SELECTIVE TISSUE TENSIONING Flashcards
What is cyriax?
a model for distinguishing contractile lessions from inert/non-contractile tissue.
how do we manage to distinguish inert vs contractile structures?
by comparing responses to various tests of active and passive movement
what does the cyriax model divde MSK structures into?
Divides musculoskeletal structures into contractile and noncontractile elements for diagnostic purposes
what is contractile tissue?
Muscle with innervations and its tendons and attachments
what is non-contractile tissue?
Other structures such as bones, joint capsules, ligaments, bursae, fascia, dura mater and nerve roots
when are inert tissues stresses during the objective exam?
◦ Active and passive movements ◦ Functional testing ◦ Selected special tests ◦ Joint play testing (mobilizations) ◦ Palpation
what happens in inert dysfunction with passive joint play mvmt?
produce or increase symptoms and are restricted
when will isometric resisted mvmt be painful with inert dysfunction?
not usually painful (symptom free) unless some compression is occurring at the joint
when does pain generally occur with inert dysfunction?
Usually pain occurs as the limitation of motion approaches (end of available range); AROM and PROM limited at similar ranges
is there pain with passive, active or both movements in the same direction with inert dysfunction?
both
when is capsular pattern present?
Present when the entire capsule is affecte
how is capsular pattern assessed?
Assessed during PROM and end feel (early caps)
what joints can show a capsular pattern?
only joints that are controlled by muscles
what is a capsular pattern the result of?
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
when observing capsular pattern what are we lookiung for?
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)
what happens in the case of shoulder capsular pattern?
◦ Limitation of external rotation greater than abduction, greater than internal rotation. Flexion/extension lightly limited (Frozen shoulder – adhesive capsulitis)
what happens in elbow capsular pattern?
Limitation of flexion greater than extension (humeral-ulnar joint)
what happens in wrist capsular pattern?
flexion and extension are equally limited
what is a non capsular pattern?
Limitation (hypomobility) in one or more directions that do not correspond to the capsular pattern
what may a non-capsular pattern indicate?
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.
hypermobility associated with non-capsular pattern in one direction may be caused by?
ligament or capsule injury
when can contractile dysfunction be assessed in obective exam?
Active and passive movements ◦ Resisted isometric testing ◦ Functional testing ◦ Selected special tests ◦ Palpation
in contractile dysfunction are active and passive movements in pain in the same or opposite direction?
in opposite direction
explainnn the mechanism of pain with contractile dysfunction of infraspinatus?
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
hat is the difference between pain in active and passive mvmts in contractile vs non contractile dysfunction?
non-contractile: active and passive pain in same direction
contractile: opposite direction
how are passice joint play movements in contractile dysfunction?
normal and symptom free
what is the greatest indicator of contractile dysfunction?
reszisted mvmts produce and increase symptoms
what are the 4 contractile tissue pattern?
- Painful and strong = minor, local lesion of ms or tendon (1st or 2nd degree ms strain)
- Painful and weak = major lesion of a ms or tendon (3rd degree ms strain), may include avulsion fracture
- Painless and weak = neurological lesion or complete rupture of a ms or tendon (3rd degree)
- Painless and strong = normal
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
hypomobility of joint in elbow extension
inert structures
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
contractile
wirst extension,
what are the limitations to cyriax
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
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
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,
