Musculoskeletal Assessment Flashcards
Sagittal Plane
Separates left and right lateral halves
Frontal Plane
Separates anterior and posterior halves
Transverse Plane
Separates superior and inferior halves
Sagittal Axis
Runs through the FRONTAL plane. Frontal plane movements move about this axis.
Frontal Axis
Runs through the SAGITTAL plane. Sagittal plane movements run about this axis.
Vertical Axis
Runs through the TRANSVERSE plane. Transverse movements (rotation) move about this axis.
What is kinematics?
The study of motion without regard for the forces that are creating the motion. It describes the type, direction, and magnitude of motion; location of the bony segment in space; and the rate of change or velocity of the segments.
What is a translatory motion?
It is linear displacement.
What is a rotary motion?
It is angular displacement.
What are arthrokinematics?
Refers to the movement of joint surfaces. Classifies movement as slides (glides), spins and rolls
0 Joint Motion Grade
Ankylosed
1 Joint Motion Grade
Considerable hypomobility
2 Joint Motion Grade
Slight hypomobility
3 Joint Motion Grade
Normal
4 Joint Motion Grade
Slight hypermobility
5 Joint Motion Grade
Considerable hypermobility
6 Joint Motion Grade
Unstable
What is osteokinematics?
Gross movement of the shafts of bony segments, measured by goniometry.
What are degrees of freedom?
Type of motion available at joint. The number of degrees of freedom varies according to structure of joint.
Where is the starting position(s) for measuring all range of motion?
Anatomical or neutral position
What ROM notation system do we use?
0 to 180 degree notation system
What factors can affect range of motion?
Age, gender, BMI, disease, occupation, recreation, culture
What kind of information does active range of motion provide?
Willingness to move, coordination, muscle strength, joint range of motion, pain or structural restriction
True or false: Pain-free, unrestricted active range of motion within expected range requires further assessment.
False, it does not.
What are some reasons why there could be limited active range of motion?
Inflammation or injury to muscle tissue, irritation or pinching of non-contractile tissues, structural blocks, joint effusion or edema, capsular tightness, lack of muscle length or inadequate force production, excessive muscular or adipose tissue
What is active assistive range of motion?
Arc of motion produced by the individual’s muscle contraction assisted by an external force.
What is passive range of motion?
Arc of motion produced by the application of external force
What information does passive range of motion provide?
Integrity of joint surfaces, extensibility of the joint capsule, ligaments, muscles, and fascia, irritability of local tissues, full range allowed by a joint
What is a joint end feel?
Passive end range of motion of a joint
What can normal joint movement be limited by?
Articular surface contact, extensibility of ligaments, tendons, or muscles. Opposition of soft tissue.
What is an example of a normal soft end feel?
Knee flexion (due to soft tissue approximation)
What is an example of a normal firm end feel?
Hip flexion with the knee straight (muscular stretch), Extension of the MCP joints (capsular stretch), Forearm supination (ligamentous stretch)
What is an example of a normal hard end feel?
Elbow extension (bone on bone)
What is an example of an abnormal soft end feel?
Soft tissue edema in the elbow (occurs in a joint that has a firm or hard end-feel)
What is an example of an abnormal firm end feel?
Capsular or ligamentous shortening (occurs in a joint that has a soft or hard end-feel)
What is an example of an abnormal hard end feel?
Loose bone fragments in a joint (occurs in a joint that has a soft or firm end-feel) or Myositis ossificans
What is an example of an empty end feel?
Bursitis, abscess, fracture (no real end-feel)
What is hypomobility?
Decrease in ROM that is substantially less than normal values for that joint.
What is a capsular pattern of restricted motion?
Particular pattern of restriction involving all or most of the passive motions of the joint.
What is a non-capsular pattern of restricted motion?
Limitation of passive motion that is not proportioned.
What is hypermobility?
Ability of one or more joints to actively or passively move beyond normal limits.
What are the 5 criteria for the Beighton Hypermobility Score?
Passive appose thumb to forearm, passively extend 5th MCP more than 90 degrees, hyperextend elbow more than 10 degrees, hyperextend knee more than 10 degrees, place palms on floor by flexing trunk with knees straight.
What are the guidelines for gross ROM assessment?
Minimize position changes, test unaffected side first if possible, test AROM and always ask the patient’s opinion of why the motion is limited, test PROM of joints w/ below-normal range or pain with the motion (note joint end feel)
What are precautions to ROM?
Suspected or confirmed joint dislocation, subluxation, unstable bone fracture, rupture of tendon or ligament, infectious or acute inflammatory process, severe osteoporosis, acute injury or recent surgery, present of pain or muscle spasms, immobilized joints (e.g. cast)
What is defined as muscle length?
Maximal muscle length is the greatest extensibility of a muscle tendon unit
What is a tonic muscle?
Tonic muscles maintain an upright posture, are often two joint muscles, have a low tendency toward atrophy, higher tendency to become tight or hypertonic.
What is a phasic muscle?
Phasic muscles are frequently one joint muscles that have a higher tendency to atrophy, they fatigue easily and have a higher tendency toward inhibition and weakness
What are the guidelines for muscle length assessment?
Standardized muscle length testing positions, gather knowledge of known or suspected knowledge, analyze tissue resistance.
What is passive insufficiency?
The inability of a muscle to LENGTHEN and allow full ROM at all the joints the muscle crosses. Muscle is put on slack by passively approximating the origin and insertion of the muscle.
What is defined as muscle strength?
Amount of force produced by a muscle or muscle group to meet or overcome resistance.
True or false? Skeletal muscles must overcome gravity and other opposing forces to produce joint movement.
True.
In what range of motion should you put the joint in when performing an isometric break test?
Midrange of motion
In what position should you put the patient in when performing the make test?
Neutral or resting position
What are the contraindications to assessing muscle strength?
Unhealed fractures, pathologically unstable joints, prohibited AROM.
What are the precautions of assessing muscle strength?
Advanced osteoporosis, metastatic cancer, osteogenesis imperfecta.
5 on the MMT Grading Scale
Normal: muscle contracts normally against full resistance
4 on the MMT Grading Scale
Good: holds test position against moderate resistance
3 on the MMT Grading Scale
Fair: Holds test position against gravity with no added resistance
2 on the MMT Grading Scale
Poor: Able to move through full ROM in the horizontal plane position (eliminate gravity)
1 on the MMT Grading Scale
Trace: Palpable or observable contraction in horizontal plane position but not visible movement.
0 on the MMT Grading Scale
No palpable/ observable contraction in horizontal plane position
Strong & Pain Free on the Cyriax Scale
No lesion present in the contractile unit
Strong & Painful on the Cyriax Scale
Local lesion of the muscle or tendon
Weak & Painful on the Cyriax Scale
Severe lesion around the joint (contractile tissue)
Weak & Pain Free on the Cyriax Scale
Complete rupture of the muscle, tendon or its attachment (or peripheral nerve)
Is Muscle Strength assessment objective or subjective?
It is both a Science and an Art!
