Selective Tissue

Question 1

T/F patient is best source of information into their condition

Answer 1

True

Question 2

T/F Leading question should be used with patient

Answer 2

False

Question 3

What are inherent likelihoods when diagnosing soft tissue injuries?

Answer 3

• Soft tissue lesion behave in typical ways = regularly be faced with the same history and the same response to functional testing
• Examiner with knowledge of these patterns can recognize them quickly

Question 4

Why should we be cautious about relying a lot on palpation?

Answer 4

 Can help to narrow down the area/tissue to evaluate

 Can be unreliable – structures lie too deep

Question 5

Choose contractile tissue/non-contractile tissue/both:

Stress with stretching

Answer 5

Both

Question 6

Choose contractile tissue/non-contractile tissue/both:

Stress with isometric contraction

Answer 6

Contractile tissues

Question 7

Choose contractile tissue/non-contractile tissue/both:

Stress with palpation

Answer 7

Both

Question 8

Choose contractile tissue/non-contractile tissue/both:

No increase in discomfort with isometric contraction

Answer 8

Non-contractile tissues

Question 9

Choose contractile tissue/non-contractile tissue/both:

Joint capsules, ligaments, bursae, aponeuroses, nerves

Answer 9

Non-contractile tissues

Question 10

Choose contractile tissue/non-contractile tissue/both:

Tendons, muscle, musculotendinous junctions, bone adjacent to attachment of tendon

Answer 10

Contractile tissues

Question 11

What is meant by the “patient’s pain”? Are we looking for that?

Answer 11

We must ask if the pain we evoke is the pain in which they are seeking treatment for (it is what we are looking for)

Question 12

AROM is a quick way to narrow down what two things in regard to selective tissue tensioning?

Answer 12

 Quick way to narrow down source of symptoms

 Quick way to narrow down structures to test in detail

Question 13

What 4 things should we observe during AROM?

Answer 13

1. Pain
2. Range of motion
3. Quality of movement
4. Willingness to move

Question 14

Compare AROM to what on uninvolved side and what on ipsilateral side?

Answer 14

 Compare to uninvolved side AROM, PROM, resistance testing, and palpation
 Compare to ipsilateral results of PROM, resistance testing, and palpation

Question 15

What 4 things should we observe during PROM?

Answer 15

1. Pain
2. Range of motion
3. Willingness to allow movement
4. End feel

Question 16

Compare PROM to what on uninvolved side and what on ipsilateral side?

Answer 16

 Compare to uninvolved side AROM, PROM, resistance testing, and palpation
 Compare to ipsilateral results of AROM, resistance testing, and palpation

Question 17

During resistance movements, resist through full ROM for what areas?

Answer 17

 Resist through full ROM to fully rule out suspicious area; DO NOT need to do resistance through full ROM for all resistance testing

Question 18

What 4 things should we observe during resisted movements?

Answer 18

1. Pain
2. Willingness to allow contraction
3. Strength
4. Compensations

Question 19

If no pain and normal strength, what could disorder be?

Answer 19

Nothing

Question 20

If pain and normal strength, what could disorder be?

Answer 20

Contractile tissue

Question 21

If no pain and weak strength, what could disorder be?

Answer 21

Nervous lesion or complete rupture

Question 22

If pain and weak strength, what could disorder be?

Answer 22

Serious lesion, partial rupture

Question 23

If you performed resisted isometrics at mid range and the patient had no symptoms, but you still suspect that muscle or tendon is involved what should you do in regards to resistance?

Answer 23

Test through full ROM

Question 24

When palpating a stationary joint, what should you observe?

Answer 24

o	Temperature
o	Swelling
o	Gaps
o	Tenderness
o	Pulsation

Question 25

When palpating a moving joint, what should you observe?

Answer 25

``` o Crepitus o Clicks o End-feel o Hypermobility o Hypomobility o Willingness to move o Pain ```

Question 26

What if everything is negative for selective tissue tensioning?

Answer 26

o A negative examination does not necessarily mean that an injury is absent o May be a problem in a neighboring tissue which was not systematically tested in the examination

Question 27

T/F If patient has very slight pain: | Examination will never be totally negative

Answer 27

False, can be totally negative

Question 28

T/F If patient has very slight pain: | Palpation is very dangerous in these cases

Answer 28

True

Question 29

T/F If patient has very slight pain: | May ask patient to come back if symptoms return

Answer 29

True

Question 30

T/F If patient has very slight pain: | May provoke signs by having the patient exercise sufficiently to produce symptoms

Answer 30

True

Question 31

T/F If patient has very slight pain: | History is not of great importance

Answer 31

False

Question 32

T/F What if the patient has very severe pain? | All of examination components may be positive

Answer 32

True

Question 33

T/F What if the patient has very severe pain? | Hard for the patient to state accurately where and when pain is felt

Answer 33

True

Question 34

T/F What if the patient has very severe pain? | Functional testing and its interpretation will be easy

Answer 34

False - Functional testing and its interpretation are also difficult, either because excessive physical signs are presented or because the patient cannot move and is opposed to carrying out certain maneuvers

Question 35

T/F What if the patient has very severe pain? | History is not important

Answer 35

False

Question 36

Describe what you expect the results of your AROM, PROM, isometrics, and palpation will be for the following injuries: Muscle/Tendon strain, tendonitis, possible small tear -

Answer 36

* AROM: Likely limited due to pain and/or weakness, though may be able to move through full range, but with pain * PROM: if truly passive would have full pain free motion in all directions, EXCEPT direction which stretches involved area may be limited due to pain (empty end feel) * Isometric: Likely weak and painful when testing involved area * Palpation: Involved area painful to palpation

Question 37

Describe what you expect the results of your AROM, PROM, isometrics, and palpation will be for the following injuries: Muscle or Tendon Complete Tear -

Answer 37

* AROM: Very limited due to weakness, likely not as much pain as seen with a partial tear, but much more weakness * PROM: if truly passive would have full pain free motion in all directions, EXCEPT direction which stretches involved area may be limited due to pain (empty end feel) if there is muscle guarding in the area * Isometric: Extremely weak * Palpation: Involved area painful to palpation

Question 38

``` Describe what you expect the results of your AROM, PROM, isometrics, and palpation will be for the following injuries: Joint Capsule (ex: shoulder adhesive capsulitis) - ```

Answer 38

• AROM: Limited, possibly painful at end ranges* • PROM: Limited in same direction as AROM with a firm end feel, possibly painful at end ranges* • Isometrics: If done at mid range should not produce significant pain and should be strong; though may have pain due to compensating or guarding of surround musculature • Palpation: Depends on depth of joint capsule, but more often than not cannot palpate deep enough to feel joint capsule though surrounding structures may also be inflamed and cause discomfort with palpation • *AROM and PROM restrictions: Capsular pattern  Highly suspicious of joint capsule, though still can be joint capsule without a capsular pattern

Question 39

``` Describe what you expect the results of your AROM, PROM, isometrics, and palpation will be for the following injuries: Ligament Injury (ex: ankle sprain) - ```

Answer 39

* AROM: Full but pain at end range that stretches ligament * PROM: Full but pain at end range that stretches ligament * Isometrics: Strong and no pain when tested at mid range, unless there is guarding in the area * Palpation: Involved ligaments are painful to palpation