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EPHE 355 - Lecture Slides > General Assessment ROM and MMT > Flashcards

General Assessment ROM and MMT Flashcards

1
Q

Why is understanding levers important when it comes to muscle manual testing?

A

the longer the resistance arm is for the assessor, the less force the assessor will need to resist the patients movement

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2
Q

What are the 3 elements to a lever?

A

axis (joint usually)
resistance force
moving of effort force

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3
Q

Anatomical levers: the applied/effort or muscle force point is what?

A

the point of muscle attachment

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4
Q

Anatomical levers: the resistance point is what?

A

the point of centre of gravity of a limb

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5
Q

Tilting your head backwards is an example of what type of lever?

A

1st class

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6
Q

standing calf raises are an example of what type of lever?

A

2nd class

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7
Q

a bicep curl is an example of what type of lever?

A

3rd class

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8
Q

When testing muscle strength, we must consider hand placement relative to the fulcrum. What measure is this taking into account?

A

torque = force x distance from axis

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9
Q

When doing a MMT, are you able to generate more torque if your hand is closer or further away from the joint?

A

further away

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10
Q

When you are helping a person get up from a chair, where should your body be relative to their body?

A

closest to their COG as possible

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11
Q

Where should you place the weight relative to the joint to change the difficulty of the exercise?

A

further away

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12
Q

Resistance arm and its effects on velocity?

A

longer the RA, the more distance travelled per unit of time creating a higher velocity at the end of the longer RA

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13
Q

Full orthopaedic assessment - what must you always assess?

A

spine - unless you know 100% that it is not affected

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14
Q

What part of an orthopaedic assessment will we be able to test?

A

history and the objective examination

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15
Q

What are the two components of the objective session of the full orthopaedic assessment?

A

observation and examination of peripheral joint movement

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16
Q

What is the difference between a sign and a symptom?

A

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”

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17
Q

What are the 13 red flags discussed in class?

A

-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

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18
Q

Type of pain: cramping / dull / aching

A

muscle

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19
Q

Type of pain: dull / aching

A

ligament

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20
Q

Type of pain: sharp / shooting

A

nerve root

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21
Q

Type of pain: sharp / bright/ lightening-like

A

nerve

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22
Q

Type of pain: deep / nagging / dull

A

bone

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23
Q

Type of pain: sharp / severe / intolerable

A

fracture

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24
Q

Type of pain: throbbing / diffuse

A

vascular

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25
Q

during observation, why would you touch someone?

A

to feel for temperature differences

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26
Q

during observation, what 8 things should you look for?

A
  1. posture
  2. deformity
  3. swelling
  4. edema
  5. colour
  6. atrophy
  7. scars
  8. abnormal mvmt pattern
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27
Q

5 things to do during examination of movement

A
  1. AROM (painful mvmt last)
  2. PROM (painful mvmt last)
  3. MMT (painful mvmt last)
  4. Clear joints above and below
  5. Refer to health care professional when appropriate
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28
Q

name some factors that can affect ROM

A

age, gender, pregnant, hair colour

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29
Q

when assessing ROM, it is important to compare how?

A

contralaterally and to age/gender specific norms

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30
Q

“joint ROM that is greater than the normal ROM expected at the joint (this is not the same as instability)”

A

hypermobility

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31
Q

“joint ROM that is less than the normal ROM expected at the joint”

A

hypomobility

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32
Q

Is pain usually associated with hyper- or hypo- mobility?

A

hypermobility

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33
Q

during AROM, what are you looking for?

A

compensatory movements

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34
Q

Which should be greater, AROM or PROM?

A

PROM > AROM but should be pretty close to the same

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35
Q

“when PROM is limited in a specific pattern characteristic of that joint”

A

capsular patterns

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36
Q

T or F: Capsular patterns are joint specific and similar across people and often painful

A

true

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37
Q

what three things usually cause capsular patterns?

A

degenerative type diseases, prolonged immobilization or acute inflammation

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38
Q

If limitation of PROM is not in the capsular pattern or restriction, what does it indicate?

A

absence of total joint reaction: intra- or extra-articular non-capsular tissue or segment of capsule

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39
Q

a loose body is what type of pathology?

A

intracapsular (eg. menisci in knee)

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40
Q

when a selective portion of capsule is tight, what pathology is that?

A

capsular

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41
Q

tight or torn ligaments or muscles is what type of pathology?

A

extracapsular

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42
Q

How can you differentiate between intra-, capsular, or extra-capsular pathologies?

A

end feels!

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43
Q

During ROM assessment, what joint segment do you stabilize and which do you move?

A

stabilize the proximal joint segment and move the distal segment to end AROM or PROM

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44
Q

When using a goniometer to measure ROM, what is generally always the starting position?

A

anatomical position

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45
Q

“occurs when multijoint muscles cannot achieve full range of motion across both the joints a the same time”

A

passive insufficiency

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46
Q

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?

A

passive insufficiency

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47
Q

What can cause an abnormal passive insufficiency?

A

tightness, spasticity, scar tissue, adhesions

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48
Q

“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”

A

active insufficiency

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49
Q

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?

A

active insufficiency

50
Q

How do you position the joint when assessing a 1-joint muscle? How will you know if joint range is being limited by muscle?

A
  • so that the muscle is lengthened across that joint

- EF will be firm

51
Q

When assessing a 2-joint muscle, how do you position the joints to assess muscle length?

A

-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

52
Q

What will the EF be when assessing muscle length in 2-joint muscle?

A

firm

53
Q

ROM and EF in: Torn meniscus in the knee with a loose body

A

spring block, decreased ROM

54
Q

ROM and EF in: acute ACL tear, 1 day post

A

soft/boggy, decreased ROM

55
Q

ROM and EF in: acutely torn rotator cuff, very painful

A

empty, decreased ROM

56
Q

ROM and EF in: anteriorly subluxed talus from subacute ankle inversion sprain, trying to dorsiflex

A

hard, decreased ROM

57
Q

ROM and EF in: boney chip in the joint

A

hard but in wrong ROM point

58
Q

what is an empty EF feel like?

A

no end-feel cause pain prevents from reaching end of ROM

59
Q

When assessing muscle strength what ROM do you test first?

A

PROM

60
Q

Strength can be tested ______ through available PROM (usually concentrically) or _____ in mid-range

A

isotonically

concentrically

61
Q

“rate of movement is constant”

A

isokinetic

62
Q

“resistance is constant”

A

isotonic

63
Q

“muscle is activated, no movement”

A

isometric

64
Q

3 types of synergists?

A
  1. neutralizing or counteracting
  2. conjoint
  3. stabilizers
65
Q

Organization of Fibers in Muscle: muscle mechanics - length vs width?

A

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”

66
Q

With increased velocity of lengthening, force _____

A

increases

67
Q

with increased velocity of shortening, force _____

A

declines

68
Q

Effect of type of contraction: put concentric, eccentric, and isometric in order from greatest to least

A

ecc>iso>con

69
Q

WHere in a joint’s ROM is the potential torque production the greatest

A

??? didnt write this down whoopsies :)

70
Q

What two factors affect joint torque?

A
  1. Muscle-mechanics (length-tension relationship)

2. Moment Arm Biomechanics

71
Q

Tension in muscle reflects the length of _____ _____ before contraction

A

individual sarcomeres

72
Q

At a molecular level, what does sarcomere length represent?

A

overlap of actin and myosin

73
Q

According to the sliding filament theory, tension will vary directly with the number of what?

A

crossbridges

74
Q

How do short and long sarcomeres influence tension?

A

Long sarcomere = little overlap, few crossbridges, and therefore weak tension generation
Short sarcomere = too much overlap, limited crossbridge formation and therefore decreases tension

75
Q

Tension depends on _____ ____ and ____ ____

A

filament overlap; sarcomere length

76
Q

What is angle-torque a product of?

A

active muscle force and moment arm and load

77
Q

for most joints, where is peak torque?

A

in mid range, however there are some exceptions

78
Q

When you do MMTs, what are you trying to minimize?

A

the input of the synergists so that they only assist in motion

79
Q

When you are doing MMT, what are some things you should be thinking about while performing movement?

A
  • soft tissue affected by mvmt
  • what could cause weakness or pain (muscle lesion, pressure on nerve root, pathology of peripheral nerve supplying muscle)
80
Q

Name the manual muscle strength grade: no palpable or observable muscle contraction

A

grade 0

81
Q

Name the manual muscle strength grade: a palpable or observable muscle contraction and no joint motion

A

grade 1

82
Q

Name the manual muscle strength grade: can move through available ROM with gravity eliminated

A

grade 2

83
Q

Name the manual muscle strength grade: can move through available ROM against gravity

A

grade 3

84
Q

Name the manual muscle strength grade: able to move through available ROM against gravity and against moderate resistance

A

grade 4

85
Q

Name the manual muscle strength grade: able to move through available ROM against gravity and against maximal resistance

A

grade 5

86
Q

look at chart that has 0, 1, 1+, 2-, 2, 2+, 3-, ect.

A

:)

87
Q

Reliability for manual grading of muscle strength?

A

higher for inter-rater than interrater, so same person should evaluate strength if possible

88
Q

Is reliability for manual grading of muscle strength higher in lower or higher ranges?

A

more sensitive in lower ranges

89
Q

Limitation for manual grading of muscle strength?

A

grading is limited by strength of grader

90
Q

How do you test contractile strength?

A

strong isometric contraction with joint in neutral position

91
Q

What is inert tissue?

A

non-contractile structure. (ie. everything but muscle and tendon)

92
Q

Inert tissue injuries should cause pain when? Should be pain-free when?

A

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.

93
Q

Resisted isometric contractions test the integrity of ______ tissues

A

contractile

94
Q

Passive movements test the integrity of the _______ features of the inert and contractile structures.

A

non-contractile

95
Q

____ ___ help differentiate between joint conditions and other inert structure lesions

A

capsular patterns

96
Q

Interpretation of resisted test findings: strong and pain free

A

normal

97
Q

Interpretation of resisted test findings: strong and painful

A

contractile structure lesion, grade I muscle strain

98
Q

Interpretation of resisted test findings: weak and painful

A

grade II muscle strain

99
Q

Interpretation of resisted test findings: weak and pain-free

A

Grade III contractile structure rupture (complete tear) if acute enough, will probably still have some pain

compression neuropathy

100
Q

Interpretation of resisted test findings: all tests are painful in every direction

A

serious or acute pathology or psychogenic pain

fracture, neoplasm (tumor)

101
Q

Causes of Muscle Weakness (8)

A
  • muscle strain gr I, II, III
  • pain/reflex inhibition
  • peripheral nerve inj.
  • nerve root lesion (myotome)
  • UMNL
  • tendon pathology
  • avulsion
  • psychological overlay
102
Q

What 4 things are included in neurological screening?

A
  • reflexes
  • sensation (dermatomes)
  • myotomes
  • dural tests
103
Q

UMNL causes what type of reflex?

A

hyperreflexia

104
Q

LMNL causes what type of reflex?

A

dampened or absent reflex (hyporeflexia)

105
Q

With LMNL, where can the neve be compressed?

A
  1. nerve root
  2. nerve trunk
  3. nerve cords
  4. terminal nerve branches (peripheral nerve)
106
Q

UMNL is lesion of the ___ nervous system and LMNL is lesion of the _____ nervous system

A

central; peripheral

107
Q

Babinski and Hoffmans’ are tests for what type of neurological screen?

A

UMNL

108
Q

“an area of the skin supplied by afferent nerves from a single spinal nerve root”

A

dermatome

109
Q

“group of muscles that are supplied by a single spinal nerve root”

A

myotome

110
Q

“nerve typically made up of nerve fibers from multiple spinal nerve roots”

A

peripheral nerve

111
Q

learn dermatomes and peripheral nerve distribution for body hand especially

A

:)

112
Q

learn the myotomes for upper and lower limbs

A

:)

113
Q

What can be caused by peripheral nerve and nerve root entrapment?

A

Muscle weakness = lesion to peripheral nerve or spinal nerve root

Numbness = lesion to peripheral nerve or spinal nerve root

114
Q

numbness of pad of 3rd digit could be a problem with what nerve?

A

medial or C7

115
Q

numbness of little finger could be a problem with what nerve?

A

ulnar nerve or C8

116
Q

weakness of thumb extension and numbness of little finger is most likely what?

A

problem with C8

117
Q

numbness of little finger and weakness of 4th and 5th lumbrical and interossei is most likely what?

A

ulnar nerve problem

118
Q

What do special tests help with?

A

they are specific to each joint and target specific structures to help narrow the diagnosis

119
Q

why would you assess with joint play?

A

to test accessory movement

120
Q

why would you palpate during an assessment?

A

useful when probable tissues involved are narrowed?

EPHE 355 - Lecture Slides (3 decks)

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