Assessment of contractile & inert tissues for physiotherapy students

1. Dr Sreeraj S R

2. Sreeraj S R
Musculoskeletal Assessment
◦ Patient history
◦ Observation
◦ Clinical examination
◦ Palpation
◦ Special tests
◦ Reflexes and cutaneous distribution
◦ Diagnostic imaging
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3. Sreeraj S R
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”
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4. Sreeraj S R
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.
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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
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6. Sreeraj S R
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.
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7. Sreeraj S R
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.
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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. Sreeraj S R
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. Sreeraj S R
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. Sreeraj S R
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. Sreeraj S R
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.

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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

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