University of Scranton - Department of Physical Therapy
Edmund M. Kosmahl, PT, EdD
send e-mail to Dr. Kosmahl                    copyright 2000 Edmund M. Kosmahl

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PT351 ORTHOPAEDIC PT Dr. E. Kosmahl EXAMINATION OF SOFT TISSUES BY SELECTIVE TENSION

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EVALUATION OUTLINE

• History
• Observation
• Quarter Screening Examination
• Appropriate Examinations
• Selective Tissue Tension Examination - WHERE YOU ARE NOW
• (Spine - repeated motion, PIVMT, length/strength balance)
• Special Tests
• Reflexes and neurological
• Accessory motions
• Palpation
• X-ray studies

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SOFT TISSUE EXAMINATION (Selective Tissue Tension)

• Must selectively stress each tissue from which complaint might arise
• Contractile tissues - muscles, tendons, and attachments
• Non-contractile (inert) tissues - joint capsules, ligaments, nerves and their sheaths, bursae, and cartilages

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SEQUENCE OF EXAMINATION

• Active Movements - gives an idea of the willingness and ability of the patient to move the part
• Passive Movements - stresses non-contractile tissues, and to a lesser degree, contractile tissues
• Resisted Isometric Contractions - Stresses contractile tissues

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PASSIVE MOVEMENT EXAMINATION

• Limitation of range
• End Feel
• capsular
• soft tissue approximation
• bone on bone
• springy
• muscle spasm
• empty
• Pattern of limitation - capsular or non-capsular
• Sequence of pain (can give information about the degree of acuteness)
• pain before motion barrier = acute
• pain at motion barrier = sub-acute
• pain when motion barrier is exceeded = chronic
• pain in middle of range only = painful arc

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RESISTED ISOMETRIC CONTRACTION

• Isometric contraction of specific muscles
• "Neutral" joint position - don't allow joint motion
• Possible Responses
• "Strong and pain free" - no pathology with that muscle-tendon element
• "Strong and painful" - "minor" lesion of the muscle-tendon element (eg muscle strain, tendonitis)
• "Weak and painful" - "serious" problem (eg fracture)
• "Weak and painless" - complete tear of the muscle-tendon element or pathology in nerve supply to the element

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SUMMARIZING FINDINGS

• Active and passive movement painful in same direction indicates non-contractile tissue at fault
• Active (and resistive) and passive movement painful in opposite directions indicates contractile tissue at fault
• Resisted contraction painful or weak indicates contractile tissue at fault
• Exception - certain bursal conditions can be irritated by compression from resisted isometric contraction

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