Lecture 3 (part 2)

kms013's version from 2016-01-31 20:48


Question Answer
Overt p! behavior examplesguarding, Bracing, rubbing, grimacing, sighing
Guardingabnormally stiff, interrupted or rigid movments while moving the jt or body from one position to anothe
bracingstationary position in which a fully extended limb supports and maintains an abnormal distribution of weight
rubbingany contact between hand and injured area (touching, rubbing, holding the p!ful area)
grimacingobvious facial expression of p! that may include furroiciowed brow, narrowed eyes, tightened lip, corner of mouth pulled back, and clenched teeth
sighingobvious exaggerated exhalation of air usually accompanied by shoulders first rising then falling; pt may expand their cheeks first
AROMphysiologic movement (what the pt is willing/able to do); add combined planes/mvmts if relates to pt
Coupld of rules of thumb (though not proven) for ROMif repeated mvmts incr sx -->thinking irritable acute tississue or internal derangement postural dysfx change little w repeated mvmts
PROManatomical mvmt; what jt really can do (or at least what we can do with it)
2 things that will limit PROMjt itself (hypomobility--> assess with accesory motion testing) soft tissue that crosses the jt (lack of flexibility --> assess with mm length)
Sequence of p! to restrictionP! before restriction, p! at restriction, p! after restriction
limited AROM could be... (rule in/rule out what structures)either/both a contractile and/or jt
limited AROM but full/normal PROM --> thinking contractle
limited AROM but limited PROMthinking jt
Clarification of terms: Mobilityuniversal for how the jt (passive structures) is moving
normal mobilityunivolved side
hypomobilitylimited accessory/jt motion
hypermobilityexcessive accessory/jt motion
How is mobility assessed?jt play/accessory motion testing
Clarification of terms: Flexibilityuniversal for how the jts are moving
how is flexibility assessed?w/ mm length testing
jt playjt mvmts that are involuntary (impossible to actively isolate by oneself) but are required for normal physiological ROM
Accessory motionmvmt occuring b/w jt surfaces which is produced by Fx applied by an examiner
Accessory motion testing (AMT)process the examiner goes through when assessing the mvmts bw jt surfaces
Glidea type of accessory motion test in which the examiner attempts to reproduce the slide typically found in a given jt during a physiological motion
End-feelthe sensations that are felt by the examiners' hand at the extreme of the possible range during passive movement testing of a jt
Classification of accessory motion (Kaltenborn)0- no movement (anklyosis) 1- considerable decr mvmt 2- slight decr mvmt 3--NORMAL 4-slight incr mvmt 5- considerable incr mvmt 6-complete instability (0-2: Hypermobile) (4-6: Hypermobile)
Alternative classification of accessory motion: Hyper, normal, HypoHypomobile: Les than uninvolved side; Normal: = to unvnvovled side Hypermobile: More than univolved side
Rules for examining accessory mvmt:pt must be relaxed, each aspect of jt must be supported/protected from unguarded p!ful mvmts; 2. examiner must be relaxed, grap he/uses must be protective/firm 3. one jt examined at a time 4. One mvmt at each jt is examined at a time 5. the jt surface being examined is moved up the jt the other jt surface with is stabilized; 5. the amt of accessory motion at a jt can usually be ascertained by examining the same jt in the univolved limb, No forceful/abnormal motion test must be stopped at any point at which the p! is elicitedI In the presences of obvious clinical signs of inflammation , no accessory motion should be done
spasmthe feeling of mm "spasm" by the exminer during the ROM; Cyriaxstated this indicated the presence of acute or subacute arthritis
springy block a rebound is seen and felt at the end of range; Cyriax stated this would occur w displacement of an intra0articular structure, for example when a torn mensicus in the knee engages b/w the tibia and femur and prevents the last few degrees of extension
Emptythe end-feel when the pt complains of considerable p! during PROMbut the examiner percieves no increase in resistance to jt mvmt; A lot of p! before ROM, no resistance, pt says "stop"
capsular patternpattern of limitation of PROM, specific to each jt, that is purported to be the result of total jt! reaction (jt inflamation, capsular contraction, mm spasm)
non-capsular patternrestriction is a limitation in a jt in any pattern other than a capsular one, and may indicate the presence of internal derangement (loose bodies), restriction of one part of the jt capsule, extra-articular lesion
open loose packed (resting) positionthe position in a jts ROM at which jt is under the least amt of stress (minimal congruency b/w the articular surfaces; the jt capsule and ligmanets are in the position of greatest laxity and passive separation of the jt surfaces is at its greatest; position a clinican places a jt to test jt play mvmt)
Close packed positionsthe position in a jts ROM at which the majority of jt structures are under maximum tension (maximal congruenc b/w the articular surfaces; jt surfaces are tightly compressed; jt capsule/ligs are maximally tight; cannot separate by distractive fx; position of max jt stability; no accessory mvmt is possible
what is the best way to assess NM control and eccentric strenghtfxl strenght
isometric strength testingMMT (break test), myotome, dynamometry, biodex
dynamic strength testingisokinetics (Biodex)
Endurance testing 6 min walk test
CP: Need to decided which test is appropriate, if appropriate at all. Varies depending on the pts cirumstances. Give an example:For example, pts with post-op tendon repair should NOT have their tendons stressed prematurely
Resisted Isometric tests measure: P! or no p!; weak or strong
if resisted isometric test is: strong and p!less = OK
if resisted isometric test is:strong and p!ful = contractile (mm/tendon)
if resisted isometric test is:weak and p!less = nerve or long standing ruptureor tendon avulsion
if resisted isometric test is: weak and p!ful = acute and/or serious pathology
Special "diagnostic" test: most special tests are based on _____tissue tension. 1. stretch 2. compression 3. resistance
What are special diagnostic tests used to rule in and out different types of tissue: Which ones/Active structures (mm --> tear/strain, tendons --> tendonitis/osis) Passive structures (Labrum --> tear, ligs -->tear sprain) Combined, both active and passive (stability -->impingement, segmental instability) Neural structures (compression {radipaathy}, traction {TOS}, UMN vs LMN
Many special tests are available for each jt to determine _________whether a particular type of disease, condition, or injury is/is not present
are there any special tests that are 100% reliable, valid, sensitive, or specific?No
Why should you cluster specific special tests?They should be seldom used in isolation or as stand alone tests; should only be considered as part of an overall clinical assessment that includes hx, observation, and the rest of examination; Rarely capable of providing the clinican with a definitive answer as to what is wrong with the p!; however, they may help providea clearer picture of the pts problem when combined with other info gathered during the eval
CP: Master at leas ___ tests for each condition2
palpation 3 tips:don't palpate too soon (referred tenderness is real and can be misleading/ palpation can be provocative , incr pt anxiety, fear, and guarding) 2. only after the tissue at fault has been ID is palpation for tenderness used to determine/confirm the exact extendof the lesionwithin the tissue (perform near the end of the examination) 3. palpationis an important assessment technique that must be practiced if it is to be used' palpation of a jt and surrounding area must be carried out in a systematic fashion to ensure that all structures are examined _CP: palpate above/below before right on); Have a plannedstarting point and work from that point to adjacent tissues (don't go to "home plate"-- work your way toward that area (startin the periphery and then centralize/localize), the clinical must work slowly and carefully, applying light pressure initially and working into a deeper pressure of palpation, then feeling for pathological coniditons or changes in tissue tension, the univolved side should be palpated first so the pt has some idea of what to expect and to enable the examiner to know what normal feels like

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