Section 2- Evaluation of Joint Dysfunction

Question 1

What are the classic components of the physical exam?

Answer 1

1) Observation 2) Palpation 3) Percussion 4) Auscultation

Question 2

What are the seven components of the physical exam of the NMS system

Answer 2

(1) Observation (2) ROM (3) Palpation (Bony and Soft Tissue) (4) Muscle testing (5) Orthopedic testing (tissue damage) (6) Neurological testing (reflexes) (7) Percussion and Auscultation

Question 3

What is the Medical/Orthopedic definition of subluxation?

Answer 3

A partial or incomplete dislocation of bones/joints

Question 4

What is the chiropractic definition of subluxation–there are 2 outlined.

Answer 4

(1) alteration of the normal dynamic, anatomic or physiological relationships of contiguous articular structures
(2) Aberrant relationship between two adjacent articular structures that may have functional/pathalogical sequelae, causing an alteration in the biomechanical or neurophysiological reflections of these articular structures. And this, may be directly or indirectly affecting them.

Question 5

ACA lean more towards __________ definition of chiropractic while ICA leans more towards the ________chiropractic philosophy

Answer 5

Mixers (ACA) and Straight (ICA)

Question 6

What is subluxation syndrome?

Answer 6

A complex clinical syndrome with potential mechanical, inflammatory, vascular and neurobiologic pathalogical effects.

Question 7

What is joint dysfunction?

Answer 7

Joint mechanism that shows disturbances of function without structural or positional change. Subtle mechanical joint alterations affection quality and range of joint motion.

Question 8

What is joint fixation?

Answer 8

The state whereby an articulation has become temporarily immobilized in a position that is may normally occupy during any phase of physiological movement.
(2) The immobilization of an articulation in a position of movement when the joint is at rest or in a position of rest when the joint is in movement.

Question 9

What is Joint restriction?.

Answer 9

It is the limitation of movement and describes the direction of limited movement in dysfunctional joints.

Question 10

What are the components of joint dysfunction/subluxation?

Answer 10

Pain, Asymmetry, ROM abnormality, Tone/Texture/Temprature, Special tests (PARTS)

Question 11

How do you assess pain in a joint dysfunction/subluxation?

Answer 11

Look at location, quality, intensity of pain

Question 12

How do you assess Asymmetry in a joint dysfunction/subluxation?

Answer 12

look at sectional or segmental variation

Question 13

How do you asses ROM abnormality?

Answer 13

Assess by motion palpation and test for increase/decrease or loss of specific movements.

Question 14

True or false: Tone/Texture/Temperature aspect of assessing subluxation mainly applies to soft tissues

Answer 14

true

Question 15

What are the three things responsible for causing joint dysfunction?

Answer 15

(1) Macrotrauma (single incident, i.e MVC)
(2) Microtrauma (repeated cumulative traumas. i.e. carpal tunnel)
(3) Posture

Question 16

What is joint dysfunction?

Answer 16

The presence of joint pathomechanics with out any further pathophysiologic process

Question 17

What is joint dysfunction and disease?

Answer 17

A causal relationship exists between the joint pathomechanics and other conditions through somatoautonomic reflexes. This is theoretical and controversial

Question 18

What are the three types of reflexes caused by joint dysfunction?

Answer 18

1) Somatosomatic reflex: a primary somatic problem causes a secondary somatic problem (eg: segmental muscle hypertonicity secondary to spinal joint dysfunction)
(2) Somatovisceral reflex: a primary somatic problem causes a secondary visceral problem. (i.e. constipation is secondary to lumbopelvic joint dysfunction)
(3) Viscerosomatic reflex: a primary visceral problem causes secondary somatic problem. eg: thoracic dysfunction secondary to gastrointestinal disease

Question 19

True or False: Joint dysfunction and disease happen codependantly with some causal relationships existing between the two.

Answer 19

False. (eg: diabetes and hypertension)

Question 20

RE: physical assessment of joint dysfunction/subluxation. What are the three components of the “observation” step?

Answer 20

1) Superficial observation: size/shape of body part. Look for swelling, appearance, bruising, moles and scars.
2) Posture
3) Gait: walking, rising from sitting, mechanics of the feet/knees/hips.

Question 21

RE: physical assessment of joint dysfunction/subluxation. What defines global range of motion?

Answer 21

the evaluation of a joint or spinal regional movement in all its ranges of movement.

Question 22

RE: physical assessment of joint dysfunction/subluxation. What are the two ways to measure ROM?

Answer 22

1) Goniometry (spine/extremities. better for extremities than joints) 2) Inclinometry (spinal motion)

Question 23

RE: physical assessment of joint dysfunction/subluxation. What is palpation?

Answer 23

The act of feeling with hands and applying variable manual pressure through the surface of the body for the purpose of determining the shape/size/consistency/position/mobility and health of the tissues

Question 24

RE: physical assessment of joint dysfunction/subluxation. What is static palpation?

Answer 24

palpatory diagnosis for somatic structures in a neutral static position.

Question 25

RE: physical assessment of joint dysfunction/subluxation. What structures can you palpate for during static palpation?

Answer 25

1) Soft Tissue (dermal layer, subdermal/functional or muscular layer for tenderness/contour/mobility) (2) Bone/cartilage (alignment/shape/attachments)

Question 26

What is Motion Palpation?

Answer 26

palpatory diagnosis of passive and active segmental joint range of motion.

Question 27

What are the objectives of motion palpation?

Answer 27

Test: 1)Quantity/Quality of joint movement. 2)Joint Play- quality of resistance 3) End feel: at what point is end feel encountered?quality? 3) symptoms- changes in the amount/location of pain.

Question 28

Define: Joint Play

Answer 28

Discrete, short range movements of joint independent the action of voluntary muscles, determined by springing each vertebrae in the neutral position.

Question 29

Define: Active ROM

Answer 29

Movement accomplished without outside assistance, patients moves the part himself

Question 30

Define: Passive ROM

Answer 30

movement which is carried through by the operator without consious assistance or resistance by the patient.

Question 31

Define Physiological Barrier

Answer 31

End point of the active joint movement

Question 32

Define End play (end feel)

Answer 32

Discrete, short range movements of a joint independent of the action of voluntary muscles, determined by springing each vertebra at the limit of its passive ROM

Question 33

Define: Elastic barrier

Answer 33

the elastic resistance that is felt at the end of passive range of movemen, further motion toward the anatomic barrier may be induced passively by the examiner.

Question 34

Define Paraphysiological space

Answer 34

area of the increased movement beyond the elastic barrier available after cavitation with the joint's elastic range (important in chiropractic...when we hear the "pop" sound)

Question 35

Define: Anatomic Limit

Answer 35

the limit of anatomical intergrity. the limit of motion imposed by anatomic structures. Forcing the movement beyond this barrier would produce tissue damage.

Question 36

Re: motion palpation. True of false: A joint's normal end play at one joint may be pathalogical at another

Answer 36

true

Question 37

Define capsular joints and give an example

Answer 37

firm but giving, resistance builts with lengthening the joint like a piece of leather. ie. external rotation of shoulder/ abnormal when scar tissue forms

Question 38

Define Ligamentous joints and give an example

Answer 38

similar to capsular but firmer. ie knee extension. abnormal when ligament is shortened and abnormal resistance occurs.

Question 39

Define: Soft tissue approximation end play

Answer 39

giving, squeezing quality results from the approximation of the soft tissue. typically painless. ie. elbow flexion. abnormal when muscle hypertrophy occurs, soft tissue swelling.

Question 40

Define bony end play

Answer 40

hard, non giving, abrupt stop. for example eblow flexion. abnormal when hypertrophic changes occur ie. arthritis

Question 41

Define musclar end play

Answer 41

firm but giving, builds with elongation, not as stiff as capsular or ligamentous. for exampleL hip flexion

Question 42

What can be palpated in normal and abnormal conditions for joint motion/end play

Answer 42

capsular, ligamentous, soft tissue approximation, bony joints and muscular joints

Question 43

What can be palpated only in abnormal coditions

Answer 43

1)muscles spasm (gaurded, resisted by muscle contraction. cannot feel end play because of pain. 2) Interacticular - bouncy stringy quality such as mescinal tears. 3) Empty - where normal end feel resistance is missing and end feel is not encountered at normal point and the joint has unsual amount of give/deformation. hypermobility

Question 44

Define: Painful arc

Answer 44

pain during the normal arc of joint motion

Question 45

Define: Capsular pattern

Answer 45

injuries or disorders of the joint capsule leading to predictable patterns of end play restrictions

Question 46

Define: Noncapsular pattern

Answer 46

injuries to only one part of the joint that doesn't follow typical capsular pattern

Question 47

Define: Hypermobility

Answer 47

joint moves too much

Question 48

Define: Hypomobility

Answer 48

joint moves too litte

Question 49

Define muscle testing

Answer 49

clinical assessment of the strength of a muscle to evaluate the integrity of muscle tissue and its nerve supply. Not in the AK sense and it has a grading system (0-5)

Question 50

What is the clinical significance of muscle testing?

Answer 50

If it is strong and painful it is indicative of minor musclotendinous lesion (primary or secondary strains). Weak and painful is indicative of partial muscolotendinous rupture (secondary strain) and painful inibition can be assocated with pathology. Weak and painless is indicative of neurological lesion and a complete muscolotendinous rupture immediately after injury (golden period).