Functional analysis of the musculoskeletal system based on the principles of James Cyriax

Methodology

• The diagnostic method is selective tensiometry (specifically for testing soft tissue), which tests non contractile structures by passive motion and contractile structures by resistance testing.

• Provoking the symptom by increasing the tension (stretching) of the tissues

Main symptoms

• Pain
• Reduced range of motion: function is changed

Test principle

healthy structures can function without pain, but damaged structures cannot

PAIN

-Regular/periodic

-Localization: - deep/superficial, radiating/superficial

-Internal medicine/musculoskeletal (spine; limb)

-Period of the day

Determining the quality of movement

-The quality of movement is determined by a combination of the range of motion and joint end feel.

Range of motion

-Active: harmony of movement; rhythm; value: cm, degree
-Passive: quality of movability; value; end-feel

-The range of movement can be full/limited. A reduced range of motion indicates a contracture,

END-FEEL

-flexible
-elastic
-bony(elbowjoint)
-spastic(muscle)
-flexible block(meniscus)

 scar, surgery, tendonitis, tendovaginitis,calluses

General aspects of the examination

start the examination on the healthy side first (to avoid defensive muscle contraction). Painful side last.

If the active range of motion is not full, the range of motion should be forced (overpressure) carefully

When testing for instability, not only the range of motion but also the quality of displacement is important

During isometric testing the joint should be in resting position

The ligament tests are repeated several times and adequate force is applied so that defensive muscle activity (contraction) can be avoided during instability

When measuring muscle strength, the patient should hold the segment in end position for 5 seconds (without tremor, full ROM).

• The patient should be informed that the test may increase symptoms!

Order of examination

active; passive; isometric resistance movement test

All three test forms are repeated several times to determine whether the symptom is increasing/on the same level/decreasing.
• Nerve stretch: stagnant; increasing
• Muscle stretch: decreases

• For full range of motion (ROM), the end-feel is also determined. If these two are physiological, the passive movement test is negative.

Contractile element: (muscle; muscle- tendon junction)

Tension is increased:
• During shortening (active increase in tension)
• During stretching (passive increase in tension)

Non-contractile element: (joint capsule; ligaments; bursa; nerve; vessel; dura; articular cartilage)

Tension is increased:
• During stretching
• When pinched
• During forceful pressure

Differential diagnosis of the contractile element

• One direction of active movement is painful.
• The same direction of isometric movement is painful.
• Passive movement in the opposite direction provokes pain, especially at the end of the movement range.
• However, passive movement in the same direction is not painful.

• Muscle weakness can also be detected.

ΣTHE OPPOSITE DIRECTION OF ACTIVE AND PASSIVE MOVEMENT CAUSES PAIN!
• E.g.: m. biceps brachii → active flexion and passive extension are painful, passive flexion is not painful

Differential diagnosis of the non-contractile element

• Pain is usually felt in the last third of the range of motion, or at the end of the range of motion.
• Isometric movement is usually painless.
EXCEPTION: If the isometric test provokes compression of a contractile element (e.g. scalenus- brachial plexus)

ΣTHE SAME DIRECTION OF ACTIVE AND PASSIVE MOVEMENT CAUSES PAIN! (e.g.: subacromial bursa)

Damage patterns of the contractile element

• Movements strong + pain-free → no problem in the contractile element

• Movement is strong + painful → indicates localized damage to the muscle or muscle-tendon junction

• Movementis weak + painful → indicates severe injury, inflammation/fracture

• Movement weak + pain-free → indicates chronic muscle tear, atrophy, neurological causes

Damage patterns of the non-contractile element

• Painful movement in all directions + movement limited in all directions → indicates an acute condition

• Some movements are painful + limited; others are not → indicates local injury: ligament injury; bursitis

• Limited movement is pain-free; in this case the end-feel is abnormal, often bony → e.g.: old injury that no longer hurts

• The range of motion is complete and pain-free → the cause should be investigated somewhere else (e.g.: herniated disc- leg pain)