Lab Class 5

Learning Objectives

By the end of this week:

  • You will be able to examine the hip joint for active and passive range of motion as well as resisted istometric testing.

  • You will be able to select appropriate muscle length tests for several muscles around the hip joint.

  • You will be able to judge the Nijmegen Gait Analysis score for the case study (Jacky Brown).

AROM, PROM and Resisted Isometric Testing

Active Range of Motion (AROM)

After you have gotten a rough idea on range of motion and muscle strength for certain movements during your functional assessment, you want to have a closer look at the range of motion in a certain joint.
Active range of motion assesses how far the patient can move in a joint by use of his own muscles. You will write down the outcome of your assessment for each movement in the lower left box of the RPS form under body functions.
Remember to start with the unaffected leg first and to compare the AROM with the affected side. Make sure to have the norm values for AROM of the respective joint in the back of your mind and compare them to your findings.
In most cases, if AROM is limited, this means that a muscle structure (either the agonist or the antagonist) is restricting the ROM. (e.g. lack of muscle strength, passive insufficiency, trigger points etc.).
In the coming weeks, you will find videos on how to perform AROM testing for the hip, knee and ankle joint.

Passive Range of Motion (PROM)

After AROM you want to assess the range of motion without the help of the patient's muscles. This is done during passive range of motion (PROM) assessment.
The goal of passive range of motion is to check for the end-feel in every movement of the joint and to see if it is normal.
Have a look at the following table to learn which "end-feels" are normal and which ones are pathological:

Endfeel Characteristics

Resisted Isometric Testing

During Resisted Isometric Testing (RIT), your goal is to assess whether muscles are the affected structure. The build-up of tension during RIT can be viewed as a provocative test for soft tissues.

 

In the coming lab classes you will find videos on how to perform AROM, PROM and Resisted Isometric testing for the hip, knee and ankle joint.

 

Tasks:

1) Complete the RPS form for the case of Mrs. Brown. Therefore, enter following (suspected) outcomes of following items in the correct box of the RPS:
- AROM
- PROM
- Outcomes of your functional assessment
- Nijmegen Gait Analysis score
- Trendelenburg Sign outcome

You will find a link to our example solution next week!

2) Take a look at the table of different end-feels and test these different end-feels with your classmate for the following movements: elbow extension, knee flexion, finger extension.
This will help you distinguish the feel of different healthy end-feels.

Preparation for next week:

1) Look up the standard values for range of motion of the hip joint!

2) Mrs. Brown shows a typical capsular pattern of the hip due to her osteoarthritis. Look up the definition of  "capsular pattern" and how the specific capsular pattern of the hip looks like. How much range of motion in each direction do you expect in Mrs. Brown's right hip joint?