Evaluation of Joint dysfunction Flashcards
What are the four components of a standard physical exam?
Look (observe), Touch (palpation), Tap (percussion), Listen (auscultation)
What are the 7 components of a physical exam of the NMS system?
Observe, ROM, Palpation, Muscle testing, Orthopedic testing, Neurologic testing, Percussion and Auscultation
What is the medical definition of subluxation?
A partial or incomplete dislocation.
What is the (basic) definition for subluxation in Chiropractic?
A dysfunctional joint (not just the spine) that can/ does affect the biomechanics.
What is subluxation syndrome?
A complex clinical syndrome with potential mechanical, inflammatory- vascular, and neurobiologic pathologic effects.
What are the 3 types of joint dysfunction?
Hypomobolity, Hypermobility, and Clinical joint instability
What is joint dysfunction?
Joint mechanics that show disturbances of function without structural or positional change- subtle mechanical joint alterations affecting quality and range of joint motions
What is joint fixation?
The state whereby an articulation has become temporarily immobilized in a position that it may normally occupy during any phase of physiologic movement.
What is joint restriction?
limitation of movement; or describes the direction oflimited movement in dysfunctional joints
What are the components of joint dysfunction/ subuxation?
P.A.R.T.S.
What does P.A.R.T.S. stand for?
Pain, Asymmetry, Range of motion abnormality, Tone/texture/temperature, and Special tests
What are the 3 (of the many) causes of joint dysfunction as seen in the clinical presentation?
Macrotrauma, Microtrauma, or Posture
What is an example of a macrotrauma?
Motor vehicle accident
What is an example of a microtrauma?
Repeated stress injury (carpal tunnel syndrome)
What is an example of poor posture for joint dysfunction?
Anterior head carriage
What is primary joint dysfunction?
The presence ofjoint pathomechanics without any further
pathophysiologic process.
What are the two examples of Joint dysfunction and disease being related?
Somatosomatic reflexes and Somatovisceral reflexes
What is a somatosomatic reflex?
When a primary somatic problem causes a secondary somatic problem
What is a somatovisceral reflex?
When a primary somatic problem causes a secondary visceral problem; or when a primary visceral problem causes a secondary somatic problem
What are two examples of joint dysfunction and disease occurring separately?
Diabetes and Hypertension
What are the four steps for physical assessment of joint dysfunction/subluxation?
Inspection/observation, Global ROM, Palpation- Static and Motion, and Muscle testing
On inspection/observation, what are you looking at?
Superficial stuff (skin, moles, etc), Posture, Gait
What is Global ROM?
The evaluation of a joint or spinal regional movement in all its ranges o f movement.
What do you compare Global ROM against?
Standards (with goniometers and Inclinometry)
What is Static palpation?
Palpatory diagnosis of somatic structures in a neutral static position.
What is palpation?
The act of feeling with the hands. The application of variable manual pressure through the surface ofthe body for the purpose ofdetermining the shape, size, consistency, position, inherent motility, and health ofthe tissues beneath.
What is motion palpation?
(segmental motion assessment)- Palpatory diagnosis of
passive and active segmental joint range o f motion.
What two structures are you looking for with static palpation?
Soft tissue (skin and muscle), and Bone/cartliage
What are the objectives of motion palpation?
Quantity of movement, Quality of movement, Joint play, End feel, and Symptoms
What is joint play?
Discrete, short range movements of a joint independent of the action of voluntary muscles, determined by springing each vertebra in the neutral position.
What is Active ROM?
Movement accomplished without outside assistance; the patient moves the part himself.
What is passive ROM?
Movement which is carried through by the operator without conscious assistance or resistance by the patient.
What is a physiological barrier?
The end point of active joint movement.
What is end play or end feel?
Discrete, short range movements of a joint independent o f the action o f voluntary muscles, determined by springing each vertebra at the limit of its passive range of motion.
What is an Elastic barrier?
The elastic resistance that is felt at the end ofpassive range of movement; further motion toward the anatomic barrier may be induced passively by the examiner
What is a paraphysiological space?
Area of increased movement beyond the elastic barrier available after cavitation within the joint’s elastic range.
What is Anatomical limit?
The limit ofanatomical integrity; the limit ofmotion imposed by anatomic structures. Forcing the movement beyond this barrier would produce tissue damage.
What are you looking for when interpreting joint motion?
End play, Painful arc, Capsular pattern, Noncapsular pattern, Hypermobility and hypomobility
What is the Capsular feeling of end play?
Firm but giving; resistance builds with lengthening, like stretching a piece ofleather.
What is a ligamentous feeling of end play?
Like capsular but may have a slightly firmer
quality.
What is the soft tissue approximation of end play?
iving, squeezing quality; results from the approximation of the soft tissues; typically painless.
What is the bony feeling of end play?
Har, nongiving abrupt stop
What is the muscular feeling of end play?
Firm but givmg, builds with elongation; not as stiff as capsular or ligamentous.
What can be palpated in normal and abnormal conditions?
Capsular Ligamentous, Soft tissue approximation, Bony, and Muscular
What can be palpated only in abnormal conditions?
Muscle spasm, Interarticular feeling, and Empty feeling
What is a muscle spasm?
uarded, resisted by muscle contraction.
The end feel cannot be assessed because of pain and/or
guarding.
What is the interarticular feeling?
Bouncy, Springy quality
What is the empty feeling?
Normal end feel resistance is missing; end feel is not encountered at normal point, and/or the joint demonstrates unusual give and deformation.
What is painful arc?
Pain during the normal arc ofjoint motion
What is Capsular pattern?
Injuries or disorders of the joint capsule lead to predictable patterns o f end play restrictions
What is noncapsular pattern?
Injuries to only one part of the joint capsule don’t necessarily follow typical capsular patterns.
What is muscle testing?
Clinical assessment o f the strength o f a muscle (integrity o f muscle tissue and its nerve supply)
What is a grade 0 in muscle testing?
No muscular contraction detected
What is a grade 1 in muscle testing?
A trace of contraction
What is a grade 2 in muscle testing?
Can move body part without force of gravity applied
What is a grade 3 in muscle testing?
Able to resist gravity (lift the body part)
What is a grade 4 in muscle testing?
Able to resist gravity against some resistance
What is a grade 5 in muscle testing?
Able to resist gravity against full resistance
What are the 3 clinical significance of muscle testing?
Strong and painful, Weak and painful, and Weak and painless
What does strong and painful muscle testing suggest?
Minor musculotendinous lesion (1 degree or 2 degree)
What does weak and painful muscle testing suggest?
Partial musculotendinous rupture (2 degree strain); or painful inhibition associated with pathology
What does weak and painless muscle testing suggest?
Neurologic lesion; or complete musculotendinous rupture (3 degree)
