Objective Exam (Physiologic ROM) - Musculoskeletal Flashcards
physiological movements
ROM
use of a goni
what are physiological movements
normal movements we perform during our daily activities
how can physiological movements be performed
active or passively
AROM
performed voluntarily
what does AROM show
pt’s combined willingness to move
joint ROM
location of pain
muscle power
what do contractile tissues experience during ROM
tension placed on them
by stretching or contracting them
what do inert tissues experience during AROM
tension placed on them by stretching or pinching
inert tissues
all structures other than contractile tissues
determination of a problem…
should not be made by the first positive sign
when should we determine the problem
when all other contradictory signs have been eliminated
what should we note when testing active movements (1)
when and where in the movement the onset of pain occurs
if movement increases the intensity +/or quality of the pain
pts rxn to pain
amount of observable restriction
pattern of movement
what should we note when testing active movements (2)
movement of associated joints
willingness to move
quality of the movement
any limitation of movement
nature of limitation
when and where in the movement the onset of pain occurs
w/ pain at start, middle and end
if movement increases the intensity +/or quality of the pain
should be suspicious of contractile tissue pathology
but dont jump to conclusion
dont jump to conclusion
it could be vascular or the joint may be very irritated
pattern of movement
beware of subs
movement of associated joints
look at what occurs at surrounding joints
quality of movement
is the motion smooth and controlled
is it coordinated
PROM
pt must be completely relaxed
PT brings pt through the motion
what should the PT do as they take the pt through the motion –> PROM
continuously talk to the pt
movement must be –> PROM
proceeded through as must ROM as possible
through discomfort and up to the pain
what is PROM done to determine
amount of movement
sequence of pain and resistance
end feel
painful arc
sequence of pain and resistance
as we take the pt through the ROM, something will stop you
indicates the suitability of the area to be stretched
if there is pain before resistence
interpreted as an acute lesion
unsuitable for stretching
if pain occurs synchronously
lesion is subacute
may not tolerate gentle stretching
resistance before pain
chronic lesion
suitable for stretching
painful arc
when taking a pt through motion
starts pain free –then pain –> then goes away
PROM will also determine
capsular patterns
non capsular patterns
joint end feel
capsular patterns
directly related to passive physiological ROM
what is capsular pattern
when looking at the inert components of a joint
restriction of motion presents w/ consistent pattern of limitation for that respective joint
limitation = capsular pattern
what can the capsular contracture be the result of
many primary causes
primary causes of capsular contracture
non-use following a minor injury
strain or sprain that went unattended
any insult to a joint that will cause the capsule to fibrose
how do limitations occur –> capsular pattern
proportional pattern of restriction
NOT JUST THE DEGREE OF LOSS
what does the capsular pattern NOT indicate
pathology
extend of the joint involvement
non-capsular pattern
reveals capsular irritation is not present
what does the presence of a non-capsular pattern mean
irritation of the entire joint capsule is not contributing to the limitation of movement
another tissue type must be at fault
3 possible causes of non-capsular patterns
ligamentous adhesions
internal derangement
extra-articular lesions
ligamentous lesions –> non capsular pattern
usually occurs after an injury when adhesions occur
internal derangement –> non capsular pattern
occurs in joints where there is the possibility of having an intra-articular fragment of cartilage or bone
ex: meniscus in the knee
extra-articular lesions –> non capsular pattern
resisting structure is outside of the joint
if a capsule pattern isnt present
capsule could still be involved
joint end feel
important for determining the nature of the restriction that causes the end of motion
3 normal end feels
bone to bone
soft tissue approximation
tissue stretch
which normal end feel is most common
tissue stretch
5 abnormal end feels
muscle spasm
empty end feel
capsular end feel
bone to bone
springy
