TERM 1
Arthropathies
DEFINITION 1
An arthropathy is a disease of a joint.
TERM 2
Arthritis
DEFINITION 2
inflammation
TERM 3
Reactive
DEFINITION 3
Infection
TERM 4
Crystal
DEFINITION 4
gout or uric acid
TERM 5
Diabetic
DEFINITION 5
diabetes
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MSK Management Principles and Concepts Lecture -- Ch 1 | PHYS - Muscle Physiology, Quizzes of Physiology
Class: PHYS - Muscle Physiology; Subject: Physics; University: Touro College; Term: Forever 1989;
Typology: Quizzes
2014/2015
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Arthropathies
An arthropathy is a disease of a joint. TERM 2
Arthritis
DEFINITION 2 inflammation TERM 3
Reactive
DEFINITION 3 Infection TERM 4
Crystal
DEFINITION 4 gout or uric acid TERM 5
Diabetic
DEFINITION 5 diabetes
Disorders of joint movement
decreased movement -- hypomobility increased movement -- hypermobility abnormal movement due to instability blocked movement due to internal derangement -- meniscal tear TERM 7
Disorders of bone
DEFINITION 7 fractures dislocations tumors infections TERM 8
neurological lesions due to spinal disorders
DEFINITION 8 nerve root compression or referred pain TERM 9
peripheral joint referred pain
DEFINITION 9 ex. hip lesion causing knee pain or entrapment neuropathy of peripheral nerve TERM 10
Synovial joints
DEFINITION 10 bone ends lined with avascular articular cartilage and nourished by synovial fluid
Types of tissue
contractile tissues -- muscles tendons and musculotendinous attachmentsnervous tissuesinert tissues -- non-contractile or neurological capsule, ligaments, bursae, BV, cartilage and dura mater TERM 17
How is tension placed on contractile tissue?
DEFINITION 17 by stretching or contraction TERM 18
how is tension placed on nervous tissues?
DEFINITION 18 by stretching and pinching TERM 19
Active movements
DEFINITION 19 "Actively" performed by the patient's voluntary muscles TERM 20
Things to do/observe during active
movements
DEFINITION 20
- note if and where in the range there are symptoms2. note the quality of movement and perform more than once perform single plane movements (flexion/extension) and combined movements (hand behind back)
- based on severity and irritability, overpressure may apply at end ROM if doesn't produce symptoms and end-feel normal then don't need PROM
passive movements
performed to determine available anatomical ROM and end feelmay be WNL, hypomobile, hypermobilePROM>AROM TERM 22
3 normal end feels
DEFINITION 22 bone to bone = "hard" and painless ex. elbow extension soft tissue approximation = "mushy" yielding compression from muscles ex. elbow flexion tissue stretch = hard or firm (springy) movement with slight give elastic (soft) feel without definite stopping point (DF) capsular firm feel with definite stopping point (knee extension) found when capsule/ligaments are primary restraints TERM 23
5 abnormal end feels
DEFINITION 23
- muscle spasm -- sudden and hard2. capsular -- similar to tissue stretch but doesn't occur where one would expect decreased ROM3. bone-bone -- similar to normal bone-bone but occurs earlier in ROM than expected or when not expected4. empty -- no resistance detected, pain5. springy block -- similar to tissue stretch but occurs where not expected, often in joints with menisci TERM 24
Capsular pattern
DEFINITION 24 pattern of limitation or restriction as a result of total joint reactioneach joint has characteristic pattern of limitation TERM 25
causes of total joint reaction
DEFINITION 25 muscle spasmcapsular contractiongeneralized osteophyte formation
Components of Selective Tissue Testing
- AROM -- ability and willingness to move, ROM possible, muscle power2. PROM -- state of inert tissues, must determine end-feel and whether symptoms and resistance are achieved together3. Resisted Movements -- state of muscle group around joint, may provoke pain or weakness or both4. Painful arc -- may or may not appear at extremes, implied tender structure pinched between 2 bony surfaces5. abnormal sensations -- look at both when joint is moving and stationary TERM 32
Purpose of resisted isometric movements
DEFINITION 32 determines whether contractile tissue is at faultalso tests myotomes TERM 33
position of the joint in resisted isometric
movements?
DEFINITION 33 joint in a resting position to decrease inert tissue tensionMMT TERM 34
Stretch weakness
DEFINITION 34 positional weakness that results from muscle positioned in prolonged lengthened position TERM 35
pathological weakness
DEFINITION 35 weakness throughout the ROM
What is the effect if testing is done in fully
lengthened position of the muscle?
intert tissue is tight and there is increased load on contractile tissue TERM 37
What is the effect if testing is done in the fully
shortened position?
DEFINITION 37 weakest position TERM 38
What may cause muscle weakness?
DEFINITION 38 UMN lesion Peripheral nerve lesion NMJ pathology Nerve root lesion Lesion or disease of muscle, tendon, bony insertions Test isometrically first to determine which movements are painful and then perform individual muscle tests to determine exactly which muscle is at fault TERM 39
Procedure of resisted isometric
testing
DEFINITION 39 joint in midrange resistance strong enough to prevent joint from moving apply resistance so only one muscle group tested placement of hands to detect even minor weakness muscle groups tested 1 by 1 and pt asked if discomfort induced or increased If one movement induces or increases discomfort and the others do not, and passive ROM is full then it is almost certainly a muscle lesion. If movement involves more than 1 muscle, then use accessory motions TERM 40
if shoulder medial rotation is painful and
adduction is painless, which muscle is
implicated?
DEFINITION 40 subscapularis
reliability of special diagnostic tests is reliant
on what?
cooperation of patient skill of clinician calibration of equipment measured using ICC or K useful to know standard error of measurement (SEM) small SEM = stable test TERM 47
How to determine diagnostic accuracy of
special tests?
DEFINITION 47 sensitivity specificity likelihood ratios TERM 48
Sensitivity
DEFINITION 48 A test's ability to detect those patient's who actually have the disorder as indicated by a reference standard True-positive rate Tests with high sensitivity are good for ruling out a disorder SnNout ANYONE WHO COMES OUT NEGATIVE IS TRULY NEGATIVE TERM 49
Specificity
DEFINITION 49 Tests ability to detect those pts who actually do not have the disorder as indicated by the reference standard True-negative rate Tests with high specificity are good for ruling in a disorder SpPin ANYONE WHO IS POSITIVE IS TRULY POSITIVE TERM 50
Likelihood ratio
DEFINITION 50 Determines the odds that a condition, dysfunction, or disease is present by combining sensitivity and specificity The higher the likelihood ratio, the greater the likelihood that the pt has the problem
Minimum Detectable Change (MCD)
The MDC is the minimum amount of change in a patient's score that ensures the change isn't the result of measurement error. TERM 52
Minimum clinical important difference
(MCID)
DEFINITION 52 Tests responsiveness The MCID is a published value of change in an instrument that indicates the minimum amount of change required for your patient to feel a difference in the variable you are measuring. TERM 53
Provacative tests
DEFINITION 53 Goal is to reproduce signs and symptoms Decision to perform must take this into account Know contraindications/precautions TERM 54
What is physiological movement?
DEFINITION 54 "voluntary movement" TERM 55
Accessory movement
DEFINITION 55 Small ROM (less than 4 mm in any direction) that is not under voluntary controlNeeded for full painless function and ROM of the joint Typically, dysfunction 2 loss of accessory movement If movement is limited, it must be restored for patient to regain full voluntary ROM
Assessing quantity of movement
- gionometric measurement2. manual grading of movement TERM 62
Manual grading of
movement
DEFINITION 62 0- No movement (ankylosis) 1- Considerable decreased movement 2- Slight decreased movement 3- Normal 4- Slight Increased Movement 5- Considerable Increased Movement 6- Complete instability TERM 63
Physiologic vs. Pathologic end-feel
DEFINITION 63 physiologic -- each joint has a characteristic end- feelpathologic -- occurs at a different location or is of a different quality than is characteristic of the joint being testedex. scar tissue, muscle tone or shortened connective tissue TERM 64
Empty end-feel
DEFINITION 64 patient stops or asks that movement be discontinued before true end-feel is met.Typically secondary to fractures, acute inflammatory process or can be psychogenic. TERM 65
Hypomobility or hypermobility are
pathological findings only if what?
DEFINITION 65 if they are associated with symptoms and a pathological end- feel
indications for joint mobilization
Pain, muscle guarding and spasmReverse joint hypomobilityPositional fault/subluxation TERM 67
Precautions for joint mobilization
DEFINITION 67 Hypermobility Joint effusion Inflammation Hypermobility in associated joints Total Joint Replacements Newly formed or weakened connective tissue (corticosteroids) TERM 68
contraindications for joint mobilization
DEFINITION 68 Malignancy Bone disease detectable on radiographs Unhealed fracture Excessive pain Systemic connective tissue diseases TERM 69
osteokinematics vs. arthrokinematics
DEFINITION 69 osteo -- Articulation of two or morebony or limbsegmentsjoint arthro -- Motion that occursbetween the articularsurfaces of the joints Roll Slide Glide, Translation Spin TERM 70
Roll associated with knee flexion is what?
DEFINITION 70 physiological movement of joint
2 main types of manipulation
non-thrust manipulation (mobilization) When the joint is either oscillated within the limits of an accessory motion or taken to the end of its accessory range and then oscillated or stretched thrust manipulation When a sudden high velocity, short amplitude motion is delivered at the limit of an accessory motion TERM 77
Creation of movement diagram
DEFINITION 77 Axis -- X = range (1/4, 1/2, 3/4), Y = intensity (pain, resistance, spasm)A is 0B is at end of rangeC is at end of intensityD closes boxAB is available ROMAC is intensity of symptomsCD BD complete box TERM 78
How to apply techniques
DEFINITION 78 choose technique choose joint/level choose position for pt and PT (pain dominant = pain easing position, stiff dominant = symptom provoking position) choose direction choose grade (pain = 1,2,3 stiffness = 3-5) choose rate/rhythm choose duration choose number reps reassess