Objective Flashcards
physical exam items are most likely to be in an MSK objective
observation
palpation
functional screen
clearing related joints
PROM/AROM
joint mobility
muscle performance
what are we looking for in observation during an exam
gait
transfers
posture
visible atrophy or tone differences
malformations / deformities
in a functional screen, what are we looking for?
we are hoping to localize / find the origin of pain, but looking for
symptom reproduction
hesitancy to complete the movement
changes in motion
what are some functional screens for UEs
arms overhead
reaching behind head/back
lifting a weight / carrying a weight
functional tests for the spine
flexion/bending to pick up
extending
lifting / carrying a load
functional tests for LE
squats
walking
sit to stand
stairs
what is something to keep in mind when “clearing” a joint
joint above and below but also the spine
UE - cervical/thoracic
LE - lumbar spine/SI jt
what are the criteria for “clearing” a joint
able to actively move through ROM in a normal movement pattern
application of overpressure
- both without reproduction of symptoms
joint clearing is an example of
screening
criteria for AROM
quality
quantity
reactivity
- of motion
what is quality of motion
“fluidity” of motion
compensatory or lack of compensatory patterns
what is used for quantity of movement
goni
normative shoulder motion degrees
flex - 180
ext - 60
abd - 180
IR - 70
ER - 90
normative elbow motion degrees
flex - 150
ext - 0
pro - 80
sup - 80
normative wrist motion degrees
ext - 70
flex - 80
radial dev - 20
ulnar dev - 30
what is important to keep in mind when doing PROM on a painful joint
pain may be opposite of the painful active motion due to muscle stretch
how to minimize gaurding
body contact
bed set up
patient position
steps to ROM assessment
active or passive to first point of pain/resistance
– assess response
repeat to max point of pain/resistance
– assess response
repeat motion to determine if pain or ROM changes
full motion and painless = overpressure
what can cause adaptive shortening
restricted mobility
tissue damage
prolonged immobilization
disease
neuro involvement
what is morphological muscle shortening
contracture
what is physiological muscle shortening
spasmodic
what is neurological muscle shortening
hypertonicity
normal end feels? what makes each occur
soft - soft tissue approximation
firm - joint tissue, capsule, ligaments
hard - bone on bone
joint mobility grading and description
0 - no mvmt
1 - mvmt
hypo / normal / hypermobile
difference between capsular and joint stiffness
capsular - multiple plane of mvmt
joint stiff - singular plane
Grade 1 maitland oscillations
small amplitude
beginning of range
- for pain
grade 2 maitland oscillation
large amplitude
within available range, up to tissue resistance
- for pain
grade 3 maitland oscillation
large amplitude
into tissue resistance
- for mobility
grade 4 maitland oscillation
small amplitude within tissue resistance
- for mobility
what are resisted isometrics used for
if pain/weakness is present during muscle activation
are resisted isometrics break or make tests? how come?
make - match resistance of pt
“break” will hurt the patient and decrease self-efficacy
at what portion of ROM are resisted isometrics completed
mid-range position
indications for “strong but painful” patients?
what interventions?
those with
muscle tendon issue
joint pathology
resisted isometrics
indication of “weak but painless”
nerve palsy
complete tendon tear
indication of “weak and painful”
major lesion
what are used to measure muscle performance in nonpainful situations
MMT
dynamometry
uses of palpation
skin temp / inflammation
swelling / jt effusion
anatomical structure tenderness
muscle tone or abnormalities
distal pulses
what can palpation tell you about a muscle
trigger points
tonic changes
fasciculations
when is neuro screen indicated
radiating pain / paresthesia
referred pain in dermatomal dist
weakness without pain during function, resistance or MMT
what is in a neuro screen
sensation
muscle strength
reflexes
neural dynamic testing
upper extremity performance based measures examples
CKCUEST
TFAST
Shelf Taps
spine performance based measures examples
multifidi leg raise
biofeedback cuff (C/T Spine)
trunk extension hold
lower extremity performance based measures examples
5xSTS
6 MWT
TUG
13 Steps
how can 5xSTS be adapted based upon population
stronger/more able pts can do a kickstand version with one leg out and one leg back
– back leg does most of work
