SELECTIVE TISSUE TENSIONING

Question 1

What is cyriax?

Answer 1

a model for distinguishing contractile lessions from inert/non-contractile tissue.

Question 2

how do we manage to distinguish inert vs contractile structures?

Answer 2

by comparing responses to various tests of active and passive movement

Question 3

what does the cyriax model divde MSK structures into?

Answer 3

Divides musculoskeletal structures into contractile and noncontractile elements for diagnostic purposes

Question 4

what is contractile tissue?

Answer 4

Muscle with innervations and its tendons and attachments

Question 5

what is non-contractile tissue?

Answer 5

Other structures such as bones, joint capsules, ligaments, bursae, fascia, dura mater and nerve roots

Question 6

when are inert tissues stresses during the objective exam?

Answer 6

◦ Active and passive movements
◦ Functional testing
◦ Selected special tests
◦ Joint play testing (mobilizations) 
◦ Palpation

Question 7

what happens in inert dysfunction with passive joint play mvmt?

Answer 7

produce or increase symptoms and are restricted

Question 8

when will isometric resisted mvmt be painful with inert dysfunction?

Answer 8

not usually painful (symptom free) unless some compression is occurring at the joint

Question 9

when does pain generally occur with inert dysfunction?

Answer 9

Usually pain occurs as the limitation of motion approaches (end of available range); AROM and PROM limited at similar ranges

Question 10

is there pain with passive, active or both movements in the same direction with inert dysfunction?

Answer 10

both

Question 11

when is capsular pattern present?

Answer 11

Present when the entire capsule is affecte

Question 12

how is capsular pattern assessed?

Answer 12

Assessed during PROM and end feel (early caps)

Question 13

what joints can show a capsular pattern?

Answer 13

only joints that are controlled by muscles

Question 14

what is a capsular pattern the result of?

Answer 14

Is a result of total joint reaction, with ms spasm, capsular contraction (the most common cause) and generalized osteophyte formation as possible mechanisms at fault

Question 15

when observing capsular pattern what are we lookiung for?

Answer 15

or a specific pattern of limitation at each joint (proportional limitation)– because each joint has a characteristic pattern of proportional limitation (capsular pattern of restriction)

Question 16

what happens in the case of shoulder capsular pattern?

Answer 16

◦ Limitation of external rotation greater than abduction, greater than internal rotation. Flexion/extension lightly limited (Frozen shoulder – adhesive capsulitis)

Question 17

what happens in elbow capsular pattern?

Answer 17

Limitation of flexion greater than extension (humeral-ulnar joint)

Question 18

what happens in wrist capsular pattern?

Answer 18

flexion and extension are equally limited

Question 19

what is a non capsular pattern?

Answer 19

Limitation (hypomobility) in one or more directions that do not correspond to the capsular pattern

Question 20

what may a non-capsular pattern indicate?

Answer 20

May indicate the presence of a joint derangement, a restriction in one part of the joint capsule or an extra-articular lesion that obstructs joint motion.

Question 21

hypermobility associated with non-capsular pattern in one direction may be caused by?

Answer 21

ligament or capsule injury

Question 22

when can contractile dysfunction be assessed in obective exam?

Answer 22

Active and passive movements
◦ Resisted isometric testing
◦ Functional testing
◦ Selected special tests
 ◦ Palpation

Question 23

in contractile dysfunction are active and passive movements in pain in the same or opposite direction?

Answer 23

in opposite direction

Question 24

explainnn the mechanism of pain with contractile dysfunction of infraspinatus?

Answer 24

Active external rotation of the shoulder is painful and restricted as the affected ms contracts ◦ passive external rotation is painfree and shows a greater range of movement
◦ passive internal rotation is painful as the affected ms is stretched

Question 25

hat is the difference between pain in active and passive mvmts in contractile vs non contractile dysfunction?

Answer 25

non-contractile: active and passive pain in same direction | contractile: opposite direction

Question 26

how are passice joint play movements in contractile dysfunction?

Answer 26

normal and symptom free

Question 27

what is the greatest indicator of contractile dysfunction?

Answer 27

reszisted mvmts produce and increase symptoms

Question 28

what are the 4 contractile tissue pattern?

Answer 28

1. Painful and strong = minor, local lesion of ms or tendon (1st or 2nd degree ms strain) 2. Painful and weak = major lesion of a ms or tendon (3rd degree ms strain), may include avulsion fracture 3. Painless and weak = neurological lesion or complete rupture of a ms or tendon (3rd degree) 4. Painless and strong = normal

Question 29

``` would this be an inert or contractile dysfunction? why? hypo or hypermobility elbow extension: AROM: missing 10 degrees, pain ◦ PROM: missing 8 degrees, pain, early capsular EF ◦ RISOM: stronofg, no pain elbow flexion ◦ AROM: WNL, no pain ◦ PROM: WNL, no pain ◦ RISOM: strong, no pain ```

Answer 29

hypomobility of joint in elbow extension | inert structures

Question 30

``` would this be an inert or contractile dysfunction? why? hypo or hypermobilitycAROM: full, pain ◦ PROM: WNL, no pain ◦ RISOM: strong, painful Wrist flexion ◦ AROM: full, no pain ◦ PROM: WNL, pain ◦ RISOM: strong, no pain ```

Answer 30

contractile | wirst extension,

Question 31

what are the limitations to cyriax

Answer 31

interpretation of findings can be less clear in some pathologies ◦ Subtle contractile tissue lesions ◦ In cases where a significant inflammatory process produces pain during a resisted test ◦ When ms contraction produces symptomatic joint compression in underlying dysfunctional joints

Question 32

``` nert or contractAnkle DF ◦ AROM: full, no pain ◦ PROM: WNL, no pain ◦ RISOM: strong, no pain Ankle PF ◦ AROM: decreased, pain ◦ PROM: decreased, muscle spasm (guarding) end feel ◦ RISOM: strong, no pain ```

Answer 32

inert since no pain in risom arom and prom in ankle PF are both decreased cannot he hyper, if hypo end feel should be early capsular endfeel, however since we have a muscle spasm guarding end feel its a method of protection thus probably in an acute inflammatory phase. injury,