General Assessment ROM and MMT Flashcards
Why is understanding levers important when it comes to muscle manual testing?
the longer the resistance arm is for the assessor, the less force the assessor will need to resist the patients movement
What are the 3 elements to a lever?
axis (joint usually)
resistance force
moving of effort force
Anatomical levers: the applied/effort or muscle force point is what?
the point of muscle attachment
Anatomical levers: the resistance point is what?
the point of centre of gravity of a limb
Tilting your head backwards is an example of what type of lever?
1st class
standing calf raises are an example of what type of lever?
2nd class
a bicep curl is an example of what type of lever?
3rd class
When testing muscle strength, we must consider hand placement relative to the fulcrum. What measure is this taking into account?
torque = force x distance from axis
When doing a MMT, are you able to generate more torque if your hand is closer or further away from the joint?
further away
When you are helping a person get up from a chair, where should your body be relative to their body?
closest to their COG as possible
Where should you place the weight relative to the joint to change the difficulty of the exercise?
further away
Resistance arm and its effects on velocity?
longer the RA, the more distance travelled per unit of time creating a higher velocity at the end of the longer RA
Full orthopaedic assessment - what must you always assess?
spine - unless you know 100% that it is not affected
What part of an orthopaedic assessment will we be able to test?
history and the objective examination
What are the two components of the objective session of the full orthopaedic assessment?
observation and examination of peripheral joint movement
What is the difference between a sign and a symptom?
Symptom: what the patient tells you that you can not confirm. ie. “I have pain at night”
Sign: something that you can confirm. ie. “my knee is swollen”
What are the 13 red flags discussed in class?
-severe unremitting pain
-pain unaffected by meds or position
-severe night pain
-severe pain with no history or trauma
-severe spasm
-bowel/bladder changes
-changes in vision
-swallowing or speech changes
-balance/
coordination/falling
-shortness of breath (SOB)
-heavy chest
-unexplained weight loss
Type of pain: cramping / dull / aching
muscle
Type of pain: dull / aching
ligament
Type of pain: sharp / shooting
nerve root
Type of pain: sharp / bright/ lightening-like
nerve
Type of pain: deep / nagging / dull
bone
Type of pain: sharp / severe / intolerable
fracture
Type of pain: throbbing / diffuse
vascular
during observation, why would you touch someone?
to feel for temperature differences
during observation, what 8 things should you look for?
- posture
- deformity
- swelling
- edema
- colour
- atrophy
- scars
- abnormal mvmt pattern
5 things to do during examination of movement
- AROM (painful mvmt last)
- PROM (painful mvmt last)
- MMT (painful mvmt last)
- Clear joints above and below
- Refer to health care professional when appropriate
name some factors that can affect ROM
age, gender, pregnant, hair colour
when assessing ROM, it is important to compare how?
contralaterally and to age/gender specific norms
“joint ROM that is greater than the normal ROM expected at the joint (this is not the same as instability)”
hypermobility
“joint ROM that is less than the normal ROM expected at the joint”
hypomobility
Is pain usually associated with hyper- or hypo- mobility?
hypermobility
during AROM, what are you looking for?
compensatory movements
Which should be greater, AROM or PROM?
PROM > AROM but should be pretty close to the same
“when PROM is limited in a specific pattern characteristic of that joint”
capsular patterns
T or F: Capsular patterns are joint specific and similar across people and often painful
true
what three things usually cause capsular patterns?
degenerative type diseases, prolonged immobilization or acute inflammation
If limitation of PROM is not in the capsular pattern or restriction, what does it indicate?
absence of total joint reaction: intra- or extra-articular non-capsular tissue or segment of capsule
a loose body is what type of pathology?
intracapsular (eg. menisci in knee)
when a selective portion of capsule is tight, what pathology is that?
capsular
tight or torn ligaments or muscles is what type of pathology?
extracapsular
How can you differentiate between intra-, capsular, or extra-capsular pathologies?
end feels!
During ROM assessment, what joint segment do you stabilize and which do you move?
stabilize the proximal joint segment and move the distal segment to end AROM or PROM
When using a goniometer to measure ROM, what is generally always the starting position?
anatomical position
“occurs when multijoint muscles cannot achieve full range of motion across both the joints a the same time”
passive insufficiency
When stretching your hamstring with foot up on a table, if you employ a posterior pelvic tilt you can generally stretch further. What is this an example of?
passive insufficiency
What can cause an abnormal passive insufficiency?
tightness, spasticity, scar tissue, adhesions
“occurs when multijoint muscles shorten across both joints and therefore cannot create enough tension due to sarcomere overlap to concurrently move all of its joints through their full ROM”
active insufficiency
When you put your wrist into flexion and then try to make a fist, it is very difficult and you get pulled out of full flexion. What is this an example of?
active insufficiency
How do you position the joint when assessing a 1-joint muscle? How will you know if joint range is being limited by muscle?
- so that the muscle is lengthened across that joint
- EF will be firm
When assessing a 2-joint muscle, how do you position the joints to assess muscle length?
-put one of the joints crossed by the muscle in a position to lengthen the muscle across the joint and move the second joint through ROM to put full stretch on the muscle
What will the EF be when assessing muscle length in 2-joint muscle?
firm
ROM and EF in: Torn meniscus in the knee with a loose body
spring block, decreased ROM
ROM and EF in: acute ACL tear, 1 day post
soft/boggy, decreased ROM
ROM and EF in: acutely torn rotator cuff, very painful
empty, decreased ROM
ROM and EF in: anteriorly subluxed talus from subacute ankle inversion sprain, trying to dorsiflex
hard, decreased ROM
ROM and EF in: boney chip in the joint
hard but in wrong ROM point
what is an empty EF feel like?
no end-feel cause pain prevents from reaching end of ROM
When assessing muscle strength what ROM do you test first?
PROM
Strength can be tested ______ through available PROM (usually concentrically) or _____ in mid-range
isotonically
concentrically
“rate of movement is constant”
isokinetic
“resistance is constant”
isotonic
“muscle is activated, no movement”
isometric
3 types of synergists?
- neutralizing or counteracting
- conjoint
- stabilizers
Organization of Fibers in Muscle: muscle mechanics - length vs width?
width = more strength and power - greater ability to produce force and shorter muscles provide stability
length = greater change in ROM (mobility) and associated with “speed of motion”
With increased velocity of lengthening, force _____
increases
with increased velocity of shortening, force _____
declines
Effect of type of contraction: put concentric, eccentric, and isometric in order from greatest to least
ecc>iso>con
WHere in a joint’s ROM is the potential torque production the greatest
??? didnt write this down whoopsies :)
What two factors affect joint torque?
- Muscle-mechanics (length-tension relationship)
2. Moment Arm Biomechanics
Tension in muscle reflects the length of _____ _____ before contraction
individual sarcomeres
At a molecular level, what does sarcomere length represent?
overlap of actin and myosin
According to the sliding filament theory, tension will vary directly with the number of what?
crossbridges
How do short and long sarcomeres influence tension?
Long sarcomere = little overlap, few crossbridges, and therefore weak tension generation
Short sarcomere = too much overlap, limited crossbridge formation and therefore decreases tension
Tension depends on _____ ____ and ____ ____
filament overlap; sarcomere length
What is angle-torque a product of?
active muscle force and moment arm and load
for most joints, where is peak torque?
in mid range, however there are some exceptions
When you do MMTs, what are you trying to minimize?
the input of the synergists so that they only assist in motion
When you are doing MMT, what are some things you should be thinking about while performing movement?
- soft tissue affected by mvmt
- what could cause weakness or pain (muscle lesion, pressure on nerve root, pathology of peripheral nerve supplying muscle)
Name the manual muscle strength grade: no palpable or observable muscle contraction
grade 0
Name the manual muscle strength grade: a palpable or observable muscle contraction and no joint motion
grade 1
Name the manual muscle strength grade: can move through available ROM with gravity eliminated
grade 2
Name the manual muscle strength grade: can move through available ROM against gravity
grade 3
Name the manual muscle strength grade: able to move through available ROM against gravity and against moderate resistance
grade 4
Name the manual muscle strength grade: able to move through available ROM against gravity and against maximal resistance
grade 5
look at chart that has 0, 1, 1+, 2-, 2, 2+, 3-, ect.
:)
Reliability for manual grading of muscle strength?
higher for inter-rater than interrater, so same person should evaluate strength if possible
Is reliability for manual grading of muscle strength higher in lower or higher ranges?
more sensitive in lower ranges
Limitation for manual grading of muscle strength?
grading is limited by strength of grader
How do you test contractile strength?
strong isometric contraction with joint in neutral position
What is inert tissue?
non-contractile structure. (ie. everything but muscle and tendon)
Inert tissue injuries should cause pain when? Should be pain-free when?
Painful during stretch or compression and during active/passive movements in the same direction.
Pain-free during isometric resisted motions if tested in neutral position.
Resisted isometric contractions test the integrity of ______ tissues
contractile
Passive movements test the integrity of the _______ features of the inert and contractile structures.
non-contractile
____ ___ help differentiate between joint conditions and other inert structure lesions
capsular patterns
Interpretation of resisted test findings: strong and pain free
normal
Interpretation of resisted test findings: strong and painful
contractile structure lesion, grade I muscle strain
Interpretation of resisted test findings: weak and painful
grade II muscle strain
Interpretation of resisted test findings: weak and pain-free
Grade III contractile structure rupture (complete tear) if acute enough, will probably still have some pain
compression neuropathy
Interpretation of resisted test findings: all tests are painful in every direction
serious or acute pathology or psychogenic pain
fracture, neoplasm (tumor)
Causes of Muscle Weakness (8)
- muscle strain gr I, II, III
- pain/reflex inhibition
- peripheral nerve inj.
- nerve root lesion (myotome)
- UMNL
- tendon pathology
- avulsion
- psychological overlay
What 4 things are included in neurological screening?
- reflexes
- sensation (dermatomes)
- myotomes
- dural tests
UMNL causes what type of reflex?
hyperreflexia
LMNL causes what type of reflex?
dampened or absent reflex (hyporeflexia)
With LMNL, where can the neve be compressed?
- nerve root
- nerve trunk
- nerve cords
- terminal nerve branches (peripheral nerve)
UMNL is lesion of the ___ nervous system and LMNL is lesion of the _____ nervous system
central; peripheral
Babinski and Hoffmans’ are tests for what type of neurological screen?
UMNL
“an area of the skin supplied by afferent nerves from a single spinal nerve root”
dermatome
“group of muscles that are supplied by a single spinal nerve root”
myotome
“nerve typically made up of nerve fibers from multiple spinal nerve roots”
peripheral nerve
learn dermatomes and peripheral nerve distribution for body hand especially
:)
learn the myotomes for upper and lower limbs
:)
What can be caused by peripheral nerve and nerve root entrapment?
Muscle weakness = lesion to peripheral nerve or spinal nerve root
Numbness = lesion to peripheral nerve or spinal nerve root
numbness of pad of 3rd digit could be a problem with what nerve?
medial or C7
numbness of little finger could be a problem with what nerve?
ulnar nerve or C8
weakness of thumb extension and numbness of little finger is most likely what?
problem with C8
numbness of little finger and weakness of 4th and 5th lumbrical and interossei is most likely what?
ulnar nerve problem
What do special tests help with?
they are specific to each joint and target specific structures to help narrow the diagnosis
why would you assess with joint play?
to test accessory movement
why would you palpate during an assessment?
useful when probable tissues involved are narrowed?
