foundations quiz three

Palpation

The use of touch to identify anatomical landmarks

Role of Palpation in Clinical Practice

Helps locate anatomical landmarks

Range of Motion (ROM)

The amount of movement available at a joint determined primarily by joint structure and surrounding connective tissues

Muscle Length

The ability of a muscle to lengthen across one or more joints and is different from joint ROM

Active Range of Motion (AROM)

Movement produced entirely by the patient's voluntary muscle contraction against gravity

Active Assisted Range of Motion (AAROM)

Movement performed by the patient with assistance from a therapist or gravity-eliminated positioning

Passive Range of Motion (PROM)

Movement performed by the examiner with no active muscle contraction by the patient

Purpose of AROM

Evaluates muscle function

Purpose of AAROM

Assists movement when the patient cannot complete full ROM independently

Purpose of PROM

Assesses available joint motion without muscle activation and evaluates end feel

Goniometer

A tool used to measure joint angles and range of motion

Inclinometer

A device that measures ROM using inclination and is commonly used for spinal measurements

Tape Measure

Instrument used to assess ROM indirectly by measuring distance

Electrogoniometer

Electronic device providing continuous measurement of joint motion

Radiographic ROM Assessment

X-ray measurement of joint position and movement

Photography and Video Recording

Visual methods used to document movement patterns and ROM

Clear Plastic Goniometer

Easy to visualize bony landmarks through the instrument

Metal Goniometer

Durable instrument commonly used in clinical settings

Full Circle Goniometer

Measures through 360 degrees

Half Circle Goniometer

Measures through 180 degrees

Finger Goniometer

Small goniometer designed for finger joints

Axis of Goniometer

The central pivot aligned over the joint axis

Stationary Arm

Arm aligned with the proximal body segment

Moving Arm

Arm aligned with the distal moving segment

End Feel

The quality of resistance felt at the end of passive ROM

Bony End Feel

Hard abrupt stop caused by bone contacting bone

Capsular End Feel

Firm leathery resistance caused by tightening of the joint capsule

Muscular End Feel

Firm resistance due to muscle tension

Soft Tissue Approximation

Soft compression of soft tissues limiting motion

Empty End Feel

ROM limited by pain before resistance is felt

Muscle Spasm End Feel

Protective muscle contraction limiting movement

Springy Block End Feel

Elastic rebound suggesting internal derangement such as a meniscus injury

Step 1 of ROM Measurement

Introduce yourself explain the procedure and obtain informed consent

Step 2 of ROM Measurement

Position the patient appropriately

Step 3 of ROM Measurement

Instruct the patient using simple layperson language

Step 4 of ROM Measurement

Perform PROM through available ROM while assessing end feel

Step 5 of ROM Measurement

Measure the starting position

Step 6 of ROM Measurement

Measure the ending position

Step 7 of ROM Measurement

Record findings accurately

Layperson Language

Using simple terms patients understand instead of medical terminology

Importance of Standard Positioning

Allows reliable and reproducible measurements

Joint Stabilization

Prevents substitution and unwanted movement during ROM testing

Importance of Assessing End Feel

Helps identify whether ROM limitation is normal or pathological

Single Motion Recording Technique

Documents beginning and ending joint angles separately

Example Single Motion Recording

Right knee flexion 0-125 degrees PROM

SFTR Recording Technique

Records movement as extension-starting position-flexion or equivalent based on plane

SFTR Sagittal Format

Extension-Start Position-Flexion

SFTR Frontal Format

Abduction-Start Position-Adduction

SFTR Rotation Format

External Rotation-Start Position-Internal Rotation

Why Avoid Single Number Recording

Single numbers fail to describe starting position and motion limitations

ROM Documentation Requirements

Include joint motion side degrees contraction type and relevant notes

Example ROM Documentation

Right shoulder flexion 0-160 degrees AROM with 2 out of 10 pain at end range

Normative Data

Reference values from healthy individuals used for comparison

Primary Source for Norms in Class

AAOS normative values

Factors Affecting ROM

Age sex culture occupation and recreational activities

ROM Safety Precaution

Do not test unstable fractures

ROM Safety Precaution

Avoid ROM testing after tendon or ligament rupture unless cleared

ROM Safety Precaution

Avoid testing during active infection or severe inflammation

ROM Safety Precaution

Use caution with severe osteoporosis

ROM Safety Precaution

Avoid ROM that may disrupt tissue healing

Manual Muscle Testing (MMT)

Clinical assessment of muscle strength using manual resistance

Hand Held Dynamometry (HHD)

Portable device that quantitatively measures muscle force

Purpose of Muscle Screen

Rapidly identifies potential weakness requiring further testing

Purpose of Muscle Strength Test

Measures strength of a specific muscle or muscle group

Advantage of MMT

Requires little equipment

Advantage of MMT

Useful when functional testing is not practical

Disadvantage of MMT

Subjective for grades above 3

Disadvantage of MMT

Produces ordinal rather than quantitative data

Reliability of MMT

Good when standardized procedures are followed

Validity of MMT

Better for lower grades than higher grades

Gravity Resisted Position

Used when muscles are expected to grade 3 or higher

Gravity Eliminated Position

Used when muscle strength is below grade 3

Grade 0 MMT

No visible or palpable muscle contraction

Grade 1 MMT

Trace contraction without joint movement

Grade 2 Minus MMT

Partial ROM in gravity eliminated position

Grade 2 MMT

Full ROM in gravity eliminated position

Grade 2 Plus MMT

Full ROM gravity eliminated plus less than half ROM against gravity

Grade 3 Minus MMT

Full gravity eliminated ROM plus more than half ROM against gravity

Grade 3 MMT

Full ROM against gravity with no resistance

Grade 3 Plus MMT

Full ROM against gravity with minimal resistance

Grade 4 MMT

Full ROM against gravity with moderate resistance

Grade 5 MMT

Full ROM against gravity with maximal resistance

Step 1 of MMT

Introduce yourself explain the procedure and obtain consent

Step 2 of MMT

Position the patient correctly

Step 3 of MMT

Instruct the patient in the desired movement

Step 4 of MMT

Assess PROM and end feel before testing strength

Step 5 of MMT

Palpate the muscle during movement while stabilizing appropriately

Step 6 of MMT

Apply resistance gradually in the correct direction

Step 7 of MMT

Prevent substitutions with proper stabilization

Step 8 of MMT

Document findings accurately

MMT Documentation

Include muscle side score testing method and relevant notes

Example MMT Documentation

Right biceps brachii 4 out of 5 MMT

Advantage of HHD

Provides quantitative measurements of strength

Advantage of HHD

More sensitive than MMT for stronger muscles

Limitation of HHD

Requires patient understanding and maximal effort

Limitation of HHD

Examiner strength may limit testing

General Principle of HHD

Maintain consistent positioning across trials

General Principle of HHD

Place dynamometer at the same anatomical location each trial

General Principle of HHD

Use maximum stabilization

General Principle of HHD

Use the same examiner whenever possible