Test 1: Module 3 (Surface anatomy, goniometry, muscle performance testing)

Question 1

What is surface anatomy?

Answer 1

• Surface anatomy involves the external features of the body and is essential for understanding
  characteristics, conditions, and internal structures.
• Key to assessment in clinical practice for physical therapists

Question 2

Palpation

Answer 2

• the use of touch for medical
  purposes, usually with the hands, as a part of a methodological, detailed examination
• There’s an art and science to palpation that
  takes mindful practice to develop proficient skills
• Palpation can help determine characteristics
  or conditions of specifical tissues (normal vs abnormal tissue responses)

Question 3

Beneficial effects of touch

Answer 3

• Non-verbal communication
• Therapeutic effect of touch (Reducing pain, anxiety, and depression in adults and children, Reduction in cortisol levels)

Psychological implication (Benefits of touch for patient-therapist alliance, Interpersonal connection)

Question 4

Risk of touch

Answer 4

• Personal and cultural preferences and points of view
• Age differences
• Sex/gender differences
• Social roles, authority, hierarchy

Question 5

TYPES OF TOUCH

Answer 5

Light Touch: Used to feel for superficial structures such as
skin and subcutaneous fat

Moderate Pressure: Used for identifying muscles, tendons,
and bony landmarks

Deep Pressure: Used to assess deeper structures and
tissues.

Question 6

PRINCIPLES OF PALPATION

Answer 6

• Slow and Deliberate Movements: Avoid rushing; accuracy improves
  with careful palpation.
• Consistency: Be systematic in approach, moving from superficial to deeper layers.
• Feedback information: Stay attuned to variations in tissue texture, resistance, and responsiveness.
• Communication: Always communicate with the patient about discomfort or sensitivity during palpation

Question 7

PALPATION TECHNIQUES

Answer 7

• One-Handed Palpation: Ideal for smaller, superficial
  structures.
• Two-Handed Palpation: Used for deeper, larger structures,
  providing stability and control.
• Cross-Fiber Palpation: Moving fingers perpendicular to
  muscle fibers to distinguish muscle and tendon.

Question 8

CLINICAL APPLICATION OF PALPATION

Answer 8

• Assessment: Identifying inflammation, swelling, or abnormal lumps.
• Therapeutic Guidance: Assisting in manual therapy and treatment modalities.
• Diagnostic Support: Pinpointing areas of pain, tension, or abnormality.

Question 9

Kinematics

Answer 9

Study of motion without regard to the forces creating that
motion.

Question 10

Arthrokinematics

Answer 10

Movement of joint surfaces in relation to each other

Spin – rotary motion
Roll – rotary motion
Glide/Slide – translatory motion

Question 11

Concave surface moving on a Convex

Answer 11

Concave surface moving on a Convex surface will roll and glide in the same direction (of
the angular motion)

Question 12

Convex surface moving on a Concave

Answer 12

Convex surface moving on a Concave surface will roll and glide in opposite directions

Question 13

Osteokinematics

Answer 13

the gross movement of the shafts of bony segments

• Often refers to only the rotary (angular) motion at a joint
• Occur in the 3 cardinal planes (Sagittal, Frontal, Transverse) around the corresponding axes
• Measurement of joint angles

Question 14

ROM measurement utilizes what degree of notation system and starting position?

Answer 14

0-180 degrees

Anatomical or “Neutral” starting position

Question 15

Factors Affecting ROM

Answer 15

Known Factors:
- Age
- Gender
- Active vs Passive ROM

Possible Factors:
- BMI
- Occupational activities
- Recreational activities
- Testing procedures:
- type of instrument
- experience of examiner
- time of day

Question 16

What does PROM inform us of?

Answer 16

• Integrity of joint surfaces
• Extensibility of joint capsule, ligaments, muscles, tendons, fascia, and skin

Question 17

What does AROM inform us of?

Answer 17

Willingness to move, coordination, muscle strength*, and joint ROM

Potential painful tissues:
- Contracting or stretching “contractile” tissues – muscles & tendons
- Stretching or pinching noncontractile tissues – ligaments, joint capsule, bursa, fascia, skin

Question 18

What is End Feel?

Answer 18

With slight overpressure, tissue structures that limit motion have a characteristic “feel” detectably by the examine

Question 19

Normal soft end feel

Answer 19

Soft tissue approximation

Ex. knee flexion (contact between soft tissue of posterior leg and
posterior thigh)

Question 20

Normal firm end feel

Answer 20

Muscular stretch: hip flexion with knee straight (passive tension on hamstrings)

Capsular stretch: Extension of metacarpophalangeal joint of fingers

Ligamentous stretch: forearm supination

Question 21

Normal hard end feel

Answer 21

Bone contacting bone: elbow extension

Question 22

Abnormal End-Feel

Answer 22

Empty: No real end-feel because pain prevents reaching end of
ROM. No resistance is felt except for individual’s protective
muscle splinting or muscle spasm. (Acute joint inflammation, Bursitis, Abscess, Fracture, Psychogenic disorder)

Soft: Occurs sooner or later in the ROM than is usual or in a joint
that normally has a firm or hard end-feel. Feels boggy. (Soft tissue edema, Synovitis)

Firm: Occurs sooner or later in the ROM than is usual or in a joint
that normally has a soft or hard end-feel. (Increased muscular tonus, Capsular, muscular, ligamentous, and fascial shortening)

Hard: Occurs sooner or later in the ROM than is usual or in a joint
that normally has a soft or firm end-feel. A bony grating or
bony block is felt (Chondromalacia, Osteoarthritis, Loose bone fragments in joint, Myositis ossificans, Fracture)

Question 23

What would cause limited PROM? (Hypomobility)

Answer 23

Abnormalities of joint surfaces

Passive shortening of:
* Joint capsules
* Ligaments
* Muscles/tendons
* Fascia
* Skin
* Or inflammation of the above structures

Question 24

Capsular patterns of restricted motion

Answer 24

Pathologies involving entire joint capsules may present predictable patterns of restricted passive motion

• Proportions of motion relative to another motion at that joint

(Ex. Joint effusion, relative capsular fibrosis)

Question 25

Noncapsular pattern of restricted motion

Answer 25

Usually involves structures other than the entire joint capsule

Usually involve 1-2 joint motions

Ex. Internal joint derangement, adhesion of part of a joint capsule, ligament shortening, muscle strain, muscle contracture

Question 26

Hypermobility and what causes it

Answer 26

Ability to move actively or passively beyond normal limits

Due to:
* Laxity of soft tissue structures
* Abnormal joint surfaces
* Frequently caused by trauma
* Possible hereditary connective tissue disorder (Marfan syndrome, hypermobility syndrome)

Question 27

Beighton Hypermobility Score

Answer 27

Cutoff score: 4

May not be abnormal in
children (65% score > 4)

Higher scores associated with poor joint position sense
(proprioception & kinesthesia)

Each side (left and right) gets a score of 1 or 0
- Passively appose thumb to forearm
- Passively extend fifth MCP joint more than 90 deg
- Hyperextend elbow more than 10 deg
- Hyperextend knee more than 10 deg
- Place palms on floor by flexing trunk with knees straight

Question 28

Maximal Muscle Length

Answer 28

greatest extensibility of muscle-tendon unit

Question 29

Reliability

Answer 29

From 0.9 (excellent) to 0.55 (fair) depending on the specific
joint and population

• Intrarater: same tool, same tester
• Interrater: dif tool, dif tester

Question 30

Validity

Answer 30

Is this measuring what we’re intending to measure

Question 31

SEM

Answer 31

standard error of measurement

2.3-5 deg

Question 32

Contraindications of measurement

Answer 32

Absolute:
- Fracture
- Dislocation

Relative:
- Immediately post op
- Severe injury/rupture

Question 33

Precautions of measurement

Answer 33

Inflammation/Effusion
Osteoporosis
Hypermobility
Paralysis
Hematoma
Hemophilia

Question 34

3 Factors Affect Muscle Strength

Answer 34

• Physiological - muscle volume, pennation angle (fiber orientation), cross-sectional area,
  density/quality, and physiological adaptations to training (contractile proteins vs extracellular matrix and other “support structures”)
• Neurological – CNS and PNS signaling
• Mechanical – amount and direction of forces, axis of joint rotation, lever arm length, etc

Question 35

Impaired Muscle Performance

Answer 35

• Weakness (paresis)
• Absence of strength (plegia)
• Loss of muscle bulk (atrophy)
• Exhaustion
• Limit of endurance, no further performance is possible
• Overuse or Overwork weakness

Question 36

Clinical Utility of Muscle Performance Testing

Answer 36

Direct clinical management: Development of a POC

Predicting functional outcomes (PT prognosis)

Inform a diagnosis: Patterns of weakness give clues to origin of the pathology

Establish functional STG & LTG

Question 37

MMT Technique

Answer 37

Screen Range of Motion
Consider Gravity Vector
One-joint Muscles – typically tested in a shortened position
Two-joint Muscles – typically tested at mid range
Therapist gradually introduces resistance

Question 38

PSIS

Answer 38

Position
Stabilization
“Isolation”
Substitution

Question 39

Contraindications to MMT

Answer 39

Absolute
* recent fracture
* severe pain
* Severe wound or extensive
op site

Relative
* moderate pain
* hysteria
* lack of motivation
* unstable joint or joint surface
erosion
* neurological muscle spasm
* Inability to follow commands
(motor skills, cognition)

Question 40

Documentation of MMT

Answer 40

MM Grade can be documented by:
* joint motion
* muscle name
R/L grade