Chapel Garden

Orthopaedic

Lecture Notes

EVALUATION OUTLINE

  • History
  • Observation
  • Quarter Screening Examination
  • Appropriate Examinations
    • Selective Tissue Tension Examination
    • (Spine - repeated motion, PIVMT, length/strength balance)
    • Special Tests
    • Reflexes and neurological
    • Accessory motions
    • Palpation
  • X-ray studies

SOFT TISSUE EXAMINATION (Selective Tissue Tension)

  • Must selectively stress each tissue from which complaint might arise
  • Contractile tissues - muscles, tendons, and attachments
  • Non-contractile (inert) tissues - joint capsules, ligaments, nerves and their sheaths, bursae, and cartilages

SEQUENCE OF EXAMINATION

  • Active Movements - gives an idea of the willingness and ability of the patient to move the part
  • Passive Movements - stresses non-contractile tissues, and to a lesser degree, contractile tissues
  • Resisted Isometric Contractions - Stresses contractile tissues

PASSIVE MOVEMENT EXAMINATION

  • Limitation of range
  • End Feel
    • capsular
    • soft tissue approximation
    • bone on bone
    • springy
    • muscle spasm
    • empty
  • Pattern of limitation - capsular or non-capsular
  • Sequence of pain (can give information about the degree of acuteness)
    • pain before motion barrier = acute
    • pain at motion barrier = sub-acute
    • pain when motion barrier is exceeded = chronic
    • pain in middle of range only = painful arc

RESISTED ISOMETRIC CONTRACTION

  • Isometric contraction of specific muscles
  • "Neutral" joint position - don't allow joint motion
  • Possible Responses
    • "Strong and pain free" - no pathology with that muscle-tendon element
    • "Strong and painful" - "minor" lesion of the muscle-tendon element (eg muscle strain, tendonitis)
    • "Weak and painful" - "serious" problem (eg fracture)
    • springy
    • "Weak and painless" - complete tear of the muscle-tendon element or pathology in nerve supply to the element

SUMMARIZING FINDINGS

  • Active and passive movement painful in same direction indicates non-contractile tissue at fault
  • Active (and resistive) and passive movement painful in opposite directions indicates contractile tissue at fault
  • Resisted contraction painful or weak indicates contractile tissue at fault
  • Exception - certain bursal conditions can be irritated by compression from resisted isometric contraction

 

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