Archive for Alternative Medicine
Physiotherapy Examination of a Joint
Posted by: | CommentsWe 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.
Observing the patient as they walk into the examination room and sit down can give the physiotherapist valuable information about the state of their joint. Slow and guarded movement is common, along with splinting of the joint and carrying it in a close and protected position to minimise joint stresses. Once the physio has taken a history they will check out the joint visually, looking for swelling, effusion, warmth or a joint deformity. If there is no obvious problem in a cool, settled joint the physiotherapist will need to stress the joint more thoroughly to find the restriction. However, a swollen, inflamed joint should be treated acutely as soon as possible.
After the visual examination the physiotherapist will palpate the joint and surrounding structures, which means exploring or stressing an area logically with the fingers or hand, an important physio skill to clarify the diagnosis. The physio will palpate around the joint margins, the joint line itself, the tendon insertions and the ligaments surrounding the joint. Effusion, which means the presence of synovial fluid in a joint, can be felt by the resistance it gives if it is tight, by its thickness and plasticity if it is sticky and by the way it can be moved around the joint if it watery.
Once the joint has been assessed visually, which takes a very short time, the physiotherapist will move on to palpation of the joint structures which will help identify which parts of the joint are affected. Palpation involves systematically feeling and stressing structures in an anatomical area to pin down faulty structures more closely. Palpation of the joint involves testing the joint line, the insertions of the tendons and ligaments, along the ligaments themselves and around the joint margins. Fluid in the joint is called an effusion and can be thick and sticky, very tight and firm if there is a lot, or movable if the fluid is thin
Normal joint function is dependent on normal ligaments and physiotherapy testing of them is routine by manual stressing. Major joint ligaments have great strength and normally should show no reaction to being stressed, however testing can reveal a stretched, painful or ruptured ligament. Muscle strength is charted on the Oxford scale of 0 to 5, although patients may not exert their strength if they are in pain or very anxious. Sensibility of the joint and joint position testing tells the physio that normal joint feedback is occurring which is vital for planning of normal movement.
The last part of the examination is to test the joint in functional activities or positions, especially if there is little to find on the more detailed examination. The physiotherapist can see how the patient is willing to use the joint and this may reveal difficulties with joint function which until then have not been clear.
