Lecture ROM, RISOM, MMT, and STTT Flashcards
define range of motion
Joint movement that is available in a specified plane or direction of movement. N.B. the “available” ROM refers to the movement that can be performed in a clinical situation. It is not exclusively limited by the anatomical constraints of the joint, but may be restricted by a wide variety of factors (see End-Feel).
define end of range
The end of the available ROM of a joint, in a given direction
define AROM and PROM
AROM: Available ROM when the movement is performed by the patient, without assistance PROM: Available ROM when the movement is performed by the therapist, with the patient is fully relaxed
define flexibility - what situation is it reserved for?
The extent to which a muscle / muscle group can be lengthened across all relevant joints, by a movement which increases the distance between the origin and insertion of the muscle / muscle group. N.B. the term “flexibility” is generally reserved for situation in which the movement being assessed is limited by the extensibility of the muscle (tissue stretch end-feel)
define over pressure
Slight pressure, applied by PT in the direction of the movement, at EOR
define end feel
Quality of resistance felt by therapist at EOR.
describe bony end feel
normal: hard block not painful to patient abnormal: not explained by normal joint contoures (early in ROM), can result from osteophyte formation or malaligned fractires
describe soft tissue approximation end feel
limited by the compression of the muscle bulk (considered normal). Examples: can be felt in some muscular patients when doing elbow flexion or knee flexion. Exception: abnormal when limited by adipose tissue.
describe normal tissue stretch E/F (2 types)
Normally, this is felt as a gradual and progressive increase in the resistance to movement, over a fairly small range, depending on the length of the structure limiting the movement. elastic/soft tissue: typically limited by muscle stretch (therapist feels a firm or springy sensation with some give, ankle DF with knee extension) capsular: limited by the extensibility of the joint capsule and/or associated ligaments. The therapist feels a firm E/F with some give (for example: ankle DF with knee in flexion)
describe abnormal tissue stretch E/F
early/hard capsular:a rapid increase in resistance is felt over a shorter-than-expected range and is generally accompanied by a reduced ROM in that direction. It indicates joint hypomobility in that direction. soft capsular:in the case where the capsular resistance is less than expected and is generally accompanied by an increase in ROM in that direction. It indicates joint hypermobility in that direction (e.g. shoulder ER in 90° of abduction in someone with a history of chronic shoulder dislocation). early elastic: Elastic E/F but it does not occur where one would expect.Example: a tight single joint muscle.
describe a muscle spasm E/F
an involuntary muscle contraction often associated with pain and/or the anticipation of pain. Early muscle spasm: occurs before the normal expected EOR (joint inflammation, bursitis) Late muscle spasm: felt at the actual EOR of the movement generally accompanied by a ROM greater than expected. (chronic joint instability)
describe an ‘empty’ end feel
limited by pain reported by the patient, but with no physical sensation of resistance felt by the PT. -can continue to move joint either actively or passively to get good idea of ROM -Often indicative of a serious or severe pathology. For examples: subacromial bursitis, tumor, fracture.
describe springy block end feel
limited by a resistance that gives the impression of a spring being compressed (“rebound” sensation) - this is normal for cervical spine compression but abnormal for meniscal tear for example
describe boggy end feel
limited by a resistance that gives the impression of viscous resistance, or of a balloon filled with a thick fluid being compressed. Often associated with joint effusion or hemarthrosis.
define: inert structures
Anatomical tissues that are not involved in the generation or transmission of force by the skeletal musculature. This includes ligaments, joint capsules, bursae, blood vessels, cartilage, dura matter, neural structures
define contractile structures
Anatomical tissues that are involved in the generation or transmission of force by the skeletal musculature. This includes muscles (ms), tendons, aponeuroses and myofascial.
what are the connective tissues associated with nerves classified as?
neural structures, inert
define: functional excursion (and what it depends on)
The range over which a muscle is capable of shortening, during normal physiological movements For single joint muscles, this is generally limited by the ROM of the joint. For multi-joint muscles, this is generally limited by the flexibility of the muscle in one direction (passive insufficiency) and the ability of the muscle to overcome the passive resistance to stretch of the antagonist muscle(s) in the other direction (active insufficiency).
define passive instability
increased movement relative to normal (physiological or accessory) - may be due to ligament or capsular laxity and present with abnormal E/F (soft capsular)
define active instability
Inability to actively control the movement of a joint through its full available ROM. may be associated with giving way (or sensation of that)
what are osteokinematic movements?
physiological movements that can be voluntarily controlled through forces generated by contractile tissue. N.B. these movement will place stress on both inert and contractile structures.
what are arthrokinematic movements?
Accessory Movements that occur during physiological movements, but that are generally not actively controlled (ie controlled by anatomical constraints) -generally assessed with joint glides, which are primarily limited by inert structures
explain how ROM is assessed correctly
Assessed by placing relevant multi-joint muscles on slack at joints other than the one being assessed e.g. ROM knee ext. – ensure hip is not flexed
explain how flexibility is assessed correctly
Flexibility assessment = Muscle range Assessed by lengthening the muscle to be assessed across ALL relevant joints - Generally reserved for multi-joint muscles - e.g. flexibility, hamstring muscle group 1) Hip flexion to 90 degrees 2) Knee extension
what structures does movement through ROM affect?
- ALL structures!! Muscles Joint surfaces Capsules Ligaments Bursae Fasciae Vessels Nerves
contraindications and precautions for ROM assessment
describe the ROM assessment steps
- note: test healthy side first!
what are the contraindications for assessing muscle flexibility?
- same as for ROM assessment
explain how to perform a flexibility assessment
instruments summary
note validity = measurements taken vs what it shows on x-rays
for a goniometer, what is the minimal detectable change for the same therapist vs different therapists?
contraindications and precautions for RISOM and MMT
describe the utility of MMT as a screening test (compared to dynamometer)
describe sensitivity vs specificity in context of the MMT screening text
MMT = not very good sensitivity, therefore when in doubt just give the exercises (can’t hurt to do mroe exercises)
describe RISOM procedure
interpretation for RISOM
MMT flowchart - for grading
MMT grading (normal)
MMT grading (gravity negligable)
STTT - describe what movements would be painful for contractile tissues put on strain
STTT - inert tissue grading
STTT - contractile tissue patterns
