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INTERNATIONAL EDUCATIONAL RESOURCES, LID. 4 D. Upper quarter screening exam, 1. Postural assessment. Active ge of motion of cervical spine 3. Passive overpressures if symptom i 4. Vertebral artery test (see Special Tests in this chapter, 4 Quadrant test (see Special Tests in this chapted, Resisted muscle tests ical spine rotation (C 1) Resisted shoulder elevation (C 2,3,4 8, Resisted shoulder abduction (C 5) Active sh ulder tlexion, abduction, intemal and external rotation, Resisted elbow flexion (C 6), 11. Resisted elbow extension (C 12, Active range of motion of elbow: 13, Resisted wrist flexion (C7) 14, Resisted wrist extension (C 6 3 15, Resisted thumb extension (C 8), 16, Resisted finger abduction (T 1), 17, Babinskis reflex test (UMN) (see Neurological Examination in this chay i I. EXAMINATION PROCEDURES ) A. Structural examination, i 1. evolves observing the structure ofthe Lone, joints, and muscles ofthe aea of com 2. Includes a general observation of how the person sis, stands, walks, transfers, ct am 8. Mobifty examination. | 1. Consists of active, passive and accessory mobili tess | a. “Adler ad Ge eats ae piplologlealraoversenaé that Gh pevirnedl elu 1) Provide information about the patent's functional capable, including the patients witingness and ability to move a joint 2) The following should be considered during active mobility testing. : | (a) Range of motion ROM | + Goniometty is the measurement of joint ROM, using specific locations on the exterity } +The most comion 10! used 0 measure joint ROM isthe goniometer q | «The moveable atm ofthe goniometer is placed parallel 10 the long ais of th Feb ofthe joint | +The stationary arm is placed parallel tothe long axis ofthe fixe side ofthe joint | '* The axis of motion will be where the two axes intersect over the specific join | b) Quilty of motion eg. substitution pattems, apprehension, quarding, catching, giving way i (c) Symptoms associated with movernent, id) Crepitus or joint noise. ae 194 EXAM REVIEW MATERIAL (e) Response to overpressure. ‘+ Applied to determine end feel of motion limitation 4. Passive mobility tess {1} Differentiate benween contractile and non-contractile structures. (2) The joint may be hypomobile, hypermobile or normal. {3) Passive joint mobility assessment considerations {a) Range of mation (ROM) might be symmetrical, normal, restricted, or hypermobile. {b) Any symptoms associated with movement? (©) End-eel isthe quality of resistance 19 motion at the end of available range (4) Normal end-fets, {@) Soft tissue approximation (eg, calf against the posterior thigh during knee flexion) (b) Tissue stretch (e.g, rotator cuff muscles and glenohumeral capsule stretching at the end of shoulder internal rotation) (6) Bone on bone (e.g,, olecranon in the fossa with full elbow extension). (6) Abnormal end-ieels {a) Capsular: joint capsule is limiting factor with a firmer endfeel than normal tissue stretch and earlier in the ROM. For the capsular patterns of different joints see Anatomy chapter. {&} Bone on bone: joint hypertrophy due to trauma or DID is limiting factor for decreased joint ROM. (©) Muscle guarding: often associated with pain; muscle contraction prevents futher joint movement associated with internal derangement, fracture or serious pathology. (d) Springy: similar to tissue stretch but occurs earlier than expected; sudden resistance indicates intemal derangement; gradual resistance means intra-anicular edema (e) Empty: unable to move joint enough to obtain end fee!; pain limits joint ROM or joint is grossly Unstable. Mobilization techniques are contraindicated with an empty end feel @. Accessory mobility tests (1) Help determine the origin of the abnormal motion. (2) There are nwo types of accessory mobility fests, {a) Component motions. © Occur with normal active motions. © Not under voluntary control (e.g, scapular upward rotation during shoulder flexion) (b) Joint play © Intra-artcular motions that occur between joint sufaces during normal physiological movement * Can be duplicated passively by the clinician (e.g, tibial glide anteriorly during knee extension) (3) Accessory mobility scale. (a) Testing of the joint mobility is completed when the joint capsule is most relaxed or in the loose packed position. {b) The following scale can be used to grade accessory mobility. This scale is not universal, use the ‘words instead of the numbers 0 Ankylosed joint 1 - Considerable limitation 2-- Slight limitation C. Strength examination. Utilized to rule out muscle involvers exist and provide a baseline for a strengthening program ‘Specific muscles can be tested manually in a comfortable neutral position, Resisted isometric movements, b. Manual muscle testing (MMT). INTERNATIONAL EDUCATIONAL RESOURCES, LTD. 3 - Normal mobility 4 Slight hypermobility 5 - Considerable hypermobility 6 - Pathologically unstable as a cause of any Consist of a strong, static voluntary muscle contraction, Allows for a differentiation between contractile and iner tissue. with resisted muscle testing, There are four possible finding (1) Strong and painless: no pathology in contractile tissue 2) Strong and painful: minor structural lesion of the muscle-tendon unit, (3) Weak and painless: complete rupture of muscle-tendon unit or neurological deficit presen Further testing is needed (4) Weak and painful: partial disruption of muscle-tendon unit, Pain response due to serious pathology for concurrent neurological deficit Aan integral part of a physical therapy examination. Z Provides information that is useful in differential diagnosis and treatment of neuromuscular and musculoskeletal conditions. Muscle weakness may be due to nerve involvement, disuse atrophy, stretch weakness, pain or fatigue, Differentiating the action of a ane-joint muscle from that of a mult-joint muscle is done by placing the multi joint muscle at a disadvantage. 1) If a muscle that crosses two oF more joints produces simultaneous movement at all of the joints that it crosses, i¢soon reaches a length at which it cannot generate full muscle force. ) The muscle at this length isin active insufficiency eg. full wrist flexion and hand grasp When a muscle or group of muscles compensates for the lack of function of a weak or paralyzed muscle, the result is a substitution movement Grades of muscle testing, (1) Normal = 65/5) Can move into test position against gravity with maximal pressure (2) Good = (4/5). Same as normal but can only resist moderate pressure (3) Fair+ = (34/5) Same as good but can only resist minimal pressure (4) Fair = (3/5) Can only move into the test position against gravity and hold 5) Fair- = (3/5) Same as fair but gradual release against grav (6) Poot + = (24/5) Can move against gravity in a small ROM (7) Poor 2/5) Can move in full ROM with gravity eliminated (8) Poor (2/5) Can only initiate ROM with gravity eliminated 9) Trace = (1/5) Fasciculation oF palpable muscle contraction but unable to move 10) Zer) = (0) _Navisible or palpable muscle contraction