Download Intro to Evaluation Process Handout

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Chapter 1 Handout
Below is a series of charts and pictures that will aid in the understanding of palpation,
MMT’s and end-feels.
Possible Causes of Changes in Tissue Density with Palpation
Tissue Feel
Possible Cause
Spongy, boggy over a joint Synovitis
Hard, warm
Blood accumulation
Dense Thickening
Scar tissue formation
Dense/viscous
Pitting edema
Increased muscle tone
Muscle spasm/hypertrophy
Hard
Bone or bony outgrowth
(exostosis)
Grading System and Instructions for Manual Muscle Testing
Verbal Numerical Clinical Finding
Normal 5/5
Patient can resist against maximal pressure. Unable to break
Good
4/5
Patient can resist against moderate pressure.
Fair
3/5
Patient can move the body part against gravity thru full ROM
Poor
2/5
Patient can move in gravity-eliminated position thru full ROM
Trace
1/5
The patient cannot produce movement, but a contract is felt
Zero
0/5
No contraction is felt
Patient positioning: Position the patient so that the muscle(s) being tested must work
against gravity.
Evaluative procedure:
1. Provide stabilization proximal to the joint to isolate the joint to the
motion/muscle(s) being tested. Do not apply resistance yet.
2. Instruct the patient to perform the requested motion, such as elbow flexion
with the forearm supinated.
3. While the patient is attempting the motion, palpate the muscle(s) to ensure
contraction is occurring.
4. If the patient is able to complete the ROM against gravity, a starting grade of
“fair” or “3/5” is given.
5. Position the joint in the mid-ROM and apply resistance. Instruct the patient
“Don’t let me move you.” Gradually increase the resistance.
6. Apply resistance as far away as possible from the target joint without crossing
the distal joint.
7. Grade as needed based on the table above.
Normal End-Feels to PROM
End-Feels Structure
Soft
Soft tissue approximation
Firm
Muscle, capsular, ligamentous
Hard
Bone on bone
Example
Knee flexion (contact of the soft tissues)
Hamstring stretch, extension of fingers
Elbow extension
Abnormal End-Feels to PROM
End-Feels Description
Soft
Occurs in joint that normally has firm or hard
end-feel.
Firm
Occurs in a joint that normally has a soft or
hard end-feel
Hard
Feels like a bony block
Spasm
Motion is stopped due to muscle contraction
Empty
No resistance felt except for patient’s
protective muscle guarding
Example
Soft tissue edema
Increase in muscle, capsular
or muscle shortening
Loose bodies, fracture
Inflammation, Strain
Sprain, bursa, fracture
Grading System for Ligamentous Laxity
Grade Ligament endfeel Damage
Slight stretching of the ligament with little, if any, tearing of the
I
Firm (normal)
II
Soft
III
Empty
fibers. Pain is present, but the degree of laxity roughly compares with
that of opposite extremity
Partial tearing of the fibers. There is increased play of the joint
surfaces upon each other or the joint “opens up” when compared to
opposite side
Complete tearing of the ligament. The motion is excessive and
becomes restricted by other joint structures, such as muscle or tendon.