Chapter 1 Purpose, Definitions and Rules (page 2)

Question 1

Identify the purpose(s) of assessment.

Answer 1

1. To identify the physical structures responsible for the client’s symptoms. With orthopedic conditions, the examiner aims to perform a physical test (or tests) that duplicates exactly the symptoms of which the patient complains. It is not always possible to identify a primary lesion.
2. To assess the function of all related tissues and structures. (This includes those resulting from and predisposing to the primary complaint.)
3. To assess the ability of the client to perform daily activities.

Question 2

________________ is where the distance between the origin and insertion of the muscle increases.

Answer 2

ECCENTRIC contraction

Question 3

_______________ is where the distance between the origin and insertion of the muscle decreases.

Answer 3

CONCENTRIC contraction

Question 4

________________ is the type muscle contraction without change in the force of contraction.

Answer 4

ISOTONIC

Question 5

This is the type of muscle contraction without a change in distance in the length of the muscle.

Answer 5

Isometric Contraction

Question 6

_________: A group of muscles innervated from a single spinal nerve root.

Answer 6

Myotome

Question 7

_____________ involves resisting the action of the specific muscle innervated by a particular nerve root.

Answer 7

Myotome Testing

Question 8

____________: an area of bone, joint, or ligament innervated from a single spinal nerve root.

Answer 8

Sclerotome

Question 9

____________ refers to the area of skin supplied with afferent nerve fibres by a single posterior spinal root.

Answer 9

Dermatome

Question 10

Dermatomal sensory testing is performed with a _________, ________ or _____________ to assess the patency of a single spinal nerve.

Answer 10

Cottonball

Pinwheel

Reflex Hammer

Question 11

__________________: a reflected action or movement, where a stimulus is sent to the spinal cord and relayed back to a muscle via a lower motor nerve, used to evaluate the integrity of the nerve supply of specific nerve roots in the area being tested.

Answer 11

DEEP TENDON REFLEX (DTR)

Question 12

_________________ involves the patient’s movement of a joint through its entire range without assistance.

Answer 12

ACTIVE RANGE OF MOTION TESTING

(AROM or AF-Mobility)

Question 13

___________________ involves the therapist attempting to move the joint through its entire range of motion without assistance from the patient.

Answer 13

PASSIVE RANGE OF MOTION TESTING

(PROM or PR-Passive Relaxed)

Question 14

Identify 3 things that a therapist should observe during the movement (AROM).

Answer 14

1. The patient’s willingness to move the joint.
2. Where, in the range there is onset of pain or restriction.
3. How the affected side’s range, compares to the unaffected side.

Question 15

Identify 3 things that a therapist should observe during the movement (PROM).

Answer 15

1. Where in the range there is onset of pain or restriction.
2. How the point of onset of pain or restriction compares to ACTIVE range.
3. How the affected side’s range compares to the unaffected side.

Question 16

_____________ is a type of range of motion that challenges soft tissues and the joint. It is used to assess ___________.

Answer 16

PASSIVE FORCED (PF)

END-FEELS

Question 17

__________________ involves the contraction of muscle against resistance supplied by the examiner.

Answer 17

RESISTED TESTING (ARROM)

Question 18

Identify at least 3 rationale for the use of ARROM.

Answer 18

1. To assess for lesions in muscle and tendon
2. To test nervous innervation of muscle
3. To assess strength

Question 19

________ is a small additional force exerted by the therapist when the AROM and PROM are not full to lengthen muscles, tendons, ligaments, joint capsule.

Answer 19

Stretch

Question 20

____________ is a force exerted by the therapist at the end of an _____ to take the movement passively through to the normal end of _____; it enables the examiner to assess the “end-feel” of the movement without performing PROM; may only be used on ___________.

Answer 20

OVERPRESSURE

AROM

PROM

PAIN-FREE AROMs

Question 21

When assessing for lesions in muscle and tendon, the examiner resists an isometric contraction with the joint in a neutral position so as to __________________.

Answer 21

**Slacken the capsule and non-contractile tissue **

Question 22

As long as no movement occurs across the joint, increased pain associated with isometric testing in neutral can be reasonably attributed to ____________.

Answer 22

Muscle or Tendon

Question 23

To test for nervous innervation of muscle, longer contractions against resistance are used (5 seconds or longer). Why is this so?

Answer 23

This is because myotomal weakness takes time to develop, and may not be evident with resistance of shorter duration.

Question 24

What are the guidelines when it comes to performing isotonic testing?

Answer 24

1. Maintain uniform resistance.
2. Test through complete range.
3. Speed of movement must be constant.
4. Resistance is opposite to direction of motion.
5. Limit movement to, and apply resistance across, one joint.
6. Fix proximal structures firmly.
7. Don’t press on muscle, belly or tendon.

Question 25

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ are used to test many conditions, orthopedists have developed complicated maneuvers which may combine AF, PR and AR. These are all designed to provoke the tissues in order to recreate the signs of symptoms of specific pathologies.

Answer 25

**SPECIAL ORTHOPEDIC TESTS**

Question 26

What are the three normal (healthy) end-feels?

Answer 26

**Bone to bone Soft-tissue approximation Tissue stretch**

Question 27

There are six abnormal end-feels, which indicate problems in tissues in or around the joint. Enumerate them.

Answer 27

**Spasm** **Boggy (a.k.a. soft capsular) Capsular Bony block Springy block Empty**

Question 28

This occurs when the movement is stopped due to pain. No mechanical resistance is felt by the examiner.

Answer 28

**Empty End-feel**

Question 29

\_\_\_\_\_\_\_\_\_\_\_\_: A firm springy resistance with a slight rebound. It occurs in an unusual place in the range and is associated with torn menisci, or loose bodies in the joint.

Answer 29

**Springy Block**

Question 30

\_\_\_\_\_\_\_\_\_\_\_\_: A hard resistance that feels like bone to bone but occurs earlier in the range than expected.

Answer 30

**Bony Block**

Question 31

\_\_\_\_\_\_\_\_\_\_: A firm springy resistance that feels like tissue stretch, but occurs earlier in the range than expected. It is associated with _____________ and is often described as leathery.

Answer 31

**Capsular** **Chronic capsular conditions**

Question 32

\_\_\_\_\_\_\_\_\_\_\_\_\_: A soft resistance throughout the range due to edema associated with \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 32

**Boggy (a.k.a. soft capsular) Acute and sub-acute inflammation**

Question 33

\_\_\_\_\_\_\_: A sudden dramatic stoppage in movement, ‘vibrant twang’. It is usually accompanied with pain, and can occur anywhere in the range.

Answer 33

**Spasm**

Question 34

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_: An unyielding hard sensation that happens quickly in the range.

Answer 34

**Bone to bone**

Question 35

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_: This softer yielding happens over a slightly longer portion of the range.

Answer 35

**Soft-tissue approximation**

Question 36

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_: There is firm springy resistance with a slight permissible movement. Progressively greater force meets greater resistance.

Answer 36

**Tissue stretch**

Question 37

The quality of tissue resistance toward passive end range is called \_\_\_\_\_\_\_\_\_. It gives information about the health of the tissues being stretched or compressed.

Answer 37

**End-feel**

Question 38

During physical examination, the examiner varies the forces by changing:

Answer 38

**The amount of ef fort Duration of application Speed of application Frequency Location Direction Type of movement which generates the force.**

Question 39

\_\_\_\_\_\_\_ movement that reproduces symptoms from a muscle lesion often has no effect when done \_\_\_\_\_\_\_\_\_\_\_.

Answer 39

**Active** **Passively**

Question 40

Myotome testing is held for minimum ___ secs. TOS testing is held for up to ___ secs.

Answer 40

**5** **60**

Question 41

To elicit pain from low-grade tendonitis, it may be necessary to ____________ contractions as a way to vary force by the examiner.

Answer 41

**Repeated Resisted**

Question 42

\_\_\_\_\_\_\_\_\_\_\_ must be used to carefully provoke the client’s symptoms, but _____________ may cause further damage and must be avoided.

Answer 42

**Sufficient force** **Excessive force**

Question 43

For both active and passive movements the following responses should be noted:

Answer 43

Where during the range of motion the pain begins. How the motion affects its quality and intensity. The pain distribution. The client’s reaction.

Question 44

For resisted isometric contractions the therapist would note from the response accordingly:

Answer 44

The positions of resistance which reproduce the pain. How the strength of contraction affects its quality and intensity. The pain distribution. The client’s reaction.

Question 45

\_\_\_\_\_\_ evoked in response to the test forces will vary in quality according to the tissue which is inflamed, and may exhibit classic patterns of distribution.

Answer 45

**Pain**

Question 46

**TRUE or FALSE:** When a lesion affects the entire capsule, most movements will equally be limited eventually.

Answer 46

**FALSE.** (It is incorrect to state that all movements are affected ‘equally’ in a capsular pattern of restriction).

Question 47

In a chronic capsular lesion of the glenohumeral joint, \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ will be lost first. As the capsule degenerates further, ___________ will be lost. This pattern of limitation constitutes the ‘capsular pattern of restriction’ for the glenohumeral joint.

Answer 47

**Lateral Rotation and Abduction** **Medial Rotation**

Question 48

When an inflammatory process affects an entire joint capsule, ____________ movements become ___________ in the same pattern.

Answer 48

**Active and passive** **Restricted (or limited)**

Question 49

All joints have two main positions associated with joint capsule tension. What are the proper terms for these positions?

Answer 49

**Closed or tight packed positions** **Open or loose packed positions**

Question 50

\_\_\_\_\_\_\_\_\_\_\_ - any position that is not closed, the joint capsule is the most relaxed, resting position is often a loose packed position and therefore the position that is sought after when there is effusion. Joint play is _________ in this position.

Answer 50

**Open-packed position** **Increased**

Question 51

\_\_\_\_\_\_\_\_\_\_\_\_ position is achieved when articular surfaces are in maximum contact with each other, capsule and most ligaments are taut, joint surfaces are not easily separated.

Answer 51

**Closed pack**

Question 52

The two positions (of joint capsule tension) are usually _________________ eg. if flexion creates a tight packed position then extension would create \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 52

Directly **opposite** of each other **Loose packed position**

Question 53

TRUE or FALSE: In Testing, always test the NORMAL SIDE FIRST.

Answer 53

**TRUE.** Unless simultaneous comparison is required or applicable.

Question 54

In any region, the order of testing is usually: \_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 54

**ACTIVE PASSIVE RESISTED** **SPECIAL ORTHOPEDIC TESTS** – if required. **NEUROLOGICAL TESTING** – if required.

Question 55

When testing for lesions in contractile tissue RESISTED ISOMETRICS MUST BE DONE WITH THE JOINT IN _________ POSITION.

Answer 55

**Neutral**

Question 56

The assessment procedure is performed in four steps. These are \_\_\_\_\_, \_\_\_\_\_\_, \_\_\_\_\_\_, and \_\_\_\_\_\_.

Answer 56

* *History, Observation, Examination** and * *Plan** (The same four steps are sometimes named ‘subjective’, ‘objective’, ‘action’, and ‘plan’ and abbreviated as the acronym SOAP.)

Question 57

The \_\_\_\_\_\_\_ solicits written/verbal information about the client’s specific complaint(s) and general state of health and therefore is subjective.

Answer 57

**History**

Question 58

\_\_\_\_\_\_\_\_ adds information obtained by visual inspection of the client standing (postural analysis) and walking (gait analysis).

Answer 58

**Observation**

Question 59

The \_\_\_\_\_\_\_ identifies the etiology of the complaint, proposed methods of treatment and expected outcomes within a time frame and should be explained to the client after the assessment.

Answer 59

**Plan**