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BMS150 - Physical Medicine > Week 1 - ROM & Gait/Posture > Flashcards

Week 1 - ROM & Gait/Posture Flashcards

1
Q

What is the order for ROM testing?

A

Active ROM - Done by the patient 100%
Passive ROM - Done by the examiner 100%
Resisted ROM - resisted isometric movement usually tested in neutral position

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2
Q

What side should we always start on?

A

The unaffected/non painful side of the patient

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3
Q

Any movements that are painful are done last to prevent an ___ of painful symptoms to the next movement

A

overflow

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4
Q

What does active ROM test?

A

Contractile, nervous and inert tissues that are moved

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5
Q

_____ tissue have tension placed on them by stretching or contraction

A

Contractile

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6
Q

____ tissue and their sheaths have tension put on them by stretching

A

Nervous

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7
Q

____ tissue includes all tissues that are not contractile or neurological (ligaments, bursae, bone, cartilage, and the capsule)

A

Inert

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8
Q

For active ROM, the examiner should note:

A
  • When and where during each movement the onset of pain occurs
  • Whether the intensity and quality of pain increases with the movement
  • The reaction of the patient to the pain
  • The degree of restriction
  • The rhythm and quality of movement
  • The movement of associated joints
  • The willingness of the patient to move the part
  • Any limitation and its nature (ask why?
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9
Q

Active movement may be abnormal for reasons such as:

A

Pain (common cause)
Muscle weakness
Paralysis
Spasm
Other causes including tight or shortened tissues, altered length-tension relationships, modified neuromuscular factors, and joint-muscle interaction

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10
Q

Passive ROM is usually normal, full range, and pain free, with possibly some pain at the end
of ROM when ___or ___ is stretched

A

contractile
nervous tissue

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11
Q

For passive ROM is not only the degree (amount) of movement but also the ____ of the movement that is important

A

quality (end-feel)

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12
Q

When the examiner is doing passive range of motion testing, the appropriate ___ is
applied gently and repeated several times. The ___ is increased up to but not
beyond the point of pain and is done in ____

A

stress
stress
all ranges

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13
Q

For passive ROM, the examiner should note:

A

Any Differences in ROM between active and passive movements may be
caused by:
* Spasm
* Muscle Deficiency
* Neurological deficit,
* Contractures
* Pain

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14
Q

The sensation that the examiner feels in the joint as it reaches the end of ROM is called:

A

End-feel

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15
Q

____ is applied at the end of ROM to determine end feel

A

overpressure

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16
Q

Evaluation of end feel can help you:

A
  • Assess the type of pathology present
  • Determine a prognosis for the condition
  • Learn the severity or stage of the problem
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17
Q

What are normal end feels and examples

A

Bone to bone - elbow extension
Soft tissue approximation - Knee flexion
Tissue stretch - Ankle dorsiflexion, shoulder lateral rotation, finger extension

18
Q

What are abnormal end feels and examples

A

Early muscle spasm - protective spasm following injury
Late muscle spasm - spasm resulting from instability or pain
“Mushy” tissue stretch - tight muscle
Spasticity - upper motor neuron lesion
Hard capsular - frozen shoulder
Soft capsular - synovitis, soft tissue edema
Bone to bone - osteophyte formation
Empty - acute subacromial bursitis
Springy block - meniscus tear

19
Q

Describe muscle grading on a 0-5 scale

A

5 - Normal - Complete ROM against gravity with full resistance
4 - Good - Complete ROM against gravity with some resistance
3 - Fair - Complete ROM against gravity with no resistance
2 - Poor - Complete ROM with some assistance and gravity eliminated
1 - Trace - Evidence of slight muscular contraction; no joint motion evident
0 - Zero - No evidence of muscle contraction

20
Q

Describe the pain sensations and associated structure

A

Muscle - Cramping, dull, achy
Joint capsule, ligament - Dull, achy
Nerve root - Sharp, shooting
Nerve - Sharp, bright, lightening-like
Sympathetic n. - Burning, pressure-like, stinging, achy
Bone - Deep, nagging, dull
Fracture - Sharp, severe, intolerable
Vasculature - Throbbing, diffuse

21
Q

Resisted ROM finds problems in ___ tissues

A

contractile

22
Q

Testing is always done with the patient in ____ so that minimal
tension is placed on the inert tissue.

A

neutral position

23
Q

True or False: In resisted ROM, the patient is asked to contract the muscle as strongly as possible while the examiner resists for a few seconds to prevent any movement from occurring

A

True

24
Q

In resisted ROM, the examiner ensures that ___ is isometric and controls the amount of ___ exerted

A

contraction
force

24
Q

Both ___ and ___ demonstrate symptoms if contractile tissue is affected

A

active ROM
resisted ROM

24
Q

For resisted ROM, _____ must be used to determine if there is weakness or not

A

muscle strength grading

24
Q

What are the 3 views for postural assessment

A

anterior, lateral (both sides), posterior

25
Q

Review the characteristics of anterior view

A

Head (Jaw, Nose, Ears)
* is head straight / tilted to one side / rotated
* may be result of weak muscles, trauma, hearing loss
* Nose is inline with manubrium Shoulders
* Trapezius , AC joints
* symmetrical with no deviation
* deviation may be from dislocations of AC or SC joints or fractures
* dominant shoulder may be slightly sloped downward Chest
* Other
* no protrusion, depression or lateralization Pelvis (Iliac crests, ASIS,
Pubic bones)
* waist angles are equal
* arms equal distance from the waist
* patella should point straight ahead
* knees may be in genu varum or valgum Feet (Feet arches, Feet angle)
* check for equal arches
* Are toes pointed out or pigeon toed?

26
Q

Review the characteristics of lateral view

A

Ear lobe
* in line with the tip of the shoulder (acromion) and high point of the iliac crest
* a forward poking chin may correspond with lumbar lordosis Spinal segments
* spine has normal curvature
* large glut max muscles or excessive fat may give the appearance of exaggerated
lordosis
* examine the spine in relation to the sacrum not
* The Shoulders
* look for rounded shoulders
* possibly caused by tight pectoral
* The Knees
* normally slightly flexed 0 to 5 degrees
* hyperextended knees likely with increased lumbar lordosis
* increased flexion seen with tight hamstrings
* Ideally the centre of Gravity/Plumb Line passes through the following
* anatomical landmarks
* External auditory meatus
* Humeral head and acromion
* Middle of the body of L3 vertebrae
* Greater trochanter
* Just behind the mid knee

26
Q

Review the characteristics of posterior view

A
  • Mastoid process AC joint
  • Inferior scapula
  • spines and inferior angles should be level
  • PSIS
  • should be level, one higher than the other may
    indicate a leg length
    discrepancy, or rotational problem
  • Assess the in forward flexion (skyline view):
  • Asymmetry of rib cage (rib humping)
  • Asymmetry in the spinal musculature
  • Kyphosis
  • Whether lumbar spine straightens or flexes
  • Any restrictions to forward bending
  • Just anterior to the lateral malleolus
27
Q

What are the 2 phases of gait analysis

A

1) Stance Phase - When the foot is on the ground
(60% of gait cycle)
2) Swing Phase - When the foot is moving forward
(40% of gait cycle.

27
Q

What are the components of the stance phase

A

heelstrike
foot flat
midstance
push off
acceleration
midswing
deceleration

28
Q

What are the 3 causes for abnormal gait patterns?

A

1: Due to a pathology or injury in a specific joint
2: Compensation for an injury or a pathology in
other joints on the ipsilateral side
3: Compensation for an injury of a pathology on
the contralateral limb

29
Q

What are the different abnormal gait patterns

A
  • Arthrogenic Gait
  • Ataxic Gait
  • Gluteus Maximus Gait
  • Trendelenburg’s Gait
  • Hemiplegic Gait
  • Parkinsonian Gait
  • Scissors Gait
  • Drop Foot Gait
30
Q

Describe arthrogenic gait

A
  • Stiff hip or Knee
  • Results from stiffness, laxity, or deformity, and
    it may be painful or painless
31
Q

Describe ataxic gait

A
  • Stagger Gait with Exaggerated Movements
  • Patient presents with poor sensation or lacks muscle
    coordination, poor balance and a wide broad base stance
  • Results usually from damage to the cerebellum.
32
Q

Describe gluteus maximus gait

A
  • The Backward Lurch of the Trunk
  • Results from a weak gluteus Maximus.
  • Patient thrusts the thorax posteriorly at heel strike to
    maintain hip extension of the stance leg
33
Q

Describe trendelenburg’s gait

A
  • gluteus medius gait
  • Results from weak gluteus med/minimus
  • During the stance phase, patient exhibits an excessive
    lateral list where the thorax moves to keep centre of gravity
    over the stance leg
  • Also, the Trendelenburg test will also be positive
34
Q

Describe hemiplegic gait

A
  • Presents as a swinging of the paraplegic leg
    outward and ahead in a circle or pushes it
    ahead. Also, the affected upper limb is carried
    across the trunk for balance
35
Q

Describe parkinsonian gait

A
  • FESTINATED GAIT
  • The neck, trunk, and knees of a patient are flexed.
    There is also a SHUFFLING or rapid short steps. Arms
    are held stiffly and the patient may lean forward and
    walk progressively faster as though unable to stop
    (Festinating)
36
Q

Describe scissors gait

A
  • A result of spastic paralysis of the hip adductor
    muscles. This causes the knees to be drawn
    together so that the legs can be swung forward
    only with great effort.
37
Q

Describe steppage/foot drop gait

A
  • Results from weak or paralyzed dorsiflexor muscles. To
    avoid dragging the toes against the ground, the patient lifts
    the knee higher than normal. Initial contact, the foot
    SLAPS on the ground.

BMS150 - Physical Medicine (1 decks)

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