objective exam principles Flashcards
explain how the body is positioned in anatomical position?
- body is erect
- palms face forward
- thumbs point out
- feet are slightly apart
- feet and toes point down
in how many planes of reference is the body divided into? what are they
3 anatomical/cardinal planes
- sagittal
- frontal
- transverse
how are the antomical planes situated from one another?
at right angles to each other an intersect at the center of gravity
what are the planes of reference used for?
for describing and measuring anatomical bone movements
what plane Divides the body symmetrically into right and left halves
sagittal plane
what plane Divides the body into anterior (ventral) and posterior (dorsal) halves
frontal plane
what plane divides the body into cranial and caudal halves and extremities into distal and proximal halves
transverse plane
when talking about anatomical directions what does superior refer to? what other word may be used?
Closer to the head
Cranial: used when referring to structures on the trunk
when talking about anatomical directions what does inferior refer to? what other word may be used?
Closer to the feet
Caudal:used when referring to structures on the trunk
when talking about anatomical directions what does anterior refer to?
structure further in front in comparaison to another structure
when talking about anatomical directions what does posterior refer to?
a structure further toward the back of the body than another structure
when talking about anatomical directions what does medial refer to?
pertains to a structure closer to the midline or center of the body
when talking about anatomical directions what does lateral refer to?
refers to a structure further from the midline
when talking about anatomical directions what does distal refer to?
a structure further away from the trunk or the boldy’s midline (extremities)
when talking about anatomical directions what does proximal refer to?
a structure closer to the trunk (extremities)
when talking about anatomical directions what does superficial refer to?
a structure closer to the body’s surface
when talking about anatomical directions what does deep refer to?
a structure deeper in the body
where do anatomical axis lie?
Anatomical axes lie at the intersection of two anatomical planes and anatomical bone movements take place around theses axes
where does the frontal axis run?
runs from left to right
where does the sagittal axis run
runs in the dorsal-ventral direction
where does the longitudinal axis run?
runs in the cranial-caudal direction
what is flexion?
Bends a joint or brings the bones closer together
what is extension?
Straightens or opens a joint
in what plane does flexion and extension happen? around what axis?
Flexion and extension occur in the sagittal plane around a frontal axis
in what plane does dorsiflexion/plantarflexion and hyperextension happen? around what axis?
occur in the sagittal plane around a frontal axis
what is abduction?
Move a limb laterally away from the midline
what is adduction?
Move a limb medially towards the body’s midline
in what plane and about what axis does abd/add occur?
frontal plane around a sagittal axis
in what plane and axis does side flexion of the trunk occur?
frontal plane around a sagittal axis
in what plane does elevation and depression of the scapula occur?.
frontal plane around a sagittal axis
in what plane does ulna and radial deviation of the wrist occur?
frontal plane around a sagittal axis
in what plane and axis does inversion and eversion of the foot occur?
frontal plane around a sagittal axis
where does medial rotation happen in the body? describe it?
- shoulder and hip
- limb will turn towards the midline
what is lateral/external rotation?
limb turns away from midline
about what plane and axis does medial and lateral rotation occur?
transverse plane around a vertical (longitudinal) axis
in what plane and axis does rotation of the head, neck and trunk occur?
transverse plane around a vertical (longitudinal) axis
in what plane and axis does horizontal abd//add or the arm or thigh occur?
transverse plane around a vertical (longitudinal) axis
in what plane and axis does pronation/supination of the forearm occur?
transverse plane around a vertical (longitudinal) axis
where does supination occur? in what position is it commonly seen?
occurs in the forearm and foot
the forearm is supinated in anatomical position–> palm up
turning the foot up leads to supination –> subtalar inversion, talocrural plantar flexion and forefoot adduction
what movements are required to have the foot in a supine position?
subtalar inversion, talocrural plantar flexion and forefoot adduction
what movements are required to have the foot in a prontated position?
subtalar eversion, talocrural dorsiflexion, forefoot abduction
where does pronation occur?
occurs in the forearms and foot
- forearm: palm facing down
- foot when it gets turned down
what happens to the foot and movements of the joints during inversion?
its when the foot turns in an elevates the medial side and brings the sole of the foot medially
what happens when the foot goes into eversion?
the foot turns out and elevates the lateral side and moves the sole laterally
what is meant by placing the patient in a supine position? use layman terms
lie face up
lie on your back
what is meant by placing the patient in a prone position? use layman terms
lie face down
on your stomach
what is meant by placing the patient in a side laying position? what may be needed in this position?
laying on the side
may require pillow between knees
what is crooked laying?
laying supine (on back) with knees bent
a correct diagnosis though objective exam depends on what?
-knowledge of functional anatomy
accurate patient history
dilligent observation
thougrough exam
what does the differential diagnosis process involve?
involves the use of clinical signs and symptoms, physical examination, a knowledge of pathology and mechanisms of injury, provocative and palpation (motion) tests
what should be established by examiner to ensure that nothing is overlooked in the objective exam?
sequential method
assessment needs to be organized, comprhensive and reproducable
what is the aim of visual observation in objective exam?
Therapist gathers visual information that contributes to the pt’s problem(s) and formulating an appropriate assessment plan
what type of information can the therapist gain from visual input?
- symmetrical or compensatory motion
- body posture
- muscle contours
- body proportions
- color and skin condition
does the body part being assessed need to be exposed for visual inspection?
yes
how should a therapist be postured when assessing patients?
- broad base of support
- weight shifting and balance
- stand with trunk and head upright, feet which are shoulder width apart, knees slightly flexes and one foot slightly ahead of the other
- stance is in line with the direction of accomplished movement
what are some functional tests that can be accomplished during objective exam?
-mobility
-gait
-stairs
-up on toes
DF in WB
torsion test
squat
etc.
what is ROM used to describe?
describe the extent of movement possible at a joint
what factors limit ROM?
bones ligaments capsule length of muscles that cross the jount amount of tone in muscle injury chronic response to injury such as swelling and scar tissue gender and age
what is AROM?
active ROM
What is PROM?
Passive ROM
What is RISOM?
RESISTED ISOMETRIC CONTRACTRACTION
What type of range of motion is described by “The person moves a given joint through its possible range independently”
AROM
what can be assessed by evaluating arom?
- quality of physiologic motion
- patients willingness to move
- assess level of pain
- assess both inert and active structures responsible for movement
- assess muscle compensations
- assess the quality of movmt
- evaluate patterns of motion restriction
what does full and pain free arom suggest?
normalcy for that mvmt
how should the PT be positionned when assessing the patients AROM?
where you can observe the motion as well as the client’s facial
expressions, which may reveal pain
how to evaluate AROM
- have patient in an upright posture
- demonstrate the motion that the client needs to preform
- ask patient to accomplish motion on unaffected side and then on the affected side; look for limitations, breaks, symmertry and normal rythmn
- ask about pain/stretch/ feeling blocked
- measure and record finding using goniometer
when testing AROM when should painful movements be performed
at the end if possible
what happens if AROM is not full?
overpressure is applied with extreme care to prevent the exacerbation of symptoms
what happens if AROM is full
overpressure may be carefully applied to determine the end feel of the jount
why is the normal unaffected side tested first?
provides a baseline/comparaison as to what should be expected
are active or passive movement done first in an objective exam?
active before passive, provides an idea of what the patient thinks he can accomplish
what is PROM
ccurs when the client is resting and the therapist moves a joint through its possible range. The joint is taken through its full possible motion
what can the PT determine from PROM?
the end feel of a joint or its limiting factors by applying over pressure
what is end feel of a joint?
is the sensation transmitted to the therapist’s hands at the extreme end of the PROM and indicates the structures that limit the joint movement
what can be provided by the end feel of a joint
significant insight into the health and function of passive or inert stabilizers (ligaments, joint capsules) as well as the ms/tendons being stretched during movement
how should the patient be positionned when assessing PROM?
comfortable and supported position where support surrounding the joints is applied to protect and maximize relaxation
what should the PT ensure as he preforms PROM?
Inquire about pain or discomfort that may be felt by the patient
what should be recorded by the end of PROM?
THE END RANGE OF THE JOINT, IDENTIFY IF THE END FEEL IS NORMAL OR ABNORMAL AND DOCUMENT FINDINGS USING GONIOMETER
What is end feel? what can it indicate
quality of resistance at end range; can indicate to the clinician the cause of motion restriction
what is normal end feel when does it exist?
exists when there is full PROM at the joint and the normal anatomy of the joint stops the movement
what are the 4 healthy types of end feel?
- bony
- capsular
- elastic
- soft tissue approximation
what is a boney/hard end feel a result of? provide an example
he contact of the two bones is limiting the mvmt (eg. Elbow extension)
what is capsular end feel? provide an example?
joint capsule provides firm limitation; hard arrest to movement with some give when the capsule or ligaments are stretched (eg. Internal rotation hip)
what is elastic/muscular end feel?
stretching of ms/tendons – more elastic feel – shoulder abduction (teres major and lat dorsi)
what is soft tissue approximation end feel? provide an example
tissues meet each other and stop the movement – eg. Elbow and knee flexion
when is an abnormal end feel obtained?
exists when there is either a decreased or increased passive joint ROM or when there is normal PROM but structures other than the normal anatomy stop the movement
how can abnormal end feel be determined?
presence of muscle spasms springy block or loose/soft endfeel spongy early capsular hard empty
what is a muscle spasm in the case of abnormal end feel. provide an example
protection mechanism – feels jerky or shaky – injured tissue (ms, tendon or joint) e.g pain or ms strain
what is springy block in the case of abnormal end feel?
provide an example
bouncy stoppage that occurs prior to end range – usually torn cartilage, or foreign body in the joint – e.g. meniscus in the knee
what is loose/soft end feel? provide an example
abnormal motion is allowed where a ligament or joint capsule should prevent it e.g torn ligament
what is spongy end feel? what does it indicate? provide an example
squishy or boggy – indicating swelling in the joint e.g. acute ligament sprain or inflamed bursa
what is early capsular end feel a result of?
hypomobility
what is hard end feel a result of? provide an example?
bone contacts bone, or a bony grating sensation when rough articular surfaces move past one another- example a joint that contains loose bodies, degenerative joint disease , dislocation or fracture
what is an empty end feel? provide an example?
produced solely by pain (pt unable to tolerate more), therapist feels no tissue resistance – usually indicative of serious pathology (neoplasm, fracture, extra-articular abscess, acute bursitis or joint inflammation)
what is important when assessing PROM?
For Passive ROM it is not only the amount (i.e. degree) of movement available but also the quality (end feel) of the motion that is important
What are contractile tissues? provide examples?
Structures that are stressed with a ms contraction
ex: the muscle bellies, tendons, tenoperiosteal junction, submuscular/tendinous bursa
what is inert tissue?
Joint capsule, ligaments, bursa, articular surfaces of the joint, synovium, dura, bone, and fascia
when does RISOM occur?
Occurs when the client meets the resistance of the therapist in attempting to produce movement at the joint
what is RISOM used to assess?
the health and function of contracting muscles and their corresponding tendons
what work together in RISOM?
The nervous system, ms fibers and tendons all work together to generate force against gravity and the therapist’s resistance
How is RISOM tested?
done with the joint in neutral or resting position so that stress on the inert tissue is minimal. patient is in a well aligned posture, therapist in in a position where it can resist movement adequately and evaluate facial expressions
what should be done when assessing RISOM to decrease the compensation and maximize the ability to target specific muscles?
tabilize the joint proximal to the one being tested either positionally or with your other hand.
what command is said to the patient in order for him/her to match the resistance your are applying?
dont let me move you
should the patient overmatch the resistance you are applying?
no, it should results in an isometric contraction of the muscle
what should the PT look for when assessing RISOM?
Look for strong/weak side
inquire about pain and discomfort
what side should be the first assessed in RISOM?
UNAFFECTED SIDE
if a muscle is identified as being weak in RISOM what is the following step?
proceed to manual muscle testing of the given individual muscle
why may AROM/PROM/RISOM be repeated several times and held for a certain amount of time?
- to see whether symptoms increase or decrease
- to see if a different pattern of movement results
- whether there is an increased weakness
- determine if there is possible vascular insuFficency
what information is provided by AROM?
gives us information on the pt’s willingness to move, if there is a contractile problem or inert problem, ms spasm, and pain
what info is provided by PROM?
gives us information on inert structures (joint, ligament), contractile structures and end feel etc.
what info is provided by RISOM?
gives us information on the strength and health of muscles and tendons (contractile structures)
What is palpation
The examination of the body surface by touch, usually as a diagnostic aid.
what is palpation performed?
performed to assess
Bony and soft tissue contours Soft tissue consistency
Skin temperature and texture
what is involved with palpation?
locating a structure
becomming aware of its characteristics
assessing the quality or condition so you can determine how to treat it
what must the PT be able to do in order to properly palpate?
dentify bony or soft tissue irregularities and to recognize structures that require direct treatment
locate the bony landmarks adequately
determine the presence of muscle contraction when assessing strength or conducting reeeducation exercises
locate structures that need to be stabilized to isolate jount mvmt when mobilizing a joint
how should th patient be during palpation?
made comfortable
kept warm
body or body part is well supported to relax the muscles adequately to allows to palpate deep or inert structures
what are guidelines for palpation for the PT?
- short nails
- visually observe region being palpatied
- palpate with pads of index and middle finger
- fingers are in direct contact with skin
- provided a feeling of security to the patient
- avoid poking
how is a muscle palpated?
the patient will isometrically contract the muscle against resistance then followed by a relaxation, muscle is palpated in both contracted and relaxed phases
how to palate a tendon?
The tips of the index and middle fingers are placed across the long axis of the tendon and gently rolled forward and backwards across the tendon
what is required for proper palpation?
Receptive hands and fingers Open eyes
Listening ears
Calm breath
Quiet mind
what are the 3 principles of palpation
- move slowly
- avoid excessive pressure
- focus on what ut is you are feeling, be present
what should the PT warn the patient about at the end of the objective exam why?
that he or she may experience exacerbation of symptoms as a result of the assessment
a good exam involves stressing different tissues and it will prevent the patient from thinking that the inital treatment has made them worse
what happens if the conclusion following examination happens to be beyond the scope of the PT?
he examiner should not hesitate to refer the pt to another appropriate healthcare professional
