Objective assessment 1

Question 1

Routine assessment

Answer 1

Obs- alignment, atrophy, swelling, colour, deformity,

palpation- swelling, temp, atrophy, effusion, AROM/PROM, resisted testing, accessory, ligament, functional tests

Question 2

observations- alignment

Answer 2

limb position, shape, deformity

valgus more common in men, varus more common in women, bony points can highlight incorrect joint position

Question 3

observations- atrophy

Answer 3

can be caused be neurological conditions, muscle bulk/ size, hypertrophy, atrophy- decrease in muscle size

Question 4

observations- colour

Answer 4

necrosis- blackened grey areas of tissue, with potential wound breakdown, cellulitis- swelling/ infection of skin

Question 5

observations- deformity

Answer 5

acquire or congenital flat foot- caused by rupture of tibialis posterior tendon, tenting- bone stretches the skin, haglunds deformity- changes on calcaneus of foot

Question 6

AROM- quality

Answer 6

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

Question 7

AROM- range

Answer 7

goniometer, forms objective marker, muscle spasms or any resistance to movement

Question 8

AROM- pain response-

Answer 8

when and where, when did symptoms start/ finish,

Question 9

AROM- what does it test

Answer 9

mechanical/ structural- muscle and tendon (contractile tissue), and inert tissue (joint, ligs, capsule) stretches and pulls, load transfers/ acceptance

Question 10

If PROM is pain free or painful what does it show

Answer 10

free- it shows a muscle problem

pain- joint (inert) problem

Question 11

AROM- biopsychosocial aspects

Answer 11

willingness to move, pain behaviour, avoidance, reluctance fear, could be O*

Question 12

PROM

Answer 12

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)

Question 13

what are you looking for with PROM

Answer 13

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

Question 14

PROM- normal end feel

Answer 14

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

Question 15

what does PROM test

Answer 15

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

Question 16

what are you feeling for PROM

Answer 16

the pattern of movement limitations, end feel, the movement of associate joints, the ROM,

Question 17

abnormal end feel

Answer 17

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

Question 18

capsuler patterns

Answer 18

only joints controlled directly by muscles have a capsular pattern, capsule must be tested in physiological ranges, identify patterns of restrictions

Question 19

causes of capsular pattern

Answer 19

capsular contraction, muscle spasm, osteophyte formation

Question 20

non-capsular patterns

Answer 20

internal derangement, extra articular lesions, single muscle involvement

Question 21

what is goniometry

Answer 21

measuring the available ROM or the position of the joint (typically PROM)

Question 22

goniometer procedure

Answer 22

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,

Question 23

goniometer consideration- positioning

Answer 23

start at 0°, document limiting factor

Question 24

goniometer consideration- stabilizing

Answer 24

usually stabilize proximal joint components, promote patient relaxation so voluntary muscle contractions doesn’t interfere (PROM)

Question 25

goniometer consideration- accuracy

Answer 25

validity, reliability- intra-tester <5°, inter-tester >5°

Question 26

Documenting AROM

Answer 26

the joint, movement, active or passive, test position, start position, end position, ROM, limiting factor

Question 27

documenting PROM

Answer 27

the joint, movement, active or passive, test position, start position, end position, ROM, limiting factor, quality of movement, end feel