Objective assessment 1 Flashcards
Routine assessment
Obs- alignment, atrophy, swelling, colour, deformity,
palpation- swelling, temp, atrophy, effusion, AROM/PROM, resisted testing, accessory, ligament, functional tests
observations- alignment
limb position, shape, deformity
valgus more common in men, varus more common in women, bony points can highlight incorrect joint position
observations- atrophy
can be caused be neurological conditions, muscle bulk/ size, hypertrophy, atrophy- decrease in muscle size
observations- colour
necrosis- blackened grey areas of tissue, with potential wound breakdown, cellulitis- swelling/ infection of skin
observations- deformity
acquire or congenital flat foot- caused by rupture of tibialis posterior tendon, tenting- bone stretches the skin, haglunds deformity- changes on calcaneus of foot
AROM- quality
willingness to move- fear fall of movement? or unable to move limb due to nerve input? or they present themselves moving by being rigid and tense, smoothness/ coordination of movement
AROM- range
goniometer, forms objective marker, muscle spasms or any resistance to movement
AROM- pain response-
when and where, when did symptoms start/ finish,
AROM- what does it test
mechanical/ structural- muscle and tendon (contractile tissue), and inert tissue (joint, ligs, capsule) stretches and pulls, load transfers/ acceptance
If PROM is pain free or painful what does it show
free- it shows a muscle problem
pain- joint (inert) problem
AROM- biopsychosocial aspects
willingness to move, pain behaviour, avoidance, reluctance fear, could be O*
PROM
client should be supported and comfortable, clinician comfortable with bed at correct height, passively take joint through available range of motion, if pain free can go to overpressure (low SIN)
what are you looking for with PROM
feel quality of movement- end feel, further range?, resistance or muscle spasm and any symptoms produced?, limit to movement- resistance or pain?, pain response, ROM achieved
PROM- normal end feel
soft- soft tissue approximation and bony end feels
hard- bony approximation
spongy- inflamed or effused
soft with hard end feel- capsular, ligament, or muscle stretch
what does PROM test
test inert tissue and non-contractile tissue, should be no muscle activity, where and when does pain begin and finish (P1 and P2), how does further movement affect pain, where and when does stiffness begin- S1
what are you feeling for PROM
the pattern of movement limitations, end feel, the movement of associate joints, the ROM,
abnormal end feel
bone-bone- hard
muscle spasm
empty- no end feel, only get this when pain stops the movement, or could be fearful, or could be ligament laxity
elastic/capsular - too early in range
springy block- can be menisci- springs back
capsuler patterns
only joints controlled directly by muscles have a capsular pattern, capsule must be tested in physiological ranges, identify patterns of restrictions
causes of capsular pattern
capsular contraction, muscle spasm, osteophyte formation
non-capsular patterns
internal derangement, extra articular lesions, single muscle involvement
what is goniometry
measuring the available ROM or the position of the joint (typically PROM)
goniometer procedure
position joint in 0 position and stabilize proximal joint component, move joint to end range, determine end feel at the point where measurement will be taken, identify and palpate bony landmarks, align goniometer with bony landmarks while holding joint,
goniometer consideration- positioning
start at 0°, document limiting factor
goniometer consideration- stabilizing
usually stabilize proximal joint components, promote patient relaxation so voluntary muscle contractions doesn’t interfere (PROM)
goniometer consideration- accuracy
validity, reliability- intra-tester <5°, inter-tester >5°
Documenting AROM
the joint, movement, active or passive, test position, start position, end position, ROM, limiting factor
documenting PROM
the joint, movement, active or passive, test position, start position, end position, ROM, limiting factor, quality of movement, end feel
