Lower Limb 1.2 Flashcards
What are the joint movements permitted at a particular joint determined by?
- shapes of the reciprocal articular surfaces of the bones
- surrounding ligaments
- muscle tone
What are general rules for examination of joints?
1) Look – visual inspection
2) Feel - palpation
3) Move – range of passive movements
4) Measure – measure the degrees of movement
5) Compare with the opposite limb
How do you assess the passive movements and tone of joints in the lower limb?
- After inspection and palpation ask the patient to consciously relax the limb and trunk muscles
- hold the part of the limb and move the joint gently
- Notice and record any abnormalities during the passive movement of the joint
What are you looking for when you hold the part of the limb and move the joint gently
- stability of the joint
- abnormal movements
- joint crepitus
- rigidity
- spasticity
- pain
- Range of movements
What do you compare the joint of one limb with?
the other limb
What is the passive range of movement?
When the examiner moves the joint through a range of motion, with no effort from the patient
What is the range of movement of a joint determined by?
- joint structure
- ligaments
- tendons
- muscles
- skin
- tissue injury
- fat tissue
- body temperature
- activity level
- age
- sex
What can these factors affect?
- passive movement of a joint
- result in hyper mobility or hypo mobility of. joint
What else affects joints other than physical factors?
neuromuscular activity in the muscles responsible for voluntary movement at a joint usually causes few muscle fibres within a muscle being in a state of contraction all the time
What is this contraction responsible for?
skeletal muscle tone
How do you test degrees of loss or increase of tone?
- passively moving the joints 2. comparing the resistance to the movements by the muscles on the two sides of the body
What do you feel when you test for passive movement of a joint?
some residual resistance even though the patient was not consciously contracting that muscle
What is this residual resistance?
muscle tone
What is responsible for the muscle tone?
reflex control from the afferent nerve endings situated in the muscle itself
What underlies muscle tone?
integrity of the spinal segmental reflex arc
What happens if there is a breach in the spinal segmental reflex arc where the simple spinal reflexes are not functioning?
- that muscle will be without any tone
- muscle will remain fully relaxed or floppy
What happens if you test for passive movement of the joint where. break in spinal segmental reflex arc?
experience hypermobility
What does the anterior root of the spinal nerve do? What are these motor neurones referred to as?
- it is part of spinal segmental reflex arc
- sends motor neurons to the muscle
- these motor neurons are referred to as the lower motor neurons
What are the lower motor neurons of the spinal segmental neurons are influenced by?
nerve impulses received from the cerebral cortex, midbrain, pons and medulla