We thrive on participating in and completing many different activities which to a large extent depend on the condition of our body joints, from the large joints of locomotion (hips, knees) to the small joints such as the temporo-mandibular for speaking and eating. Our well-designed and durable joints do a very good job of allowing us to get about and involve ourselves in activity. Damage to our joints can be the result of disease, illness or trauma and this can restrict our mobility and reduce our functional capacity. Joint examination is a core ability of physiotherapists, consisting of a logical assessment, testing to find an abnormality and targeting of the treatment plan to these problems.
A joint is a junction between two bones and in the body our joints have different functions such as force transmission, weight bearing and movement. The symphysis pubis and acromioclavicular joints are examples of force transmission joints, the back is mostly a weight bearing series of joints and the shoulders and knees have to do with movement. The joints we are most familiar with are the synovial joints, the most common type and these have a cartilage lining over the bone ends, synovial fluid secreted by the joint lining and have ligamentous structures surrounding the joint to support its function.
Moving on from the relatively quick visual joint assessment the physiotherapist will start to palpate round the joint structures. This systematic manual examination allows the physiotherapist to clarify which parts of the anatomy are involved in the problem. The typical areas tested will be the ligaments, the areas where the tendons and ligaments insert to the bone, the joint line itself and around the margins of the joint. Any fluid in the knee, called an effusion, can be identified as it moves about if it is thin, it is very firm if the swelling is tight and it is thick and deformable if the swelling is older and stickier.
Assessment of the active joint ranges of motion is routinely recorded by the physiotherapist, who also records why the joint range is not full and states the results in degrees or as a proportion of normal. The physio then tests the passive joint ranges, with the patient relaxing the joint, to see if there are restrictions or pain with this technique. If the patient cant move their joint through its full range but the physiotherapist can then muscular weakness or pain is the likely limiting reason. If the patients own movement is limited and the physio can get no more on testing, then stiffness of the joint and/or pain may be involved.
Passive testing of the joint ligaments is an important part of physiotherapy examination as the ligaments are integral to normal joint function. Ligaments should take the full stress of a persons strength in most major joints without any pain or other problems. Systematically testing the ligaments can identify an injured, painful, stretched or absent ligamentous structure. Muscle testing is done using the Oxford scale of 0-5, taking into account that pain and anxiety may change the muscular force a patient is able or willing to exert. Sensibility and joint position testing can be useful to see if the brain is receiving the correct feedback information it needs from the joint to plan effective and safe movement.
Ligaments are very important for normal function of a joint and the physiotherapist will routinely test their integrity, stressing them strongly by manual testing. The ligaments of major joints are very strong and testing a normal ligament should show no effect but it can uncover an absent, painful or stretched ligament by its effect on joint stability. Physios use the Oxford 0-5 scale to grade muscle strength, allowing for anxiety or pain which might interfere with a patients effort. Proprioception and joint sensibility may also be tested to ascertain if good feedback from the joint to the brain is present, this being important in normal movement planning.
A joint is a junction between two bones and in the body our joints have different functions such as force transmission, weight bearing and movement. The symphysis pubis and acromioclavicular joints are examples of force transmission joints, the back is mostly a weight bearing series of joints and the shoulders and knees have to do with movement. The joints we are most familiar with are the synovial joints, the most common type and these have a cartilage lining over the bone ends, synovial fluid secreted by the joint lining and have ligamentous structures surrounding the joint to support its function.
Moving on from the relatively quick visual joint assessment the physiotherapist will start to palpate round the joint structures. This systematic manual examination allows the physiotherapist to clarify which parts of the anatomy are involved in the problem. The typical areas tested will be the ligaments, the areas where the tendons and ligaments insert to the bone, the joint line itself and around the margins of the joint. Any fluid in the knee, called an effusion, can be identified as it moves about if it is thin, it is very firm if the swelling is tight and it is thick and deformable if the swelling is older and stickier.
Assessment of the active joint ranges of motion is routinely recorded by the physiotherapist, who also records why the joint range is not full and states the results in degrees or as a proportion of normal. The physio then tests the passive joint ranges, with the patient relaxing the joint, to see if there are restrictions or pain with this technique. If the patient cant move their joint through its full range but the physiotherapist can then muscular weakness or pain is the likely limiting reason. If the patients own movement is limited and the physio can get no more on testing, then stiffness of the joint and/or pain may be involved.
Passive testing of the joint ligaments is an important part of physiotherapy examination as the ligaments are integral to normal joint function. Ligaments should take the full stress of a persons strength in most major joints without any pain or other problems. Systematically testing the ligaments can identify an injured, painful, stretched or absent ligamentous structure. Muscle testing is done using the Oxford scale of 0-5, taking into account that pain and anxiety may change the muscular force a patient is able or willing to exert. Sensibility and joint position testing can be useful to see if the brain is receiving the correct feedback information it needs from the joint to plan effective and safe movement.
Ligaments are very important for normal function of a joint and the physiotherapist will routinely test their integrity, stressing them strongly by manual testing. The ligaments of major joints are very strong and testing a normal ligament should show no effect but it can uncover an absent, painful or stretched ligament by its effect on joint stability. Physios use the Oxford 0-5 scale to grade muscle strength, allowing for anxiety or pain which might interfere with a patients effort. Proprioception and joint sensibility may also be tested to ascertain if good feedback from the joint to the brain is present, this being important in normal movement planning.
About the Author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Cambridge or elsewhere in the UK.
0 comments:
Post a Comment