PS 1001:03 Lecture Notes - Lecture 10: Myositis Ossificans, Muscle Atrophy, Iliotibial Tract
Be able to state the components for objective assessment of ROM and muscle
strength
Objective assessment overview
Observation
How are they holding themselves
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In flexible position because in pain? Or problem with spine?
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Posture
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Equal?
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e.g. difference between contours of waistline
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Contours of muscle
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Gait
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Equal set lengths?
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Stumbling?
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Walking aids
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Splints, plaster of paris, dressings etc.
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Deformities
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Muscle atrophy (wastage)/hypertrophy (increase in muscle bulk)
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Facial expressions - can show pain
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Functional activities
Gait
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Sit - stand - sit
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Standing
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Sitting
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Dressing/undressing
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Daily activities etc
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Inspection
Skin - colour, bruising, sutures, scars, sweating, quality (dry? Etc.)
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Muscle tone - atrophy, hypertrophy
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Oedema - swelling and where is it situated
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Deformities
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Palpation
Heat - use back of hand to test
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Oedema - where is swelling, fluidy, lumpy
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Eliminate other joints (which
could be involved)
Check active range of movement
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Can cover whole area by doing these tests
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e.g. lower limb - squat/stand - sit/steps
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Movements
Active range of movement AROM - ROM, pain
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Passive range of movement PROM - ROM, end-feel, pain, take weight of limb, are they
inhibiting range of movement due to pain or is it just sore
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Accessory movements - pain, end-feel
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Muscle strength
Isometric strength/muscle testing IMT
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Manual muscle testing MMT
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Joint integrity
Ligaments
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Muscles around joint
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Special tests
Anterior drawer - knee
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Sharp-purser - cervical spine
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Vertebral artery and sufficiency test VBI - cervical spine
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Ober test - iliotibial band
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Eg.
Neurological tests (if
indicated)
e.g. specific sensory testing - proprioception and joint movement
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If indicated
All found on back of assessment form under "initial assessment"
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Passive and active
▪
Range of movement ROM
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Isometric strength testing
▪
Manual muscle testing
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Muscle strength
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Focus on the elements of objective examination related to testing
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Objective examination
ROM testing
In the region of a dislocation or unhealed fracture
▪
If movement is likely to disrupt healing - e.g. post-surgery
▪
If myositis ossificans (calcium deposits in a muscle) or ectopic ossification is suspected or present
▪
Both AROM and PROM assessment techniques are contraindicated
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Contraindications (CI)
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Precautions (P)
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AROM & PROM safety
Hard
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Firm - can still push a bit further
beyond their maximum
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Soft
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End feel
L2 - objective examination - range of movement and
muscle strength
Sunday, 25 March 2018
1:39 PM
Week 5 Page 1
Inflammatory or infectious processes e.g. RA, myositis ossificans
▪
Bone fragility e.g. osteoporosis, or newly united fracture so PROM should be performed with extreme
care
▪
Presence of hypermobility or subluxation
▪
Patients taking pain or muscle relaxants - patient response to pain may be effect -> injury e.g. they
don't feel as much
▪
Conditions where assessment may aggravate
▪
Circulatory problems - Haemophilia and haematoma - or other disorder which may predispose to
onset of bleeding
▪
Bony ankylosis
▪
Initial stages acute injury with soft tissue description
▪
Prolonged period of immobilisation
▪
Caution should be taken in the presence of
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Precautions (P)
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Do you understand what I have said
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Do you have any questions
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Are you happy for me to proceed
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ROM and muscle strength testing - consent
Ability and willingness of patient to move
○
AROM available at the joint
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Quality of the movement
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Movements that cause pain o are stiff
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Ability of patient to follow instructions
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Levels of pain - use scale of 0-10
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Where symptoms may originate from
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If no pain may apply overpressure to get end feel of joint
▪
End feel = firm, hard or soft
▪
End feel of the joint (when overpressure is applied) -> type of structure likely to be causing joint restriction
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Active movement tests are used to determine
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Active movement tasks
Assessment of AROM
The part being examined must be exposed (draping)
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Starting position of patient - stable, reproducible, allow full ROM (nothing blocking movement)
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Patient symptoms prior to commencement
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Demonstrate as required: useful and/or essential
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Ask patient how they feel after, is there any pain?
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Instructions - clear and concise
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Painful movements -> last
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Initially patient to perform without manual or verbal correction
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To examine active movement
Compare unaffected to affected side first
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Quality
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Range
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Pattern or trick movements e.g. if trying to flex and hit painful spot, might move out to the side instead, effect of
altering/correcting
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Observe patient from front, back and side
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Observe the return to the neutral position
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Observe
Ask patient
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Symptoms during and after
After all previous observations and questions
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E.g. if difference in range of movement between both arms
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Perform goniometry
Passive force applied at end of available AROM
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Determines end feel of a joint
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Ask patient what they feel and where they feel it
▪
e.g. if its painful cannot apply, but if sore maybe can apply
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Assesses if the application of a force at the end of range reproduces the patients problem
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On some occasions may still be applied
▪
Not routinely undertaken if AROM is painful
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Not used in cases of irritable joint
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Overpressure
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Other considerations
Passive movement tests = joint movements completed by the physio while the patient relaxes
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Comparison with AROM
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Comparison with PROM on unaffected side
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Quality of joint movement
Used to determine
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Passive movement tests
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