinous and bursa general guidelines
somatic pain
pain w/ contraction and stretch
capsuloligamentous general guidelines
somatic pain
worse at ends of range/stretch
accessory PROM –> end feel
ligamentous stress test
active ROM = passive ROM
intra-articular general guidelines
somatic pain
locking and clicking
end feel –> springy
special tests
extra-articular general guidelines
neurogenic pain
stirs up easy, hard to ease
pain w/ tension
neurodynamic testing
