OBJECTIVE ASSESSMENT

OBJECTIVE ASSESSMENT

Following the subjective assessment it is important to highlight the main findings and determine the SIN factor. A hypothesis may be reached as to the cause of the patient’s symptoms and the testing procedures are performed in order to support or refute the physiotherapist’s hypothesis.

General observation

Observe the person’s gait and general demeanour on entering the department.

Local observation

Note any localised swelling at the joint. This may be measured with a tape measure around the joint or limb circumference. Note any asymmetry of joint contours, redness of the overlying skin suggesting local inflammation, atrophy and asymmetry of musculature, deformity, and malalignment

of the joint or joints. Compare one joint closely with the other side whenever possible.

Posture

Observe any asymmetry of posture in standing, walking and sitting. Poor posture is frequently a precursor to muscle imbalance, selective tightness and weakness through over- or under-use of specific muscles. The result

of prolonged poor postural habits may lead to an acceleration of certain pathologies such as adhesive capsulitis, shoulder impingement syndrome, spinal pain and arthritis. Poor posture is frequently the cause of aches and pains and may be correctable in the early stages and improved in later stages. Correction may prevent recurrence or acceleration of specific pathologies.

Palpation

Palpate for the following:

tenderness;

heat (use the back of your hand – it is more sensitive to heat changes);

swelling;

muscle spasm.

Assessment of movement

Active movements

These are movements performed by the patient’s voluntary

muscular effort.

Passive movements

These are movements performed by an external source, such as the physiotherapist or a pulley system. There are two types of passive movements.

Physiological movements are movements that could be performed actively by the patient (e.g. flexion of the knee or abduction of the shoulder joint).

Accessory movements cannot be performed actively by the patient (e.g. they incorporate glide, roll or spin movements that occur in combination as part of normal physiological movements). An example of an accessory movement is an anterior–posterior glide at the knee joint.

Resisted movements

These are performed against the resistance of the physiotherapist or weights by the patient’s own effort. Assessment of range of movement

Measurement of joint range using a goniometer

Active movement may be assessed by the use of a goniometer or, alternatively, by visual estimation. It is measured in degrees and it is useful to practise using the goniometer by measuring the hip, knee and ankle joints

in various positions. Either the 360° or 180° universal goniometers may be used. Ensure adequate stabilization of adjacent joints prior to taking the measurements and locate the appropriate anatomical landmarks as accurately as possible. For details on specific joint measurements using the goniometer, refer to the appropriate joint assessment. Physiological and accessory passive movements are measured in terms of the above and by the end-feel respectively.

Differentiation tests

If a lesion is situated within a non-contractile structure such as ligament, then both the active and passive movements will be painful and/or restricted in the same direction. For example, both the active and passive movement

of inversion will produce pain in the case of a sprained lateral ankle ligament. However, if a lesion is within a contractile tissue such as a muscle, then the active and passive movements will be painful and/or restricted in

opposite directions (Cyriax 1982). For example, a ruptured quadriceps muscle will be painful on passive knee flexion (stretch) and resisted knee extension (contraction).

End-feel

During passive movements, the end-feel is noted. Different joints and different pathologies have different endfeels. The quality of the resistance felt at the end of range has been categorised by Cyriax (1982). For example:

bony block to movement or a hard feel is characteristic of arthritic joints;

an empty feel, or no resistance offered at the end of range, may be a result of severe pain associated with infection, active inflammation or a tumour;

a springy block is characterised by a rebound feel at the end of range and is associated with a torn meniscus blocking knee extension;

spasm is experienced as a sudden, relatively hard feel associated with muscle guarding;

a capsular feel shows a hardish arrest of movement.

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