Assessment of contractile & inert tissues

Assessment of contractile & inert tissues for physiotherapy students

1. Assessment of soft tissue Contractile & Non contractile tissues Dr Sreeraj S R

2. Musculoskeletal Assessment Patient history Observation Clinical examination Palpation Special tests Reflexes and cutaneous distribution Diagnostic imaging 2

3. Clinical examination Is all about behaviour of the tissues involved. Tissue behaviour is described by the patient during the inquiry and checked by the examiner during the functional examination. Look for ‘inherent likelihoods’ The principle of ‘selective tension” 3

4. Selective Tissue Tension Testing The possibility of making a diagnosis by selective tension depends largely on the characteristics of each tissue and on its capacity either to contract or to become stretched. Muscles and tendons may be stressed by isometric contraction of the muscle or by passive stretching in the opposite direction. By contrast, ligaments and joint capsules can be put under tension by passive stretch. 4

5. Distinguish between tissue types Contractile tissues The complex of: Muscle–bone attachment Muscle belly Musculotendinous junction Body of tendon Tenoperiosteal junction The bone adjacent to the attachment of the tendon Inert tissues Joint capsules Ligaments Bursae Aponeuroses Dural sleeve of the nerve root Peripheral nerves 5

6. Examination of movement When doing movement testing, the examiner should note whether pain or restriction predominate. If pain predominates, the condition is more acute, and gentler assessment and treatment are required. If restriction predominates, the condition is subacute, or chronic, and more vigorous assessment and treatment can be performed. It consists of; Active range-of-motion testing, passive range-of-motion testing, and midrange isometric resistance testing. 6

7. Active Movements Gives an idea of the willingness and ability of the patient to move the part AROM may be limited by pain, stiffness, and/or muscle weakness. AROM is also useful in identifying a painful arc or the presence of hypermobility. 7

8. Passive movements The passive movements should be full and painless (unless you are putting the contractile structure at fault on stretch) If there is a limitation of movement an inert structure is likely to be at fault Need to establish if the limitation of movement is in a capsular or non-capsular pattern

9. Capsular Pattern When a joint is irritated by trauma, disease or degeneration, the inflamed capsule contracts, producing a loss of range in a set proportion. This is known as a capsular pattern. Each joint has its own capsular pattern.

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11. End feel The significance of the end feel is the degree to which it corresponds or differs from what the end feel would be if the joint were normal Different types of end-feel imply different disorders.

12. End feel Normal Hard – bone to bone Soft – tissue approximation Elastic – capsular Pathological Springy – intra-articular block Firm – Spasm Empty – pain limits movement

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15. Resisted movements If a resisted movement proves painful it is likely that structure is the source of pain. Joint should be held in mid-range so no inert structures are stretched. Muscles other than those being tested must not be included. No movement should take place at the joint. The patient should produce a maximal contraction Need to be able to detect pain +/- weakness.

16. Findings Strong & painless – Normal Strong & painful – minor lesion in muscles or tendon Weak & painless – complete rupture or nerve lesion Weak & painful – significant lesion in muscle/tendon, possible fracture

17. 17 Patient With a Suspected Soft Tissue Lesion Selective tissue tension testing (STT) Exam procedure Objective Interpretation AROM PROM Midrange isometrics To identify: Increase/decrease in symptoms Quantity of motion To identify: Increase/decrease in symptoms Nature of end feels capsular or noncapsular pattern To identify: 1. Strong and painless 2. Strong and painful 3. Weak and painful 4. Weak and painless Noncontractile, inert soft tissue lesion If positive: Normal Minor contractile OR nerve entrapment, Major contractile, bony insertion fracture Neurological impairment, full thickness tear Contractile soft tissue lesion