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PT fundamentals > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Where does the objective exam fall in the 5 elements of patient management?

A

Evaluation and examination

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2
Q

The subjective exam is equal to what kind of hypothesis?

A

Hypothesis generation

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3
Q

The objective exam is equal to what kind of hypothesis?

A

Hypothesis refinement

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4
Q

What are the goals of the objective exam?

A
  • Look for patterns of movement & restrictions
  • Reproduce symptoms or produce comparable sign(s)
  • Systematic approach to confirm or rule out your working hypothesis and differentials
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5
Q

Things to consider during an objective exam?

A

• Get baseline symptoms
• Look for two sets of data:
- What the patient feels (subjective asterisks)
- Key comparable signs (objective asterisks)
• Do painful movements & tests last if possible

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6
Q

What is the layout of an objective exam?

A
  1. Collect / Test / Measure Objective Data
  2. Analyze Data / Establish Working Diagnosis
  3. Determine Prognosis
  4. Formulate a Plan of Treatment
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7
Q

What are the 3 components of motion testing?

A
  • Active ROM (Physiologic) motion testing
  • Passive ROM (Physiologic) motion testing
  • Joint Play (Accessory) motion testing
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8
Q

What are the 3 essential assessment for diagnosis?

A

• Quality of the movement
- Movement pattern, asymmetry, end-feel
• Quantity of movement
• Symptom response

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9
Q

Definition of AROM

A

The patient’s ability to actively move on their own

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10
Q

_____ are applied to normal ROM to reproduce symptoms when necessary

A

Progressions

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11
Q

During PROM, examiner takes joint through ROM with patient ____

A

relaxed

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12
Q

Each movement in PROM is compared with ___

A

opposite side (preferred) or accepted norms

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13
Q

PROM is used when…?

A

AROM is altered or painful

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14
Q

Motion testing helps us determine whether to move to ___ or move to __

A

Pain
• Pain is the dominant factor in patient’s disorder
• Range to first onset of pain (and just beyond)

Resistance
• Assess for stiffness/ hypomobility
• Apply overpressure to assess end-feel and symptom
response

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15
Q

What does PROM help understand?

A

Helps understand if there’s any limitations in the ROM (hypomobility) or if the patient has an excessive amount of ROM (hypermobility)

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16
Q

What are the 2 instruments for measuring ROM?

A
  • Goniometer

- Bubble inclinometer

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17
Q

What is a goniometer?

A

Protractor with movable arms

and comes in various sizes. Used for extremities

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18
Q

What is a bubble inclinometer?

A

360° rotating dial with fluid indicator. Commonly used for spinal movement

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19
Q

What are the ROM general procedures?

A

• Assess range of motion bilaterally (unaffected side first)
• Recommend two repetitions for each movement
• First repetition: Visually assess movement quality,
quantity, and symptom response
• Second Repetition: Joint measurement as needed

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20
Q

What are the ROM specific procedures?

A

Patient in base position
• Locate pertinent bony landmarks
• Place goniometer axis of motion at the approximate axis of joint motion
• Align stationary and moving arms along the appropriate body parts and in line with identified bony landmarks
• Move the joint through it’s active or passive ROM
• Read the goniometer at appropriate ranges of motion

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21
Q

Things to record when documenting a ROM measurement

A
  • The type of ROM: AROM or PROM
  • Right or left extremity
  • The joint and the direction of motion
  • The quantity of motion achieved
  • Symptom changes
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22
Q

Things to keep ROM measurement in check

A
  • Goniometer measurement error +/- 5 degrees
  • Reliability varies widely
  • Intra-rater generally better than inter-rater reliability
  • Reliability can be enhanced
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23
Q

When is reliability enhanced?

A
  • When we use a standardized test position
  • When we use the correct goniometer size
  • When the same person evaluates each measurement
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24
Q

What is accessory joint mobility/motion?

A

The ability to passively move a joint through arthrokinematic (accessory) motion that make up a gross osteokinematic (physiologic) motion

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25
Q

How is accessory joint motion assessed?

A

Passively by the examiner, but cannot be performed actively by the patient

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26
Q

What is osteokinematics?

A

Directions the bones move when motion occurs. AKA: “physiologic motions”

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27
Q

Osteokinematics is characterized by ___ motion during ___ movement

A

Visible motion during voluntary movement

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28
Q

Osteokinematics is typically described as ..

A

movement around a specific joint axis and within a particular joint plane

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29
Q

What are physiologic motions?

A

Movement in one of the 3 cardinal planes occurs at right

angles to the joint axis

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30
Q

What are the physiologic joint motions?

A
  • Flexion and Extension
  • Abduction and Adduction
  • Internal and External Rotation, - Horizontal ABD/ADD
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31
Q

What are the joint planes?

A
  • Sagittal
  • Frontal (Coronal)
  • Transverse (Horizontal)
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32
Q

What are the joint axes?

A
  • Frontal
  • Sagittal
  • Longitudinal (Vertical)
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33
Q

What is arthrokinematics?

A

motion between the joint surfaces during
movement.
AKA: “ accessory motions or joint play”

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34
Q

Arthrokinematics is described as motion that should occur _____

A

within the joint to allow normal

range of motion (osteokinematic) to occur

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35
Q

Arthrokinematics is characterized as being ___ and ____

A

Invisible and involuntary

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36
Q

What are types of accessory motions?

A
  • Roll
  • Slide (glide)
  • Spin
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37
Q

Accessory motion: Roll

A

Various points on one surface contact many points on another surface

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38
Q

Accessory motion: Slide (glide)

A

One point of one surface in contact with many points on another surface

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39
Q

Accessory motion: Spin

A

One point of one surface in contact with one point on another surface.

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40
Q

What are the two types of Concave-Convex “Rule”

A

Convex on Concave and Concave on Convex

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41
Q

What is Convex on Concave?

A

Convex surface moving on fixed concave surface

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42
Q

In Convex on Concave, Roll and Glide accessory motions occur in the _____ directions.

A

OPPOSITE

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43
Q

In Convex on Concave, Movement of bone is in ____ direction to movement of joint (glide).

A

OPPOSITE

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44
Q

What is Concave on Convex?

A

Concave surface moving on fixed convex surface

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45
Q

In Concave on Convex, Roll and Glide accessory motions

occur in the_____ direction.

A

SAME

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46
Q

In Concave on Convex, Movement of the bone is in ___ direction as movement of joint surface.

A

SAME

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47
Q

What are the two types of joint positions?

A
  • Open-Packed (Loose)

- Close-Packed

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48
Q

Characteristics of Open-packed (Loose)

A

• Ligaments and capsule in
position of greatest laxity
• Joint surfaces are maximally
separated
• Minimal congruency between joint surfaces
• Proper position to assess joint play and to mobilize!

49
Q

Characteristics of Close-packed

A

• Ligaments and capsule are taut
• Joint surfaces are maximally
contacted
• Maximal congruency between joint surfaces
• Position of maximal stability
• POOR position to assess joint play or to mobilize!

50
Q

What is end- feel?

A

The sensation you “feel” in the joint as it reaches the end of the range of motion

51
Q

What does end-feel do?

A
  • Assesses the quality of motion

* Assists in identifying pathology

52
Q

Normal end- feels: bone to bone

A

– hard, unyielding sensation; painless

• Example: elbow extension

53
Q

Normal end- feels: Soft-Tissue approximation

A

– soft, yielding compression

• Example: muscle contact with elbow or knee flexion

54
Q

Normal end- feels: Tissue Stretch

A

– hard or firm (springy) type of movement with a slight give
• Feeling of springy or elastic resistance
• Example: shoulder rotation, knee extension

55
Q

Abnormal end-feels: Capsular

A

– similar to tissue stretch, but occurs early in motion. Two

subdivisions: Hard capsular and Soft capsular

56
Q

What is hard capsular abnormal end feel?

A

Hard or firm end feel, thicker feeling than normal tissue
stretch
• Abrupt onset after smooth, friction-free movement
• Seen in chronic conditions

57
Q

What is soft capsular abnormal end feel?

A

– Boggy, very soft, mushy end feel typically accompanied joint
effusion
• Stiffness early in range and increases until end range
• Seen in acute conditions

58
Q

Abnormal end feel: Muscle spasm

A

sudden and hard end feel; dramatic arrest in movement accompanied with pain; usually due to subconscious effort to protect an injured joint or structure

59
Q

Abnormal end feel: Bone to Bone

A

hard, unyielding sensation similar to normal bone to bone
• Restriction occurs before normal end range is expected
• Example: osteophyte formation

60
Q

Abnormal end feel: Springy Block

A

also a firm end feel, similar to tissue stretch
• Restriction occurs before normal end range is expected
• Usually has a rebound effect indicating internal derangement in the joint (i.e., meniscal tear)

61
Q

Abnormal end feel: Empty

A

no mechanical resistance, but considerable pain is produced by movement

62
Q

What is capsular pattern?

A

Characteristic pattern of motion restriction when joint capsule is involved (contracted)

63
Q

There are ___ pattern for each joint

A

Unique

64
Q

Capsular patterns are often ___

A

inconsistent, but may be helpful

65
Q

Examples of capsular pattern

A
  • Glenohumeral joint – ER limited more than ABD, limited more than IR
  • Hip – FLEX limited more than ABD, limited more than IR
66
Q

What is a fulcrum of a goniometer?

A

The circular part of a goniometer

67
Q

What is the proximal arm of a goniometer

A

The one that is attached to the fulcrum. This is in reference to where it’ll be facing on the body

68
Q

What is the distal arm of the goniometer?

A

The one not attached to the fulcrum

69
Q

All hip motion end feel are ____ due to ____, with the exception of ___

A

Firm due to muscle tension, joint capsule or ligaments.

Exception is flexion of the hip

70
Q

Flexion of the hip end feel is ___, due to

A

Soft due to muscle bulk

71
Q

Normal end feel of hip joint extension

A
  • Firm due to muscle tension, anterior joint capsule, or ligaments
72
Q

Avoid hip joint extension if patient complains of…

A

low back (lumber) pain in extension

73
Q

Normal end feel of hip abduction

A

Firm due to medial joint capsule, muscle tension, or ligaments

74
Q

Normal end feel of hip adduction

A

Firm due to lateral joint capsule, muscle tension, or ligaments

75
Q

Normal end feel of hip internal rotation seated and prone

A

Firm due to posterior joint capsule, muscle tension, or ligaments

76
Q

Normal end feel of hip external rotation prone

A

Firm due to posterior joint capsule, muscle tension, or ligaments

77
Q

Normal knee flexion end feel is …

A
  • Soft due to muscle bulk

- Firm due to tight muscle/capsular tension

78
Q

Normal knee extension end feel is …

A
  • Firm due to muscle tension, posterior joint capsule and ligaments
79
Q

Normal ankle dorsiflexion end-feel

A

Firm due to posterior joint capsule, muscle tension or ligaments

80
Q

Normal ankle plantarflexion end-feel

A

Firm due to anterior joint capsule, muscle tension or ligaments

81
Q

Normal ankle inversion end-feel

A

Firm due to joint capsule, muscle tension, ligaments

82
Q

Normal ankle eversion end-feel

A

Firm due to joint capsule, muscle tension, ligaments

83
Q

Normal metatarsophalangeal (MTP) flexion end-feel

A

Firm due to dorsal joint capsule, muscle tension or ligaments

84
Q

Normal metatarsophalangeal (MTP) extension end-feel

A

Firm due to plantar joint capsule, muscle tension or ligaments

85
Q

Normal metatarsophalangeal (MTP) abduction end-feel

A

Firm due to joint capsule, muscle tension, ligaments or web space fascia

86
Q

Normal metatarsophalangeal (MTP) adduction end-feel

A

Firm due to joint capsule, muscle tension, ligaments or web space fascia

87
Q

Normal interphalangeal (IP) flexion end-feel

A

Firm due to dorsal joint capsule or ligaments

Soft due to soft tissue bulk

88
Q

Normal interphalangeal (IP) extension end-feel

A

Firm due to medial joint capsule, muscle tension or ligaments

89
Q

What are the two components of muscle testing?

A
  • Muscle length testing (flexibility test)

- Muscle strength testing (manual muscle testing MMT & resisted isometric test)

90
Q

What is the purpose of muscle length test (flexibility tests)?

A

To determine if range of muscle length is normal, limited, or excessive

91
Q

What is the most common form of muscle strength testing?

A

Manual muscle testing (MMT)

92
Q

What is the purpose of muscle strength test?

A

Helps us to find and measure muscle strength to determine the person’s ability to voluntarily contract a muscle or muscle group using gravity or applied manual assistance

93
Q

The manual muscle test helps…

A

determine the degree of muscle weakness from either disease, injury or atrophy that may have occurred for a patient

94
Q

Indications for Muscle Strength Testing

A
  • Diagnosis of peripheral nerve injury or nerve root injuries
  • Effects of spinal cord injury & potential recovery
  • Basis for treatment planning and prognosis
  • Provide measure for treatment progress
  • Basis for supportive devices/orthoses
95
Q

MMT General Procedures

A
  1. Position patient
  2. Explanation / PROM
  3. Screen Test / AROM
  4. Palpate
  5. Apply resistance
  6. Grade
96
Q

Grading of MMT characeristics

A
  • Attempt to express strength objectively
  • Consider age, gender differences
  • Name and number grades
  • Gravity lessened
  • Against gravity
97
Q

In the muscle grading system, a 3- or above allow _____ gravity going through ___ ROM

A
  • vertical motion against gravity

- going through full ROM

98
Q

In the muscle grading system, a 2+ or below allow _____ gravity going through ___ ROM

A

Allow supported horizontal motion: gravity is lessened

99
Q

Factors Reducing Grading Accuracy

A
  • Pain
  • Limited Joint ROM
  • Muscle Hypertonicity/Spasticity
  • Others: Fatigue, cognition, cultural/social norms
100
Q

What are the limitations of MMT?

A
  • Hard to determine which muscle is being tested
  • Different physical shapes patients
  • Inter rater ability
101
Q

A normal (5) is described as:

A

Holds test position against strong to maximum resistance.

102
Q

Good + (4+) is described as

A

Holds test position against moderate to strong resistance.

103
Q

A good (4) is described as:

A

Holds test position with moderate resistance

104
Q

A good- (4-) is described as:

A

Holds test position against slight to moderate resistance.

105
Q

A fair + (3+) is described as:

A

FullROM against gravity; able to hold end ROM against slight resistance

106
Q

A fair (3) is described as:

A

FullROM against gravity; able to hold end ROM without added resistance

107
Q

A fair - (3-) is described as:

A

FullROM against gravity; unable to hold end ROM (gradual release occurs)

108
Q

A poor + (2+) is described as:

A

Completes partial(< ½) ROM against gravity or slight resistance in gravity minimized position

109
Q

A poor (2) is described as:

A

Completes full ROM in a gravity minimized position

110
Q

A poor- (2-) is described as:

A

Completes partial ROMin a gravity minimized position

111
Q

A trace (1) is described as:

A

Slight, palpable contraction; no joint movement

112
Q

A zero (0) is described as:

A

No palpable evidence of muscle contraction

113
Q

For muscle grading from 4- to 5, the patient should be positioned ____

A

To allow VERTICAL MOTION against gravity

114
Q

For muscle grading from 2+ to 3+, patients should be positioned _____

A

To allow VERTICAL MOTION against gravity

115
Q

For muscle grading from 2 to 2-, patients should be positioned _____

A

To allow supported HORIZONTAL MOTION; gravity lessened

116
Q

For muscle grading from 0 to 1, patients should be positioned _____

A

To allow palpation of muscle with NO MOTION

117
Q

What movement happens in the frontal plane?

A

Abduction and adduction

118
Q

What movement happens in the sagittal plane?

A

Flexion and extension

119
Q

What movement happens in the transverse plane?

A

Internal and external rotation

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