Musculoskeletal Examination (10/14a) [Examination] Flashcards
Medical World vs PT World
Medical
- tissue/pathology based
- pathoanatomy
- often directs general treatment approach and informs prognosis
PT
- impairments/movement based
- usually dictates what we do with a patient
Medical World - Pathoanatomic Diagnosis
Anatomically based
Pathology based
What tissue is affected?
Pathology drives Rx
Non musculoskeletal
Pathoanatomy vs Impairments
Fractured Radius vs Wrist Joint Stiffness
Rotator Cuff Tear vs Shoulder Weakness
Lateral Ankle Sprain vs Joint Instability
Knee Osteoarthritis vs Knee Pain/Effusion
Achilles Tendinitis vs Heel Pain/Tightness
PT World - Movement Diagnosis
Impairment based
What is/are the primary impairment(s)?
What is causing them?
Impairment drives Rx
Based on the assumption that impairments relate to limitations in functional activity and participation
Are impairments and activity limitations always correlated?
No, not always directly correlated
make sure you find out what the patient cares about being able to do
correlation often below 0.5
Using Patient Management Model for Diff Dx
Functional Movement Task
- use CASSS
Observation
Hypotheses about Dysfunction
Specific Tests and Measures
Evaluation and Movement Diagnosis
Interventions
Reobserve
Cyriax - Diagnosis by Selective Tension
Identify the tissue with the “lesion”
Reproduce chief complaint symptoms by applying tension
Maitland - Diagnosis by Comparable Sign
Reproduction of the patient’s chief complaint with a movement, position, or test
Asterix on exam findings, compared over time
Developed system of vertebral manipulation
Musculoskeletal Tissues - Contractile
Muscle and tendon
and tenoperiosteal junction
Musculoskeletal Tissues - Inert
(not capable of producing movement)
Capsule, ligament, menisci, bone, bursa
Cartilage isn’t on the list since it isn’t a direct source of symptoms
Cyriax Examination - Overview
“Selective tissue tension”
Based on the notion that the “lesion” can be localized by selectively applying tensile stress to various tissues in a systematic way
Goal is to diagnose the location of the symptomatic “lesion”
Can be applied to virtually all musculoskeletal regions — works better at some than others (extremities vs spine)
Most won’t use it for the spine since it doesn’t work as well for it
Cyriax Examination - Steps
AROM → PROM → Isometric Resistance
AROM — ability / willingness to move
PROM — passive tension inert & contractile
Isometric Resistance — active tension, contractile only
Cyriax Steps - AROM
Ability and willingness to move
Quality of motion
Range, pain, painful arc
Painful Arc
pain in the middle of a ROM (EX: common with shoulder)
tend to mean something is transiently getting stressed/pinched
Cyriax Steps - PROM Sequence of Pain/Limitation
pain before end-range (acute)
pain at end-range (subacute)
pain with overpressure (chronic)
Irritability (per Maitland)
- High: pain prior to resistance/end feel → treat pain
- Low: resistance/end feel prior to pain → treat limitation
Cyriax Steps - PROM Capsular Patterns
predictable pattern of PROM for a specific joint
PROM is a proportional loss
Indicates involvement of entire joint
Arthritis, synovitis, capsulitis
EXAMPLES
Glenohumeral joint loss
- Lose more ER > Abd > Flex/IR
Hip joint loss
- Lose more IR > (Flex, Ext, Abd)
Knee joint loss
- Lose more Flex > Ext
Ankle joint loss
- Lose more Plantar Flex > Dorsiflex
Cyriax Steps - PROM Noncapsular Patterns
PROM not in capsular pattern
something other than entire joint
isolated ligament adhesion, internal derangement, extra- articular tissue
Internal derangement = something floating around in the joint that doesn’t belong there, such as a piece of tissue (EX: meniscal tear)
EXAMPLE
GH jt loss
- Lose more Abd>ER
- seen with impingement syndrome
Cyriax Steps - PROM End Feels
capsular spasm empty bony tissue approximation springy block
Cyriax Steps - Isometric Resistance
No joint movement
Midrange — minimize stress to inert structures
4 types of findings with neutral joint
Cyriax Steps - Isometric Resistance Findings
Strong / Painless = Normal
- strong = getting adequate contraction
Strong / Painful
- minor lesion in contractile unit
- usually tendinitis
- minor muscle strain
Weak / Painless
- complete tear
- neurologic (spinal nerve root, peripheral nerve)
Weak / Painful
- partial tear
- occult fracture
Summary of Cyriax Approach to Examination
AROM → PROM → Isometric Resistance
Palpation
Special Tests
- joint play (accessory motion)
- other clinical exams (sensory, reflexes, ectc)
- imaging, EMG
Functional Tests
High Irritability
DESCRIPTION
- severe pain
- symptoms (sx) easily provoked
- no control of sx’s
- acute trauma
TREATMENT
- control sx’s
- stress relief
- no end range
Low Irritability
DESCRIPTION
- less pain
- sx’s controlled
- sx’s more predictable
TREATMENT
- address impairments
- stretching
- strengthening
