Lecture 3 (9-16) Flashcards
What are the 3 reasons AROM could be limited
- Active muscle dysfunction
- Passive motion restriction
- Joint stability
What is active muscle dysfunction
Problem with the muscle
Examples of active muscle dysfunction
Organic weakness, reflex, inhibition due to pain or effusion, or abnormal motor recruitment
What falls under abnormal motor recruitment (3)
- Antagonists: guarding or splinting
- Synergists: Substitutions
- Abnormal temporal characteristics
What is passive motion restriction
Something is blocking the joint
What is joint stability
The person doesn’t want to do the same action that caused the injury
What are the 3 reasons PROM can be limited
- Passive insufficiency
- Intraarticular obstruction
- Muscle guarding or splinting
What structures is passive insufficiency due to
Capsule, ligament, or muscle that crosses 2 joints
What is intraarticular obstruction due to
Loose body, cartilage, or tissue
Can the amount of motion change with intraarticular obstruction
Yes, because loose body moves around
What is muscle guarding or splinting due to
Apprehension or pain from tissue reactivity
Who designed the contractile inert test (screen exam)
James Cyriax
When did Cyriax develop the contractile inert test
1930s
What does the contractile inert test examine
AROM, PROM, and resisted isometric testing
What end feel is bone on bone
Hard end feel
What end feel is springy rebound
Firm end feel
What end feel is soft tissue approximation
Soft end feel
What end feel occurs anytime a patient has pain or excessive ROM
Empty end feel
What are the 4 scores of the resisted isometric test
- Strong painless
- Strong painful
- Weak painful
- Weak painless
What is abnormal end feel
Limited ROM
How do you find the percentage of loss for pattern limitations
Take measured value and divide by normal value and multiple times 100 (% formula)
If pain you should ask what
Is it compression load intolerance or tensile load intolerance
What tissues experience compression load intolerance (6)
- Articular cartilage
- Periosteum
- Bursa/fat pad
- Tendon and/or tendon sheath
- meniscus or articular disc
- Neural tissue
What tissues experience tensile load intolerance (4)
- Capsule
- Ligament
- Tendon or muscle
- Neural tissue
Tendons resist what 99.9% of the time
Tensile load
True or False:
If AROM is full and pain free you can choose not to perform PROM
True
What might cause AROM to be less than PROM
- Active muscle dysfunction
- Tensile load intolerance
- Patient reluctance
What might cause AROM limitation = PROM limitation (3)
- Passive insufficiency
- Intra-articular obstruction
- Muscle guarding or splinting
What might cause AROM>PROM
Patient won’t let you move them because they don’t trust you not to hurt them
What are the 3 aspects of muscle performance and testing
- Strength
- Power
- Endurance
What is strength
10 rep max
What is power
1 rep max
What is endurance
Time component
What is a concentric contraction
Muscle shortening
What is an eccentric contraction
Muscle lengthening
What is an isometric contraction
Muscle doesn’t change length
What are the types of muscle performance examination (2)
Resisted isometric tests and strength/endurance tests
What are the types of resisted isometric tests (2)
- Cyriax classification
2. Force to pain on set (FTPO)
What are the types of strength/endurace tests (4)
- Manual muscle testing (MMT)
- Isotonic “x” RM testing
- Isokinetic testing
- Functional task testing
If a patient has pain what can’t you do
Manual muscle testing
What are the 3 things resisted isometric testing looks for
- Testing the abilities of the contractile unit
- Examining gross strength in a static position
- Possible reactivity (pain production)
What is another name for resisted isometric testing
Break testing
What things are test when testing the abilities of the contractile unit (5)
- innervation
- Muscle
- Myotendinous junction
- Tendon
- Tendoperiosteal junction
What are 3 observations an examiner should make during resisted isometric movement
- Whether the contraction causes pain
- Strength of contraction
- Type of contraction causing problem
What is indicative or strong and painless
Normal contractile unit
What is indicative of strong and painful
“Minor” involvement in muscle or tendon
What is indicative of weak and painful
More severe muscle or tendon lesion
What is indicative of weak and painless
Complete muscle or tendon rupture or neurological problem
What grade is strong and painful
Grade 1
What grade is weak and painful
Grade 2
What grade is weak and painless
Grade 3
What is the only difference between FTPO testing and resisted isometric testing
Use of a dynamometer
What is the MMT grading scale
0-5
What does 0 indicate
No contraction
What does 5 indicate
Full strength
What does + mean
Less than half the expected range
What does - mean
More than half the expected range just not full
True or False:
There is a significant function difference between 3+, 3, 3-, and 2-
True
What are the aspects of joint integrity and mobility testing (6)
- Examination of accessory motion
- Testing performed by PT
- Normally equal to or less than 4mm
- Assess patient in resting or loose pack position
- Typically assess motion parallel or perpendicular to the joint plane
- Compare bilaterally
What is component motion
Motion that accompanies active motion, but not under voluntary control
What is joint play
Motion that occurs between the joint surfaces
What is loose pack
Position where there is the most joint play
What is closed pack
No joint play, flexion or extension
What happens to sympathetic activity if you increase inflammation
Increase
What happens to sympathetic activity if you decrease vascularity
Decrease
Moist and smooth represents increased or decreased sympathetic activity
Increased
Dry and scaly represents increased or decreased sympathetic activity
Decreased
Is pitting or not pitting bad
Pitting
What does pitting indicate
Vasculature issues
