Pt 6221 - Intro To Ax

Front 1

Prior to examination...

Back 1

1. introduce
2. describe assessment procedure
3. consent (voluntary, legally competent, cover all procedures)

Front 2

Objective examination

Back 2

-nature and site of symptoms
-whether certain mvmts provoke E/C
-rule in/out hypotheses
-extensive and investigate all sources of pathology

Front 3

O/E: Scanning Examination

Back 3

-Screening tests and other comprehensive examinations of NMSK

1. R/O referral from spine or other jts
2. potential influence of other areas
3. confirm PT referral appropriate
4. R/O serious pathology
5. Contraindications
6. Indicate severity and irritability of client

Front 4

O/E: Principles of Ax

Back 4

1. Normal/less irritable side first
2. Order of ax
3. Painful mvmts last
4. End feel
5. Aggravation S/E, reproduce symptoms/detect mm weakness/vascular inefficiency
6. PROM and lig't stress test: end feel, ROM and pain are important clinical findings
7. key muscle tests 5 seconds
8. warning of excaberation
9. refer if unusual S&S or beyond scope

Front 5

O/E and Principles of Ax: Order of Ax

Back 5

1. observation
2. AROM/PROM
3. Neurological tests
4. Muscle tests
5. Special tests/lig't stress tests
6. Joint play
7. Palpation

Front 6

Key Muscle Testing
1. Myotome
2. True vs. Untrue myotomes
3. Nerve Conductivity
4. Strength and Shortened Length

Back 6

1. Dorsal aspects of vertebrate embryo giving rise to skeletal musculature. Muscles supplied by the same segmental level.
2. Multifidus, Rotatores, Short suboccipitals
3. Use key muscles most representative of that segment
4. Strength = # motor units fired and recruited. Shortened is biomechanical disadvantage, recruit more MU's to generate force. Should test in shortened position for minimum 5 seconds (fatigue)

Front 7

Key Muscle Testing
-Neurological vs. non-neurological weakness

Back 7

-Neurological - rapid fatigue
-Non-neurological - constant decrease in power without fading

Front 8

O/E: Observation
1. Purpose
2. Considerations

Back 8

1. Gather information on: functional deficits, visible abnormalities, alignment abnormalities
2. Considerations:
-Begins as soon as they enter
-note manner/attitude/facial expression
-dominant eye, alignment post/lat/ant
-equal/symmetrical limb position
-skin colour/texture (elasticity, shiny, hair loss, breakdown)
-scars, blisters, calluses

Front 9

O/E: AROM
-Provides information on?

Back 9

1. Quantity of movement
2. Quality/rhythm of movement
3. Where in ROM pain/resistance/spasm occurs
4. Willingness to move
5. Tricks/patterns of mvmt
6. Muscle power

Front 10

O/E: AROM
1. Physiological Barrier
2. Inert vs. Contractile tissue
3. Hesitation suggests?

Back 10

1. End of AROM
2. Stretched tissue = inert and contract, Contracted tissue = contractile
3. Hesitation near end AROM = instability whereas hesitation near beginning = apprehension from pain.

Front 11

Impairments of Reduced ROM?

Back 11

-reduced ability to carry out ADL's
-reduced function
-muscle weakness
-compensating muscles

Front 12

Causes of abnormal AROM

Back 12

1. Pain
2. Weakness, paralysis, spasm
3. tight/shortened muscle
4. altered length/tension relationship
5. modified NMSK factors
6. joint-muscle interaction

Front 13

O/E: PROM
1. Tests?
2. Provides information on?
3. What should be noted and why?

Back 13

1. Contractile, inert and nervous structures via passive stretch
2. Information:
-Pain and its behaviour in ROM
-Resistance to mvmt
-Capsular or non-capsular
-end feel
3. When pain/resistance/spasm occurs. Helps to determine type of tx, response to tx and cause of any limitations

Front 14

O/E: PROM Capsular Pattern

Back 14

=Pattern of limitation or restriction in a joint

-Each joint has its own CP and is determined via passive joint motion
-Etiology: OA, RA, TA

Front 15

O/E: PROM End Feel

Back 15

=Over pressure at end of PROM to determine quality of the feel of tissue in examiner's hands

Front 16

Painful or limited AROM/PROM
1. opposite direction
2. same direction

Back 16

1. lesion in contractile
2. lesion in inert

Front 17

Lesions of the contractile tissue

Back 17

-Symptoms present with RIM/AROM
-Can elicit pain with PROM if: irritable or with passive stretch in opposite direction

Front 18

Lesions of the Inert tissue

Back 18

-Painful AROM/PROM in same direction
-Depending on severity, pain occurs as limitation of motion approaches
-RIM not usually painful unless compression

Front 19

Classical Patterns of Inert Tissue Lesions during PROM

Back 19

1. No pain & full ROM - NO lesion
2. Pain & Limited ROM in ALL directions - Entire joint affected
3. Pain & Limited ROM in some directions (NC) OR Pain & Excessive ROM in some directions (NC) - pain caused by mvmts that stretch, pinch, move affected tissue
4. No pain and limited ROM

Front 20

PROM can be normal and abnormal when?

Back 20

Normal:
-In range
-Quality throughout range
-End feel
-Tolerance to testing

Abnormal
-Capsular pattern (OA, RA, TA)
-Non-capsular pattern (Nerve, something outside of joint)

Front 21

O/E: Muscle Testing RIM
1. Determines what information?
2. Basic concepts
3. Why should we have minimal inert tissue tension?

Back 21

1. whether CU is at fault
-If muscle, tendon or bone (tenopariosteal junction) are at fault = pain/weakness will occur related to degree of injury
-if nerve supply is at fault

2. no mvmt of joint, neutral position (use alternate position if c/o in different positions)

3. mvmt of joint allows movement of surrounding inert tissue. Minimal tension will rule inert tissue out as source of problem.

Front 22

O/E: Muscle Testing RIM
-Important considerations

Back 22

1. production and characteristics of symptoms
2. which muscle is at fault?
3. strength of contraction

Both AROM and RIM elicit c/o if CU at fault
PROM typically does not (if in direction of shortening)

Front 23

Patterns of Contractile Units and Nervous Tissue Lesions: Movement

Back 23

1. Movement strong & Pain-Free = Nerve and muscle are NOT the source
2. Movement strong & Painful = local lesion of mm/tendon or primary/secondary mm strain
3. Movement weak & painful = severe lesion
4. Movement weak & pain-free = mm/tendon rupture or neurological

Front 24

Patterns of Contractile Units and Nervous Tissue Lesions: Pain

Back 24

1. Pain throughout ROM = injury to muscle belly
2. Pain in lengthened = tenopariosteal injury (where tendon attaches to bone)
3. Pain on repeated test = intermittent claudication (muscle pain)
4. All resisted tests painful = acute injury or compression of acutely injured joint.

Front 25

1. Flaccidity
2. Hypotonicity
3. Hyporeflexia
4. Weakness/atrophy of involved mm
5. Fasiculation/Fibrillations

Back 25

1. Relaxed, flabby, no tone
2. Lesser degree of tension
3. Weakened/diminished DTR (deep tendon reflexes)
4. weakness
5. involuntary contraction or twitching/rapid contractions of mm fibrils

Front 26

O/E: Special tests & Ligament Stress Tests

Back 26

-Regional specific tests determine potential site of lesion/extend of injury
-Palpation: swelling, inflammation, FS, spasm, deformity
-Can be used to confirm tissue at fault and level of irritability