Objective Exam Flashcards
What are you looking for in the objective exam?
Patterns of movement and restrictions
What are you hoping to do in an objective exam?
reproduce symptoms, confirm or rule out hypotheses
What is step one of the objective exam?
collect, test, measure objective data
What is step 2 of the objective exam?
analyze data, establish working Dx
What is step 3 of the objective exam?
Determine prognosis
What is step 4 of the objective exam?
Formulate the plan of treatment
What are the two physiologic motion test?
active and passive ROM
What is the accessory motion test?
Joint play
What are you looking for in a motion test?
- quality of movement 2. quantity of movement 3. symptom response
In which motion test is the examiner taking the joint through the ROM with the patient relaxed?
Passive ROM
In which motion test is the the test applied to normal ROM to reproduce symptoms?
Active ROM
You wish to measure shoulder flexion AROM. Which of the below is MOST APPROPRIATE to use to objectively measure this?
goniometer
You want to measure a patients neck flexion range of motion (ROM). Which instrument, assuming available in the clinic, is most appropriate for performing this?
inclinometer
How should you assess ROM?
bilaterally and compare
How many repetitions are recommended for a realistic measurement?
2
What is the first step in measuring ROM?
Position the patient
What is the second step in measuring ROM?
locate the bony landmarks
What is the third step in measuring ROM?
Place goniometer
What is the fourth step in measuring ROM?
align the arms of the goniometer
What is the fifth step in measuring ROM?
Move the joint through its active or passive ROM
What is the sixth step in measuring ROM?
Read the goniometer at the appropriate ROMs
What is osteokinematics?
directions the bone move when motion occurs “physiologic motions”
What movements are in the sagittal plane?
Flexion, extension
What movements are in the frontal plane?
Abduction, adduction
What movements occur in the transverse plane?
IR/ER, Horizontal ABD/ADD
What are the joint axes?
Frontal, sagittal, longitudinal
What is arthrokinematics?
Motion between the joint surfaces during movement
What are the accessory motions?
Roll, slide, spin
What motions occur on a convex on concave surface?
Roll and glide accessory motions in opposite directions
What motions occur on a concave on convex surface?
roll and glide in the same direction
What are the joint positions?
Open packed, close packed
What is an open packed joint?
Ligaments and capsule in position of greatest laxity, joint surfaces are maximally separated
What is a closed packed joint?
Ligaments and capsules are taut, surfaces are maximally contacted
Which joint position is proper for assessing joint play and mobilization?
open packed
What is end feel?
the sensation felt in the joint as it reached the end of ROM
What are the normal end feels?
Bone to bone, soft-tissue approximation, tissue stretch
What is the normal bone to bone sensation?
Hard, unyielding sensation ex:elbow Ext
What is the soft tissue approximation sensation?
soft, yielding compression Ex: elbow Flexion
What is the tissue stretch sensation?
Hard or firm (springy) type of movement with slight give
What are the abnormal end feels?
Capsular, bone to bone, springy block, empty, muscle spasm
Describe capsular end feel.
similar to tissue stretch but occurs early in the motion
What are the two types of capsular end feels and describe them?
Hard - hard/firm end feel, abrupt onset after smooth, friction free movement.
Soft - boggy, very mushy, soft end feel accompanied with joint effusion
Describe muscle spasm end feel.
sudden and hard end feel, dramatic arrest in movement accompanied with pain
Describe an abnormal bone to bone end feel.
hard, unyielding sensation but restriction occurs before normal end range is expected
Describe springy block end feel.
firm end feel usually with a rebound effect indicating internal derangement in joint
Describe empty end feel.
no mechanical resistance, but considerable pain is produced by movement
What is a capsular pattern?
characteristic pattern of motion restriction when joint capsule is involved - unique for each joint
What are the indications for Muscle strength testing?
- Dx of peripheral nerve or nerve root injury
- effects of SCI and potential recovery
- basis for tx planning and px
- provide measure for treatment progress
- basis for supportive devices/orthoses
What are the ordered steps for MMT?
- position patient 2. explanation/PROM 3. Screen test/AROM 4. Palpate 5. Apply resistance 6. Grade
What does grading of MMT do?
attempt to express strength objectively
What are the factors that reduce grading accuracy?
pain, limited joint ROM, muscle hypertonicity/spasticity, others: fatigue cognition cultural/social norms
What grade indicates no palpable evidence of muscle contraction?
0
What is indicated by a score of 1 on an MMT?
no movement but can feel a contraction
What grade indicates a complete partial ROM in a gravity minimized position?
2-
What is indicated by a 2 on an MMT?
completes full ROM in a gravity minimized position
What score indicates a completion of partial ROM against gravity?
2+
What score indicates a completion of partial ROM with slight resistance in a gravity minimized position?
2+
What is indicated by a 3 on an MMT?
Full ROM against gravity - can hold with no resistance
what score is indicated by a full ROM against gravity but cannot hold it?
3-
What score is indicated by a full ROM against gravity and able to hole end ROM against slight resistance?
3+
What score is indicated by holding the test with moderate assistance?
4
What is a 4- on a MMT?
holds test in position against slight to moderate resistance
What is a 4+ on an MMT?
holds test in position against moderate to strong resistance
What is a 5 on an MMT?
Hold test position against strong to maximum resistance
