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PT Fundamentals > Joint Motion and Muscle Testing > Flashcards

Joint Motion and Muscle Testing Flashcards

1
Q

Osteokinematics (physiological)

A

directions the bones move when motion occurs

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2
Q

Osteokinematic quick definition

A

visible motion during voluntary movement

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3
Q

Osteokinematic technical definition

A

movement around a specific joint axis within a particular joint

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4
Q

Types of Osteokinematic

A

flex/ex
ab/ad
int/ext rot
horizontal abd/add

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5
Q

Joint Planes in Osteokinematic motion

A

sagittal, frontal, transverse

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6
Q

Joint Axes in Osteokinematic motion

A

frontal, sagittal, longitudinal (vertical)

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7
Q

Arthrokinematics (accessory motions or joint play)

A

motion between the joint surfaces during movement

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8
Q

Arhtrokinematics quick definition

A

invisible and involuntary

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9
Q

Arthrokinematics (technical definition)

A

the motion that MUST occur within the joint to allow normal range of motion (osteokinematic) to occur

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10
Q

Types of Arthrokinematics

A

Roll (pool ball across the table)
Slide(glide) (sliding pool ball back and forth on table)
Spin (top on the table)

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11
Q

Roll Characteristics (4)

A

many point on many points
angular motion
always in same direction
always in combo w/ slide or spin

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12
Q

Slide Characteristics (3)

A

one point on many points
does not occur alone
direction of slide depends on convexity or concavity of moving surface

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13
Q

spin characteristics (3)

A

one point on one point
rotates around one axis
usually in combo with the others
EX: shoulder-flex/ex, rotation

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14
Q

Concave on Covex Rule

A

Artho and Osteo motion in the same direction

Tibia on Femur

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15
Q

Convex on Concave Rule

A

Arthro and Osteo motion in opposite direction

Hip flexion

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16
Q

Joint Positions

A

open packed

closed packed

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17
Q

open Packed

A

ligament and capsule in position of greatest laxity (maximally separated and minimal congruency)–good to assess joint play

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18
Q

close packed

A

Ligament and capsule are taut (maximal contact and congruency)—good for stability

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19
Q

Typical Barriers and Range of Motion Terminology (in ascending order)

A

active range of motion, physiological barrier, passive range of motion, elastic barrier, anatomic barrier, injury

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20
Q

“End Feel”

A

sensation in joint at end of ROM

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21
Q

Normal End Feels (3)

A

bone to bone (hard)
soft tissue approximation (soft)
tissue stretch (hard springy)

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22
Q

Bone to Bone end feel example

A

elbow extension

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23
Q

soft-tissue end feel example

A

muscle contact with elbow or knee flexion

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24
Q

tissue stretch example

A

shoulder rotation or knee extension

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25
Typical Causes of Joint Dysfunction (5)
``` capsular adhesions immobilization traumatic sprains of joint capsule internal derangements unknown etiology (CAUTION) ```
26
Restrictive Barrier Concept Terminology
active motion, R1, resistance, R2 (restrictive barrier), motion loss
27
Types of Restrictive Barriers
skin, fascia, muscle, ligament, joint capsule and surface
28
5 Abnormal end feels
capsular (hard and soft), Muscle Spasm (early and late), bone to bone, springy block (special type-Empty)
29
Capsular v Noncapsular restriction
Noncapsular--does not follow classic motion restriction (ligamentous adhesions, internal derangement, extra-articular lesions)
30
Types of Motion Testing
AROM: Physiologic PROM: Physiologic Joint Play: Accessory (AROM comes before PROM)
31
Key Things to Assess in Motion Testing
Quality, Quantity, and Symptom Response
32
AROM Involves...
joint range, motor control, muscle function, patients willingness (testing for contractile, nervous, and inert)
33
Types of AROM progressions
``` OP Repeated movements sustained postures consider speed of movement combined motions ```
34
PROM invokves...
PT does the action compare w/ opposite side combines joint range and patients willingness (testing for inert tissues)
35
When performing PROM...
allow patient to relax, stabilize limb, smooth and steady, ALWAYS monitor patient
36
When to Stop in general
``` Pain (when pain is the primary issue) or Limit (when stiffness more important than pain) ```
37
Def of Goniometry
science of measuring angles
38
Purpose of Goniometry
objective measure of motion
39
Types of Postures
``` Anatomical Position Base Position (preferred by patient) ```
40
Zero Starting Position
where movement from anatomical position can take place in either of two directions
41
Fully Extended Starting Position
zero degree starting position where motion can take place in only one direction
42
Special Neutral Position
starting positions for measurements of rotary movements (shoulder and hip rotation)
43
Measurement Technique
Assess bilaterally | First and Second repetition
44
Documentation of Motion
``` active or passive L or R joint and direction of motion motion achieved any symptom changes ```
45
Goniometer Reliability
+/- 5 degrees (depends on joint, motion, and inter or intra rater) (enhanced with stable position correct goniometer size, same evaluater)
46
Two Key Components of Muscle Testing
``` Length Testing (flexibility) Strength Testing (MMT) ```
47
Muscle Inbalance
faulty body/joint alignment faulty joint mechanics painful stress/strain (on joints, muscles, ligaments) (a result of posture/occupation/recreation)
48
Janda Classification
``` Postural (tonic muscles) (primarily two joint)--prone to tightness (hamstrings, gastroc) Phasic muscles (primarily one joint)---prone to weakness (gluteal, rhomboids) ```
49
Crossed Syndromes (both tonic and phasic)
one diagonal-short/tight | other diagonal-weak/lengthened
50
Lower Crossed Syndrome
Tight: hip flexor/back extensors Weak: abs, glutes (lordosis)
51
JROM V Muscle ROM
limitations of joint | or limitation of muscle
52
One-Joint Muscle Testing
J motion = muscle length
53
two-joint muscle testing
j motion does not equal muscle length | must place one muscle at slack to test full joint ROM
54
Passive Insufficiency
length of muscle is not sufficient to permit normal elongation over both joints simultaneously (if you cannot passively take them through full ROM unless one muscle is slack...then Passive ins)
55
Active Insufficiency
inability of a two-joint muscle to generate an effective force (if you can take them through full passive range, but they cant contract through it then...active ins)
56
Muscle Length Test is for...
passive insufficiency
57
Passive Ins Example
Therapist can only take knee to full flexion when quads are slack
58
Active Ins Example
Therapist can take knee through full flexion, but pt cannot actively do it
59
Indications/Uses of MMT
``` diagnosis of PNI SCI level and potential recovery Basis for treatment planning basis for prognosis progress tracking med board standards basis for supportive devices basis for corrective surgery ```
60
key knowledge needed for MMT
``` Location/Anatomy/Function of muscles Palpation skills Observation skills use of standardized methods (because frankly its not that reliable) practice and experience ```
61
Types of MMT
Gross-estimating function/screening | Specific-diagnosis
62
MMT: Positioning
balance between PT comfort, exposure, and stabilization | gravity, axis, line of pull, type of muscle, stability, comfort
63
MMT: Test Position
specific position of the body part being tested
64
AROM optimal positions
single joint: end-range | two-joint: tested at mid-range
65
MMT: Stabilization
External (table), Internal (muscles)
66
MMT: Resistance
external force applied by examiner | consistently/gradually
67
MMT: Palpation
near tendon attachment (screening and grades 0-3)
68
MMT: Substitution
weakness, deviation from test movement, compensation
69
MMT Grading System Qualitative
``` 0-nothing 1-trace 2-Poor 3-Fair 4-good 5-Normal ```
70
Muscle Grading: 5
100%, hold position against strong resistance
71
Muscle Grading: 4+
90%, hold against moderate to strong resis
72
Muscle Grading: 4
75%, hold against moderate
73
Muscle Grading: 4-
70%, hold against slight resis
74
Muscle Grading: 3+
60%, Full ROM against gravity, hold end ROM against slight resis
75
Muscle Grading: 3
full ROM against gravity, able to hold end ROM (no resis)
76
Muscle Grading: 3-
40%, full ROM against gravity, unable to hold end ROM
77
Muscle grading: 2+
30%, partial ROM against gravity, or full ROM in gravity minimized position and able to hold against some resis
78
Muscle Grading: 2
full ROM in gravity minimized position
79
Muscle Grading: 2-
partial ROM in gravity minimized position
80
Muscle Grading: 1
10%, slight palpable contraction (no movement)
81
Muscle Grading: 0
absolutely nothing
82
Break Test (fair to normal)
1st Step: completed ROM against gravity 2nd Step: been placed within the ROM by examiner and held against gravity 3rd Step: examiner attempt to break them
83
Methods for grading trace to poor (3)
gravity lessened, stretch range, palpation
84
MMT Grades and Types of Exercise
``` ZERO: PROM Trace: AAROM Poor: AAROM--AROM in GL--AAROM against G Poor-Fair: AAROM--AROM against Gresis in GL Fair to Normal: Resis against G ```
85
MMT General Rules (10 out of 14)
1. Expose the part to be tested 2. give clear instructions 3. Check AROM first 4. Check PROM prior to MMT 5. Line up part with fibers 6. Provide proper stabilization 7. place part in fair position and ask patient to hold (or ask for full AROM) 8. Observe muscle or movement first 9. Palpate the muscle or tendon being tested 10. if able to complete range apply resistance 11. Compare to normal side 12. watch for signs of fatigue 13. move patient as little as possible (organized) 14. record, sign, date
86
Increasing validity/reliability
standardized procedure, experience, anatomical knowledge, recognizing substitutions, and reasons for weakness
87
MMT is Valid for:
normals, lower motor neuron lesions, muscle disorders
88
MMT not valid for:
upper motor neuron disorders, interference by abnormal sensation, disturbed tone/motor control
89
Factors Reducing Accuracy of MMT
Pain, limited joint ROM, Unhealed fractures, muscle synergy patterns/hypertonic spasticity

PT Fundamentals (3 decks)

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