Introduction Flashcards
Four principles of massage
Superficial to deep to superficial
General to specific to general
Periphery to centre to periphery
Proximal to distal to proximal
Orthopaedics
Branch of medical science that deals with the prevention and correction of disorders involving structures of the body, especially skeleton, joints, muscles, fascia and other supporting structures.
HOPMNRS
History Observation Palpation Movement Neurological Referred pain Special tests
Radicular pain
Associated with nerve root compression
Sharp, shooting, may be accompanied by paresthesia (dermatone, muscle weakness)
Follows nerve paths.
Cutaneous pain
Superficial tissue damage
Sharp, well-localized, burning
Deep somatic pain
Muscles, tendons, joints and periosteum
Diffuse. May refer.
Visceral pain
Arises from visceral distension or ischemia, or strong GI contractions.
Diffuse
Referred pain
May come from deep somatic, cutaneous or visceral tissue.
Functional or psychogenic pain
Psychogenic but experienced as real.
Cramping, dull, aching pain
Muscle
Dull, aching pain
Ligament or joint capsule
Sharp, shooting pain
Nerve root
Sharp, bright, lightning-like pain
Nerve
Burning, pressure-like, stinging, aching
Sympathetic nerves
Deep, nagging, dull pain
Bone
Sharp, severe, intolerable pain
Fracture
Throbbing, diffuse pain
Vasculature
Order of testing function
AROM PROM Overpressure/End feels Muscle length Muscle strength Specific orthopaedic testing
Normal end feels
Soft
Muscular or tissue stretch
Capsular stretch or leathery
Bony
Abnormal end feels
Empty Muscle spasm Boggy/soft Springy block or internal derangement Capsular stretch or leathery Bony Capsular pattern Non capsular pattern.
Gate control theory
“Gate” at spinal cord allows pain signals traveling via small nerves, block signals sent by large nerve fibres.
Normal end feel: soft
Full range of motion restricted by normal muscle bulk
ie elbow flexion
Normal end feel: muscle or tissue stretch
At extremes of muscle stretch
Ex. Hamstring stretch
Increasing tension, springiness, elasticity.
Normal end feel: capsular stretch
When joint capsule stretched at end of its normal range
Ex. ER of GH jt
Like stretching leather
Normal end feel: bony
When bone contacts bone at end of normal range
Ex. Elbow extension
Abrupt and hard
Abnormal end feel: empty
No physical restriction; only pain
Acute bursitis or joint inflammation
Abnormal end feel: muscle spasm
When passive movement stops abruptly with springy rebound and pain
From reflexive muscle spasm
Synovial inflammation if felt with capsular pattern of restriction
Abnormal end feel: boggy or soft
Occurs with joint effusion or edema
Mushy and soft
Acute inflammation
Abnormal end feel: springy block/internal derangement
Springy or rebounding sensation in NON capsular pattern
Loose cartilage or meniscal tissue within joint.
Abnormal end feel: capsular stretch or leathery
Occurring before normal end of range
Capsular fibrosis if capsular pattern of restriction with no inflammation.
Abnormal end feel: bony
Occurring before normal range
Maybe osteophytes with DJD, or malnutrition or joint following fracture
Capsular Pattern of restriction
Pattern of limitation of movement at an injured or affected joint
With injury to joint capsule or synovial lining, pattern of proportional limitation will be noted as join taken through PROM.
Noncapsular pattern of restriction
Maybe intraarticular mechanical blockage from adhesions, or from torn cartilage, or menisci.
Maybe extra capsular lesions (muscle contracture, myositis ossificans, or acute bursitis
