Movement

Some joints, such as the subtalar joint of the hindfoot. which have limited movement, are most easily examined passively. Relatively immobile joints, including sternoclavicular, acromioclavicular, manubriosternal, costocbondral and sacroiliac joints, have to be examined by palpation or stressing manoeuvres to eticit pain.

The neutral zero method of recording movement is recommended. All joints are considered to be in the neutral position when the body is in the classical anatomical position, with two exceptions, namely the hands are Hat against the thighs in the sagittal plane and the feet are at right angles to the leg (Fig. 8.2).

A goniometer (Fig. 8.3) is helpful to assess joint movement or deformity and its response to therapy, particularly in the knee, hip and elbow. Quite wide individual variations in the normal range of movement are found with age.

A Movement in one direction from neulral

A Movement in one direction from neulral

Dorsiflexion

Dorsiflexion

Gait Angle Knee Joint Movement

Palmarflexion

Neutral position Fig. 8.2 Measuring movements of joints.

Palmarflexion

B Movement in both directions from neutral

Goniometer Dorsiflexion
Flg. B.3 Goniometer.

Examination sequence

O Inspect for swelling, local muscle wasting, skin changes and joint deformities.

□ Palpate the joint to identify sites of warmth and tenderness and distinguish fluid and soft tissue swelling from bony swelling.

□ Use one hand to feel for crepitus or clicks during active movement of the joint.

□ Whenever possible, compare the affected joint with the patient's other limb acting as a 'normal control'.

□ Measure any restriction of movement.

□ Assess the patient's gait and if abnormal determine whether it is painful (antalgic) or painless.

Movementy Sequences

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