Ortho Assessment Flashcards
Observation
Use all your senses to monitor the patient:
• posture, facial expressions, any scars, any crepitus, symmetry, grimacing, guarding, bracing, rubbing, sighing, normal alignment, any obvious deformity, structural, problem vs. functional, any restrictions in ROM, color, temperature and texture of skin, is movement available and normal, patient’s attitude regarding condition … apprehension, restlessness, depression, etc.
PHYSICAL EXAMINATION
Principles
• Be systematic
• Look for consistent patterns
• Use caution to avoid aggravations
• Normal side IS usually tested first
• Active ROM before passive ROM tests
• Painful motions performed last to prevent
overflow of pain signals to the next motion
• Determine end-feel with caution if active ROM is decreased
• Assess repeated ROM and strength tests
• Isometric resistance in neutral first
• Assess quantity and quality of ROM or ligamentous laxity
• Inform patient that assessment may exacerbate symptoms, temporarily
Scanning Examination
A screening of spine and extremities
Upper Limb Scan
- cervical spine
- temporomandibular joint
- scapula
- shoulder complex
- arms and hands
- associated thoracic spine exam • associated rib exam
Lower Limb Scan
- lumbar spine
- pelvis
- lower extremities to the toes
Motion Testing
Does pain or restriction predominate?
• if pain predominates … an acute condition is present requiring gentler assessment and treatment
• if restriction predominates, a subacute or chronic condition is present that may require more vigorous assessment and can tolerate more aggressive treatment
Active Movements
Passive Movements
Hypermobile Joints Susceptible to …
Hypomobile Joints Susceptible to …
Myofascial Hypomobility
Pericapsular Hypomobility
End-feel
Three (3) Classic Normal End-feel Types
- Bone-on-Bone
- Soft-TissueApproximation
- Tissue Stretch
Bone-on-Bone End-feel … elbow extension
- “Hard”
- Unyielding
- Painless
Soft-Tissue Approximation End-feel … elbow or knee flexion
- “Mushy”
- Yielding
- Movement stopped by soft tissue compression
- Varies with muscle size
Tissue Stretch End-feel … knee extension … shoulder external rotation
- “Springy”, elastic resistance
- Firm with a slight “give”
- The most common type of normal end-feel
- Capsule and/or ligament primary end-feel • Varies depending upon tissue thickness
Five (5) Classic Abnormal End-feel Types
- Commonly associated with pain and/or restricted movement • Muscle Spasm
- Capsular
- Bone-on-Bone
- Empty
- Springy Block
Resisted Isometric Movements
Resisted Isometric Movements
Weak contractions in Resisted Isometric Movements could be due to …
• pain/reflex inhibition • muscle or tendon pathology • avulsion • disuse • nerve root lesion ...myotome • peripheral nerve injury • upper motor neuron lesion Additional reason for weakness ... • fear • unwillingness • malingering • may resolve confusion by testing the uninvolved side first
Contractile Tissue
Consists of ... • muscles • tendons • attachments ... bone • nerve tissue that supplies the above structures
Four (4) Classic Patterns of Contractile Lesions Upon Resistance
- strong and pain free … no lesion of muscle or nerve present
- strong and painful … local lesion of muscle or tendon
- weak and painful … severe lesion around the joint … e.g., fracture
- weak and pain free … muscle or tendon rupture (3rd degree strain) or involvement of the peripheral nerve or nerve root supplying that muscle
