Functional Anatomy 2

Functional Anatomy
Describe the clinical procedure for testing contractile tissue.
These structures are tested through maximal contraction of the muscle against resistance. The movement is performed isometrically where the applied tension that causes pain falls on the muscle and the structures attached to it (Oliver, 56).
List 2 contractile tissues.
1. Muscle-bone attachment (origin)
2. Tenoperiosteal junction (insertion)
Describe the clinical procedure for testing inert tissue.
These are tested only by passive stretching and squeezing.
Define inert tissue and list 6 examples of inert tissue.
These tissues do not possess the capacity to contract and relax examples include:
1. Joint capsules
2. Peripheral nerves
3. Aponeuroses
4. Ligaments
5. Dural sleeve of the nerve root
6. Bursae
List 5 reasons why AROM may be noted as abnormal, and how you would describe each:
1. Muscle spasm
2. Muscle deficiency
3. Neurologic deficit,
4. Contractures
5. Pain
Describe in your words, why it is important for a clinician to note whether pain or loss of movement is the primary limiting factor for a client’s inability to perform full Active Range of Motion (AROM) or Passive Range of Motion (PROM). For example, your client is unable to lift their arm over their head. Why is it important to know if the limitation in their arm is from pain or loss of motion? How does this affect the rest of your assessment?
Pain is the main complaint from the patient, and it is plausible that some movement may result in pain in some areas while some test may lead to pain in another region.

The patient may recognize one of these as the presenting symptoms hence the physician should concentrate on this pain alone. If pain presents before the termination of ROM, it may be an indicator of acute injury hence manipulation and stretching of the joint are contraindicated (Watkins 234). Where pain results simultaneously at the end of ROM it may be a sign of a subacute injury leading to the mild stretching program being started with caution. Where no pain is available when ROM is stretched, then a chronic injury may be present, and the ideal treatment and rehabilitation plan should be started immediately.
If PROM is abnormal, what is a hypermobile joint more susceptible to?
Where a hyper mobile joint stirs up a patients’ symptoms; it is the best criterion that shows where the lesion lies. Where the abnormal mobility does not stir up known symptoms; the problem is not related to the hypermobile joint. Hypermobility that raises symptoms is considered pathological where the phrase ‘instability’ and ‘laxity’ are used (Jenkins 89).
What are 4 causes of hypomobility?
1. The shape or depth of the sockets of the joint
2. The strength or tone of the muscle
3. Poor ability to sense how far one is stretching, i.e., proprioception
4. Family history of hypermobility
Define Myofascial Hypomobility-
This is pain that affects movement in the upper trapezius, levator scapulae, and sternocleidomastoid muscles.
Define Pericapsular Hypomobility-
Muscle pain caused by ligamentous or capsular shortening that leads to a capsular pattern of restriction that does not showcase the constant length observable fact.
Describe in your words, why abnormal contractile tissue testing will have painful active movement in one direction (contraction) and painful passive stretch toward the end range in the other direction:
This is because the test in one direction stretches the noncontractile tissues resulting in pain. Where a bone close to the tissue a tendinous insertion is affected, pain also results in a pull of the muscle. A contraction may also squeeze the underlying g structure, e.g, bursa or lymphatic gland, and if they are inflamed, squeezing results into pain. This is also true to a disorder that is bordering a muscle.
Define the 4 classic patterns identified with lesions of inert tissue
1. No ROM restriction & pain-free:
No lesion of the contractile tissue
2. Painful with limitations in every direction:
It indicates a localized lesion of the muscle that is contracting, e.g, tendonitis.
3. Painful with abnormal ROM in some but not all directions:
May indicate a muscle rupture or a lack of integrity on the nerve supply to the muscle
4. Limited ROM that is pain-free:
Severe lesion around a joint for example dislocation
Define the 4 classic patterns identified with lesions of contractile and nervous tissue.
1. Strong & pain-free:
It is a Normal strength with no pain which is a negative resisted movement where a lesion of a contractile tissue is excluded. For this scenario, there is no reason to incriminate the muscle as the pain and tenderness are clearly referred to in most cases from the cervical spine.
2. Strong & painful:
Resisted motion results into pain and the individual are able to exert normal strength. The condition is a minor lesion of a contractible structure, e.g, muscle strain.
3. Weak & painful:
The individual is either in constant pain or is pain-free, and testing against resistance even though is weak fails to elicit or change the pain. Usually caused by a nervous condition that is either intrinsic or extrinsic and depends on the severity of the lesion that varies from moderate to complete paralysis
4. Weak and pain-free
This suggests a major lesion where the motion is painful with reduced strength either because muscle use causes pain or the muscle is performing poorly hindering full contraction. Occurs in serious disorders with particular signs, e.g, metastases or fracture.
Define:
Closed- Packed Position:
This is a position where two joint surfaces fit precisely together. In contrast, a close-packed position is a position in which two joint surfaces fit precisely together.
Loose-Packed (Resting) Position:
It occurs where the existence of accessory movements can be verified through manipulation of the joint in a position that releases the least pain. It is the position in ROM where the joint is experiencing the least amount of stress while having the greatest capacity.
When would you want to position a patient in a closed packed vs. an open packed position and vice versa?
Testing of motion in the loosely packed position has the advantage of reducing the joint surface area while enhancing proper joint lubrication. This decreases the erosion and friction of the joints. With an injury, pain is increased as the joint moves to close-packed position, and when a swelling is present, the close-packed position cannot be achieved (Oliver 67).
What are the contraindications/precautions to PROM?
When performing PROM, the individual position should allow for muscle relaxation. Also, any potential painful movements should be done last to avoid the carrying over of pain from one movement to the next.
What are the contraindications/precautions to AROM?
AROM should always be performed before PROM unless contraindicated. The patient’s willingness to perform a movement should be assessed, and the extent of movement plus the fluidity of the movement should be factored in.
What are the contraindications/precautions for muscle testing?
The examiner should recognize the sequence of signs that belong to a particular pathological disorder likely to be found in sequence typical to that disorder. Each tissue and ought to be tested and interpreted in terms of anatomical possibility while palpitation should be avoided as much as possible. The physiological movement is thus encouraged always with the distinction between inert and contractile muscles. The examiner should concentrate on the patient’s pain with patient’s cooperation that is important hence the need to factor in the patient’s personality. The technical investigation should only be requested when necessary to avoid substituting ‘looking’ for ‘thinking’ (Watkins 256).
When is MMT most reliable and sensitive?
It is mainly used to treat motion impairments that cause pain and reduced the degree of motion.
List 5 simple things therapists can do to increase the reliability of the MMT assessment.
1. Use of common sense approach when dealing with patient
2. Apply use of technique selection combined with;
3. A verified and sufficient orthopedic diagnostic skills
4. Previous experience is important as it establishes a consistent course to response i.e. learned expectancy
5. The examiners/physicians positive interaction and relationship with the patient.
Conventional grading of Manual muscle test
Manual muscle test is recorded as numerical scores that range from 0 (no activity) to five (normal response) to the test evaluated through manual muscle test. Each numerical test is paired with a word that defines the test performance quantitatively.
Score Definition Explanation
Grade 0- No muscle contraction
Muscle is completely quiescent on palpation or visual inspection.
Grade 1
Flicker of contraction The examiner can detect visually or by palpation some contractile activity in one or more of the muscles that participate in the movement being tested.
Grade 2 Full array of movement in gravity eliminated level surface. The individual is able to finish a variety of movement in a position that minimizes the force of gravity. This position often is described as the horizontal plane of motion.
Grade 3- Full array of movement against gravity
This grade of muscle test is anchored on the premise of an objective measure of the individual’s capability to finish a variety of movement against gravity.
Grade 4 Full array of movement in opposition to gravity with partially maximal opposition
The individual has the capacity to finish a variety of movement against gravity and is capable of tolerating physically powerful resistance without flouting the test arrangement
Grade 5-
Full range of motion against gravity with maximal resistance The patient has an ability to complete a full range of motion or maintains end-point range against gravity and maximal resistance.
Source: (Schlossberg, Leon, and Zuidema 67).
Define substitution as it applies to muscle testing, and outline how a therapist can prevent this:
Substitution is when a muscle is paralyzed or weak, and gravity or other muscle take over and perform the movement that is normally performed by the weak muscles.
Why does a therapist palpate the muscle/ tendon that they are testing?
Palpitation is done through standard techniques to assess an illness or a health condition to determine the possibility of cartilaginous fragments, fractures or crepitus. Palpation gives information relating to several physical findings that range from deformity, pulse, temperature, swelling among others (Oliver 123).
Are there some diagnoses/conditions that would make MMT unreliable due to substitutions that cannot be prevented?
MMT is contraindicated where the movement impairment is as a result of excessive joint mobility or caused by a shortened or weakened muscles. In this case, soft tissue techniques should be used. It also does not permit for the concomitant treatment of several patients.
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Jenkins, David B. Hollinshead’s Functional Anatomy of the Limbs and Back. St. Louis, Mo: Saunders/Elsevier, 2009. Internet resource.
Oliver, Jean. Functional Anatomy of the Spine. Oxford: Butterworth-Heinemann, 1997. Print.
Schlossberg, Leon, and George D. Zuidema. The Johns Hopkins Atlas of Human Functional Anatomy. Baltimore: Johns Hopkins University Press, 1997. Print.
Watkins, James. Pocket Podiatry. Edinburgh: Churchill-Livingstone, 2009. Print.