10) Joint Integrity

joint integrity

is the joint anatomically and biomechanically normal?

joint mobility

joint to be moved passively

accessory motion

small, isolated motions at the joint that must be performed passively by an examiner or external force NOT ACTIVELY

• testing the integrity of a particular ligament

• to assess arthrokinematics

when would accessory motion potentially be used

joint surfaces vs bones

accessory motion vs physiologic ROM

ACL integrity, MCL integrity, ATF ligament integrity, shoulder capsular mobility

ex of AM

• gross motion btw limb segments w goniometer

• knee flexion/extension, ankle dorsiflexion, shoulder aBduction

• testing osteokinematics = motion btw bones

ex of PROM

• tight muscles

• tight ligaments and capsule

• pain and protective muscle guarding

what might cause limited ROM

• muscle/tendon units = strain

• periarticular joint tissues like capsule/ligaments = sprain

potential tissues injured during an overstretching type injury

• isolates periarticular joint tissues

• critical component in evaluation sprains and other join pathologies

what are the benefits of assessment of “joint play”

strain

muscles and tendons

sprain

capsules and ligaments

1. motion

2. pain

3. energy

what are the 3 variables

motion

• hypo, normal, hyper

• compared to uninvolved side

• can be based on examiner’s sense of “normal” for age and sex especially at the spine

more motion

younger and females equal

pain

inducing stress to tissue is there ____ produced?

end feel

• nature of resistance perceived by the examiner’s hand as the end range is approached

• terminology is not universal or “standard”

• can be traditional ROM or accessory motion

ortho surgeon terminology

• determines if a ligament is intact or not

• judged as hard or soft

hard

• normal ligament

• clear, abrupt stop

soft

• torn ligament

• less distinct stop

PT terminology

often used during traditional ROM testing vs accessory motion testing

capsular

leathery = normal

spasm

• pain/fear

• sudden halt

• unhappy tissue

empty

• more serious pathology

• no physical resistance

• stop due to intense pain

bony

• hard, abrupt stop

• bones bump into e/o

tissue approximation

?

sprain

overstretching injury to joint (capsule/ligament) tissue

grade 1 sprain

• overstretching, majority of fibers intact

• most common

• motion: (=) normal, no excess

• pain: (+) very painful due to overstretching and inflammation

• end feel: (=) normal, firm or hard, intact ligament

measurements of grade 1 sprain

grade 2 sprain

partial tear

• motion: (= or ^) normal or increased

• pain: (+) painful due to tear

• end feel: (= or soft) subtle judgement that there’s tear

measurement of grade 2 sprain

grade 3 sprain

complete tear

• motion: (^) more motion

• pain: (-) may not have pain b/c no more tissue stress

• end feel: (soft or non distinct) torn

measurement of grade 3 sprain

effusion

• extra fluid in confined joint space

• impossible to compress

• immediate vs delayed

immediate

swelling occurs in minutes due to tissue w vasculature being violated leading to bleeding inside

delayed

swelling occurs hours later bc tissue w no vasculature supply were violated inferring a cartilage or meniscal injury

edema

• interstitial tissue spaces (extra fluid around tissues)

• not confined and can be massaged or compressed