BASIC ORTHOPEDIC ASSESSMENT Muscle and Joint Testing The following tests are for the purpose of determining relative shortening, restriction or bind of muscle tissues. In this context the term bind in a muscle is synonymous with the feeling of restriction felt when a shortened hypertonic muscle reaches it s end range of motion (ROM). The term ease is used as the opposite of bind. One tool for determining this is to use a listening hand palpating the muscle(s) being tested. As the muscle/joint is tested this hand lightly palpates to feel or listen for the muscles end range ROM. The following directions are used describing the following: Client Position = The clients position on or off the table as well as any directions needed subsequent to beginning the test Test Protocol = Description of the test to be performed Results = Explanations of the possible test results The results are listed as: a positive (+) test meaning there is a sensation of bind prior to the muscle reaching normal ROM and negative (-) test meaning full ROM is obtained w/o bind. In some cases a positive test requires further isolated muscle tests to narrow the evaluation to a muscle or muscle group. Calves Gastrocnemius/Soleus Client Position: supine legs extended 1. Cup heel (not achilles tendon) 2. Dorsiflex foot and provide slight traction 1
- foot reaches vertical w/o bind + Gastrocnemius or Soleus bind Soleus Client Position: supine with bolster under knee (flexed knee isolates soleus) 1. Cup heel (not achilles tendon) and provide slight traction 2. Dorsiflex foot + same as previous test indicates soleus bind - less bind than previous test points to shortened gastrocnemius 2
Medial Hamstrings-Semitendinosus & Semimembranosus Short Adductors- Pectineus & Adductor Brevis Client Position: supine legs extended near side of table Note: Medially or laterally rotate hip so foot is vertical Abduct leg Note- right listening hand - abduction to 45 degrees + abduction w/bind short of 45 degrees indicates medial hamstring(s) or short adductor(s) bind 45 3
Short Adductors- Pectineus & Adductor Brevis Abduct leg then slowly lower leg into 90 knee flexion (flexed knee isolates short adductors) - leg abducts further indicating bind is in medial hamstrings + leg does not abduct further indicates bind in hamstrings or adductors Psoas Client Position: sit/lean against foot of table Instruct client to interlock fingers and clasp hands on front of flexed knee. Then have them draw their knee tightly (full posterior rotation of pelvis) to their chest as you assist them to slowly rolling onto their back. 4
- upper leg 0 at hip (femur flat with table) + any degree of hip flexion indicates psoas bind or a shortened Rectus Femoris Rectus Femoris Client Position: continued from psoas test - lower leg drops straight from knee (90 flexion) + any degree of knee extension (as shown here) indicates Rectus Femoris (quadriceps) bind or possibly Tensor Fascia Lata/Iliotibial Band. You may push gently on the front of the tibia into knee flexion and note a spring action back into extension. 5
Quadriceps Client Position: prone Place one hand over sacrum and one hand fingers wrapped just superior to the anterior knee. Feel for bind with these fingers as you use your upper arm or shoulder to flex knee. - heel near or touching buttock + any ROM short of heel near buttock (as shown) Rectus Femoris Client Position: continued from Quadriceps test With leg in knee flexion gently raise the leg off the table (hip extension). This isolates the Rectus Femoris. - leg raises without bind + leg does not extend without bind 6
Psoas Client Position: prone Slide hand up with fingers resting on level of L1,2,3. Spread the middle and ring fingers with spinous processes between them. With knee flexed not more than 90 palpate bilaterally with these fingers as you gently lift the leg off the table (hip extension). - no anterior pull on vertebrae + fingers sink forward indicates psoas bind Hamstrings Client Position: Supine leg extended Raise leg into hip flexion - leg raises without bind to 90 hip flexion + bind short of 90 hip flexion 7
Hamstrings Client Position: Supine leg extended Bring leg into 90 hip flexion then extend at the knee - leg extends at knee 170 (as shown) + any degree of extension short of 170 indicates bind in hamstrings Quadratus Lumborum Client Position: Standing Instruct client to slide one hand along the side of leg as they sidebend trunk. Repeat on the other side. - fingertips reach knee or past + fingertips stop short of knee indicates bind in opposite L 8