Interpreting Objective Data I

Selective Tissue Tension Testing

- developed by james cyriax, orthopedic MD

- system of selectively applying tension to tissues to identify the specific anatomical structure causing sx

- trying to reproduce the familiar sign

- based on movement and function of tissue being tested

3 key components of STTT

- AROM

- PROM

- Resisted Isometrics (RI)

types of tissue tested

- contractile: muscles and tendons

- inert: tissue that doesn't contract

contractile tissue

- tissue that has the ability to contract and relax

- tissue stressed by: active contraction (w or w/o external resistance), passive stretching

inert tissue

- tissue that does not have the capacity to contract/relax

- ligaments, capsule, bursa, nerve, fascia, cartilage

- tissue stressed by: tensile forces, compression forces

STTT AROM

- pt performs AROM & is activating contractile elements to move the joint

- also stressing non-contractile elements because the joint is being moved

if pain with STTT AROM

- could be contractile or non-contractile elements involved

STTT PROM

- therapist performs PROM, pt is not activating contractile elements to move the joint

- non-contractile elements will be stressed because joint is being moved

if pain with STTT PROM

- more likely non-contractile elements are involved since the contractile elements are not being stressed

- exception: if by doing PROM to joint, you put muscles on stretch

PROM test procedure

- passive insufficiency

- occurs when a multi-joint muscle lengthens at all the joints it crosses

- this limits ROM at each joint since mm. is typically not long enough to allow full ROM simultaneously at each joint it crosses

capsular pattern

- a predictable proportional pattern of limitation in ROM

- indicated problem with the joint

- unique for each joint

- may see variation depending on the resource as capsular patterns are largely based on clinical findings

- can use capsular patterns to guide clinical reasoning but consider each patient individually

STTT Resisted Isometric

- pt is stressing/activating contractile elements to produced the requested contraction

- pt is not stressing the non-contractile elements particularly since the joint stays relatively still

if pain with RI

- contractile elements is more likely involved since non-contractile elements are not being significantly stressed

- exceptions: if an inflamed non-contractile tissue lies underneath muscles that are contracting, it can cause pain OR if contractile structures are attached to non-contractile structures

Resisted Test Procedure

- active insufficiency

- occurs when a multi-joint muscle shortens across all joints simultaneously, reducing its ability to generate optimal tension and force

- mid-length/neutral position for length-tension relationship

pt response to RI is strong & pain-free

- "normal"

- no lesion of mm./tendon/referred from elsewhere

pt response to RI is strong & painful

- minor, local lesion of mm./tendon

pt response to RI is weak & painful

- partial rupture of mm./tendon

- or acute/inflammatory jt process

- or pain induced inhibition due to serious joint/mm. lesion

pt response to RI is weak & pain-free

- mm./tendon rupture

- disuse atrophy

- neuro disorder

purpose of STTT

- can be used as a basic framework

- there are exceptions

- keep an open mind and use clinical reasoning & knowledge of anatomy when examining/evaluating patients