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SHS.405.Lec.04

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33 views

SHS.405.Lec.04

Uploaded by

muhammad.fasih
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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MANUAL THERAPY

[SHS.405]
M AMMAR AKBAR
PHYSIOTHERAPIST
CONTENT
 Pathological end feels

 Elements of function testing

 Active and passive rotatoric movements

 Translatoric joint play tests

 Resisted movements

 Passive soft tissue movements

 Additional test
PATHOLOGICAL END-FEEL
A pathological end-feel is one that occurs at
another place and is of another quality than
is characteristic for the joint being tested.

 Scar tissue imparts a firmer, less elastic


end-feel.
 Muscle spasm produces a more elastic and

less soft end-feel.


 Shortened connective tissue (for

example, fascia, capsules, ligaments) gives a


firmer, less elastic end-feel
PATHOLOGICAL END-FEEL
 Boggy end feel:
Intra-articular swelling produces a soft
resistance just before or instead of the
movement's usual end-feel.

 Some end-feels are characteristic of specific


pathologies and are usually tested with
rotation bone movements. E.g. a displaced
meniscus can impart a Springy end feel.
PATHOLOGICAL END-FEEL
 The patient may guard against end-feel
testing or ask that the movement be
discontinued before you reach their "true"
end feel. This is called an empty end-feel.

 Empty end-feel is a response to severe pain


or muscle spasm secondary to conditions
such as fractures. or acute inflammatory
processes
• ELEMENTS OF FUNCTION
TESTING
ELEMENTS OF FUNCTION TESTING
Active rotatoric movements:
 provide a general indication of the location and
type of dysfunction as well as its severity.

 active movements stress both joints and soft


tissue.

Passive rotatoric movements:


 provide additional information by allowing you to
feel the quality of movement and end-feel.

 Passive movements are normally greater than


the corresponding active movements.
ELEMENTS OF FUNCTION TESTING
 There are two general categories of active
and passive rotatoric joint movements:
 Standard (anatomical) movements

 Combined (functional) movements


Painful arc:
“Pain occurring anywhere in the range of
active and/or passive movement which is
preceded and followed by no pain”
 implies that a pain-sensitive tissue is being

squeezed between hard structures.


ELEMENTS OF FUNCTION TESTING
Capsular pattern:
“entire capsule is shortened”
 A capsular pattern is usually present when

the entire capsule is affected (e.g.,


inflammatory arthritic conditions).

 Only one part of a capsule may be shortened


due to trauma, surgery, inactivity, or some
other localized lesion of the capsule.
DIFFERENTIATING ARTICULAR AND
EXTRA-ARTICULAR DYSFUNCTION
 Cyriax provides one model for distinguishing
contractile (muscle) lesion from noncontractile
(e.g., joint) lesions:

Noncontractile Dysfunction
 » Active and passive movements produce or

increase symptoms and are restricted in the same


direction and at the same point in the range.

 Passive joint play movements produce or increase


symptoms and are restricted.

 Resisted movements are symptom free.


DIFFERENTIATING ARTICULAR
AND EXTRA-ARTICULAR
DYSFUNCTION
Contractile Dysfunction
 » Active and passive movements produce or

increase symptoms and are restricted in


opposite directions.

 » Passive joint play movements are normal


and symptom free.

 » Resisted movements produce or increase


symptoms.
DIFFERENTIATING MUSCLE
SHORTENING FROM MUSCLE
SPASM
‘Shortened, tight muscle imparts a firmer,
less elastic end-feel’

‘Muscle spasm produces a more elastic


and less soft end-feel’
RESISTED MOVEMENTS
 Resisted tests simultaneously evaluate
neuromuscular integrity, the contractile
elements, and, indirectly, the status of
associated joints, nerves, and vascular
supplies.

 Cyriax interprets resisted tests in the


following ways:
RESISTED MOVEMENTS
DIFFERENTIAL DIAGNOSIS FOR
PAIN IN A MUSCLE SYNERGY
Testing a muscle's secondary function in
the same joint

 If one muscle in a joint movement synergy


has a secondary function not shared by the
other muscles in the synergy, it can be
selectively tested.
DIFFERENTIAL DIAGNOSIS FOR
PAIN IN A MUSCLE SYNERGY
Testing a muscle's secondary function at
an adjacent joint

 A muscle or tendon can be selectively


stressed if it is the only muscle in a synergy
which functions at another joint.
PASSIVE SOFT TISSUE
MOVEMENTS
 Soft tissues are examined similarly to joints,
using passive movements to assess the
quantity and quality of movement and pain.

Physiological movements (muscle length


and end-feel)

 Test soft tissue length and end-feel by


moving a limb so that muscle attachments
are moved maximally apart.
ACCESSORY SOFT TISSUE
MOVEMENTS
 Examination of accessory soft tissue
movement tests:

 Elasticity

 Mobility

 Texture of soft tissues.


Thank You

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