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A&R > Lecture 3 - Rule outs > Flashcards

Lecture 3 - Rule outs Flashcards

1
Q

list some general rule outs

A
  • joint A/B
  • fracture - tap, tuning, squeeze
  • arthrological scan axam
  • neurological scan exam - during myotomes / dermatomes
  • circulation problems- BP etc.
  • spinal problems - aching, burning sensation down limbs etc.
  • visceral pathology
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2
Q

examples of rule outs: IOS - IVD pathology

A

Rule out via forward flexion, rotation, side bending, straight leg raise
Refer to physician if you are unsure

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3
Q

explain the james cyriax technique for functional testing

A

designed to test the joint motions

designed to tell you if contractile or inert structures are involved

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4
Q

Pain at the extremes of movement indicate:

A

Painful structure is stretched

Painful structure is being compressed

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5
Q

Painful arc indicates:

A

Impingement

Typically around 60-90 degrees

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6
Q

functional testing general guidelines:

A

Test bilaterally

Uninjured side first

Most painful test last
Patient comfort
A, P, R vs. A, R, P

Testing influenced by history and observations

Support the injured site well during testing

Document referred pain as you test

Document radiating pain as you test

Ask location of pain throughout testing

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7
Q

Referral of pain is a common occurrence in problems associated with the __ system

A

MSK

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8
Q

The reference of pain is an indicator of the segment which is _____

A

dysfunctional - Don’t focus on just the areas of pain recognize the source of pain is likely a disfunction somewhere else

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9
Q

example of functional testing: Pain in the C5 dermatome could arise from:

A

irritation around C5 nerve root

disc or facet involvement of C4,5

any muscle supplied by the C5 nerve root

any visceral structure having C5 connections

the shoulder joint – something could be impinging the nerve

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10
Q

functional testing for contractile tissue refers to what components of a muscle?

A

Muscle belly

Tendon

Tendoperiosteal junction

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11
Q

how can tension be applied to contractile structures?

A

A/P/R

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12
Q

functional testing - inert tissue includes:

A

Joint capsules

Blood vessels

Skin

Fascia*

Ligaments

Meniscus

Dura mater

Nerve

Cartilage

Bursa

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13
Q

how can tension be applied to inert structures?

A

Actively moving the joint

Stretching during passive movement

Sometimes tenderness may be elicited by pinching these structures

  • fat pad
  • anterior capsule of shoulder joint
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14
Q

describe functional testing for active movements

A

Ask athlete to move the joint through as much ROM as possible

Compare ROM bilaterally

Each physiological movement for the joint is tested

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15
Q

would are the possible results for active “free” movements?

A

Normal

Limited (hypomobile)

Excessive (hypermobile)

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16
Q

what can active movements tell the therapist?

A

Active movements tell the therapist;

Athlete’s willingness to move the joint

Athlete’s active joint range

That the muscular strength can move the joint and body part

Painful or not

Trick motions

Joint surface degeneration

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17
Q

what is the method for relaxed passive movements

A

The therapist lifts the limb through the full possible ROM

Measure or approximate the degrees of motion

Compare the range bilaterally

Each anatomical range of the joint is tested

The athlete must be relaxed

Be gentle

Do not force the joint when there is pain or spasm

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18
Q

what should you record for passive movements

A

Record:

The range of motion in degrees

If there is pain during any part of the range

Describe the pain and it’s location during the movement

End feel

19
Q

what are the possible ranges for passive movement?

A

The range may be;

Normal

Limited (Hypomobile)

Excessive (Hypermobile)

20
Q

What two patterns of restriction can be present with passive movement?

A

Restriction can be in;

A capsular pattern

A non-capsular pattern

21
Q

what does end feel mean?

A

END-FEEL is the term used to describe the sensation imparted to the therapist’s hand at the extreme of the possible range

22
Q

what is the end-range sensation for soft tissue approximation?

A

The limiting factor of joint movement feels “soft” and pressure at the initial end of range of motion easily yields more range.

23
Q

what are the treatment guidelines for soft tissue approximation with regard to end-feel

A

Probably easily rehabilitated and full movement restoration will be rapid.

24
Q

what is the end-range sensation for capsular?

A

The initial end range of motion can be increased, but resistance is greater and the amount of range increase is smaller.

25
Q

what are the treatment guidelines for capsular end-feel?

A

The capsule can be stretched over a period of time, dependant on how firm the capsular end-feel is and the chronicity of symptoms.

26
Q

what is the end-range sensation for bone on bone

A

An abrupt end-feel occurs that does not yield more range from the initial end range when pressure is applied.

27
Q

what are the treatment guidelines for bone on bone end feel?

A

Small chance of increasing the present range of motion. Manipulation under anesthesia or surgical intervention most likely needed.

28
Q

what is the end-range sensation for a springy block?

A

When end range is reached, there is a rebound felt. Intra-articular meniscal displacement is usual cause.

29
Q

what are the treatment guidelines for a springy-block end feel?

A

Traction is the only alternative to allow the intra-articular block to move out of the path of movement.

30
Q

what is the end-range sensation for muscle spasm?

A

A rapid abrupt stop of movement with muscle tension is apparent.

Spasm end-feel varies many times with range. Avoidable with increases in speed of movement.

31
Q

what are the treatment guidelines for muscle spasm end feel?

A

Spasm is secondary to irritation.

Check muscle and joint structures.
Treat for inflammation.

32
Q

what is the end-range sensation for an empty end-feel?

A

When moving through the range of motion, no resistance is felt regarding the joint surfaces, but at a point in the range the client will voluntarily contract the muscles and stop further movement. An abrupt unexpected stop of movement.

33
Q

what are the treatment guidelines for an empty end-feel?

A

This end-feel can indicate major problems in tissue around and serving the joint. It can also be of psychological origin. Usually the end range does not vary with speed of movement as it does with a spasm end-feel.

34
Q

what are some normal end feels?

A

Bone on Bone

Soft Tissue Approximation

Capsular – feeling a capsular end feel is normal depending on joint

Soft Tissue Stretch

35
Q

what are some abnormal end-feels?

A

Bone on Bone

Muscle Spasm

Capsular

Springy Block

Empty

Soft Tissue Approximation

36
Q

what are some key guidelines for resisted isometric contractions?

A

Isometric

Only the muscle working

build contraction gradually

Be sure to adjust the therapist position so you can resist the athlete when they are working as hard as possible

When positive each contraction should be done in inner, middle and outer ranges

37
Q

what is the method for resisted isometric contractions?

A

Ask the athlete to attempt a joint movement while the remainder of the limb or body is stabilized

Stabilization is needed to minimize substitution and minimize joint movement

Muscle groups are tested and if a weakness is found individual muscles should be tested

Therapist and athlete build to a maximal contraction gradually disallowing any joint movement

Each muscle and tendon are tested in a position that best isolates them
They are at optimal length for a maximal contraction

The amount of therapist pressure depends on the part being tested, the leverage and the strength of the athlete

Instruct the athlete when the resistance will start and coach them on the length of contraction with a slow cessation of pressure

Muscles other than those being tested must not be included

(i.e. Elbow resistance at hand vs. above wrist)

Athlete must be encouraged to try their hardest

(NB cannot resist plantar flexors manually)

38
Q

what should the therapist record for resisted isometric contractions?

A

The degree of strength on a scale from 0-5:

Gone 0 – no contraction left

Trace 1 – muscle can be felt to tighten, but cannot produce movement

Poor 2 – produces movement with gravity eliminated, but cannot function against gravity

Fair 3 – can raise part against gravity

Good 4 – can raise part against outside resistance as well as against gravity

Normal 5 – can overcome a greater amount of resistance than a good muscle

Whether the test is painful or pain free

record where there is pain during the contraction

record when there is pain during the contraction
Ex. Did the pain come immediately or at the end

39
Q

what can the results of resisted isometric contractions show?

A

weakness can be due to a neurological deficit or actual loss of strength of the muscle or tendon

appropriate neurological testing can rule this out

It is important to determine true weakness from apparent weakness due to pain or an unwillingness of the athlete to exert the muscle

40
Q

For resisted isometric contractions - Possible combinations of other strength and pain factors include:

A

Strong and Painless

Strong and Painful

Weak and Painless

Weak and Painful

41
Q

what is the significance of resisted isometric contractions?

A

These movements test the state of the contractile structures and their nerve supply

42
Q

how do you determine “normal” in relation to muscle testing?

A

Bilateral on each patient

Build a basis for comparison of test results through experience in muscle testing

Test a series of individuals of various ages and activity levels both male and female

Test persons with faulty posture as well as those with good posture

The grade strength (0-5) of the muscle will indicate how to plan a program for muscle re-education

This will be used as a sign for continual reassessment

43
Q

What conditions could you have if you have pain and limitation in every direction with passive movement when the whole joint is affected.

A

Pain and limitation in every direction when the whole joint is affected is arthritis or capsulitis

44
Q

T/F Each joint has its own “capsular” pattern with different limitations in each direction

A

True

A&R (9 decks)

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