Welcome to physical medicine Flashcards
Range of motion testing order:
1) AROM
2) PROM
3) RROM
Always start with the ___________________ of the patient
unaffected/non-painful side
Any movements that are painful are done _______
Last
To prevent overflow of painful symptoms
AROM:
Performed by the patient
Will test: contractile, nervous, and inert tissue that are moved
-Contractile tissues have tension placed on them by stretching or contracting
-Nervous tissue and their sheaths have tension put on them by stretching
-Inert tissue includes all tissues that are not contractile or neurological (ligaments, bursae, bone, cartilage, and the capsule)
Examiner should note:
-When and where during each movement the onset of pain occurs
-Whether the intensity and quality of pain increases w/ 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 true nature (ask why?)
AROM may be abnormal for several reasons:
-Pain is a common cause for abnormal movement
-Muscle weakness
-Paralysis
-Spasm
-Tight or shortened tissues
-Altered length-tension
-modified neuromuscular factors
-joint-muscle interaction
PROM:
Performed by the examiner while patient is relaxed.
Usually:
-normal
-full range
-pain free w/ possible pain at the end of ROM when contractile or nervous tissue is stretched
-Not only the degree of movement but the quality of the movement is important
Examiner should note:
-Any differences in ROM between active and passive movements may be caused by:
-Spasm
-muscle deficiency
-neurological deficit
-contractures
-pain
End feel:
Sensation the examiner feels at the end of the ROM.
Overpressure is applied at the end of ROM to determine End feel
Evaluation at the end feel:
-Assess the type of pathology present
-Determine a prognosis for the condition
-Learn the severity or stage of the problem
Muscle strength grading:
Pain sensation and associated structure:
RROM:
Finds problems in contractile tissue:
-Testing is always done with patient in neutral position
-Patient is asked to contract muscle as strongly as possible while the examiner resists for a few seconds to prevent movement occurring
-To keep movement to a minimum, it is best for the examiner to position the joint properly in the resting position and then to say to the patient “dont let me move you”
-Both AROM and RROM demonstrate symptoms if contractile tissue is affected
-Muscle strength grading must be used to determine muscle weakness or not
Postural assessment:
Patient should be in adequate dress, in their “natural” state and their habitual relaxed posture
Consider behavior and affect of patient
Three views: anterior, lateral X2, posterior
Anterior view:
Lateral view:
Posterior view:
Gait analysis:
Manner or style of walking
Begins as soon as patient enters the room.
2 phases of walking cycle:
1) Stance phase: when foot is on the ground (60% of gait)
2) Swing phase: when the foot is moving forward (40% of gait)
Abnormal gait patterns identifications and causes:
1) Due to pathology or injury in a specific joint
2) Compensation for an injury or a pathology in other joints on ipsilateral side
3) Compensation for an injury of a pathology on the contralateral limb
Abnormal gait patterns:
-Arthrogenic gait
-Ataxic gait
-Gluteus Maximus Gait
-Trendelenburg’s gait
-Hemiplegic gait
-Parkinsonian gait
-Scissors gait
-Drop foot gait
Arthrogenic gait:
Stiff knee or hip
Results from stiffness, laxity, or deformity and it may be painful or painless
Ataxic gait:
stagger gait w/ 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
Gluteus Maximus gait:
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
Trendelenburg’s gait:
gluteus medius gait
Results from weak gluteus medius/minimus
During the stance phase, patient exhibits an excessive lateral list where the thorax moves to keep centre of gravity over the stance leg.
The Trendelenburg test will be positive.
Hemiplegic gait:
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.
Parkinsonian gait:
The neck, trunk, and knees of the 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)
Scissors gait:
Result of spastic paralysis of the hip adductor muscles. This causes the knees to be drawn together to that the legs can be swing forward only with great effort.
Steppage or drop foot gait:
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.
