Joint Function Testing

Joint Function Testing

Five components to testing for dysfunction of joints (Barak et al, 1993 – ref missing):
1) Active range of motion
2) Passive range of motion
3) Pattern of restriction
4) Resisted Movements
5) Movements that are painful or have pain at one end of range of motion

Active range of motion:
Movement produced by contraction of the muscles crossing a joint.
Gives a gross indication of quantity and quality of movement that the patient can produce.

Passive range of motion:
Movement produced by an external force without voluntary muscle contraction (normally greater than active ROM).
Need to pay special attention to end range of motion feelings.

Classification of end range “feels” :
1) Normal:
a) Soft tissue approximation – soft and spongy
b) Muscular – elastic reflex with some discomfort
c) Bone on bone or cartilaginous – abrupt halt without pain
d) Capsular – firm arrest of movement
2) Abnormal:
a) Spasm – considerable pain that prevents completion of movement
b) Springy block or rebound – cartilaginous block
c) Empty – considerable pain before end range of motion – patient actively resists movement
d) Loose – accompanies extreme hypermobility

Physiological & accessory motion:
Physiological motion:
• defined as the motion of one segment relative to another
• eg dorsiflexion and plantarflexion of the hallux relative to the first metatarsal

Accessory motion:
• defined as the motion that occurs between joint surfaces
• eg gliding of base of proximal phalanx that occurs on first metatarsal head during dorsiflexion and plantarflexion
• cannot be performed independently of physiological motions

Pattern of motion restriction:
1) Capsular pattern:
If dysfunction/lesion (limitation of movement) is in joint capsule or synovial membrane  specific pattern of limitation of movment occurs – each joint has its own pattern.

Eg in glenohumerol joint – external rotation is most limited, abduction is next most limited and flexion is least limted

In foot:
• ankle joint – limitation of plantarflexion > dorsiflexion
• subtalar joint – limitation of inversion
• midtarsal joint – limitation of dorsiflexion, plantarflexion, adduction and medial rotation (lateral rotation and abduction are normal)
• first metatarsophalangeal joint – limition of dorsiflexion > plantarflexion

Retriction can be due to effusion, inflammation or fibrosis.

check Cyriax (1982)

2) Non-capsular pattern:
If limitation of movement does not follow capsular pattern  labelled as non-capsular

Three non-capsular patterns :
i) Ligamentous adhesions – usually one movement is more restricted than others
ii) Internal derangement – displacement of loose body in joint – sudden onset of pain – movements that engage against the block are limited
iii) Extra-articular limitation – from adhesions in structures outside the joint – any movement that causes a stretching of that adhesion will be limited

Resisted movements:
Clinician resists movement of patient  for information about contractile tissues and their attachments
Maintain joint in mid range and have patient do isometric contraction.
Five responses identified by Cyriax (1974):
1) Strong and painful – indicative of a minor injury to some part of muscle or tendon (eg tendonitis)
2) Weak and painless – indicative of a rupture of muscle/tendon or disruption of nerve supply to muscle
3) Weak and painful – indicative of gross lesion, eg fracture
4) All muscle about joint painful – indicative of serious disorder or psychological problem
5) All muscle painless and strong – normal

Pain:
Two classifications relevant for joint examination:
1) Painful arc – pain at one point of joint in range of movement, but disappears at end ranges. Thought to be due to pinching of tissues.
2) Pain at end range – usually caused by tight capsular or ligament structures  creates alteration in movement pattern at en range of motion  stretch and compression of structures at end range  symptoms

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