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Additional resources for The Orthopaedic Clinical Examination
21 Section | 1 | Principles of orthopaedic medicine Resisted tests Resisted tests Pain Power Resisted isometric muscle tests assess the contractile unit – comprising the muscle, musculotendinous junction, tendon and the teno-osseous attachment to bone – for pain and power. The tendon is not strictly a contractile structure but is tested as part of the functional contractile unit. When assessing the resisted tests it is important to look for reproduction of the patient’s presenting pain and there are speciﬁc points to bear in mind which ensure that, as far as possible, only the contractile unit is being tested rather than the inert structures.
In arthritis, the individual joints resent some movements more than others, hence the capsule contracts disproportionately, making some movements more limited than others and giving rise to the characteristic pattern of limitation. For example, in the study conducted by Eyring & Murray the position of minimum pressure for the elbow was found to be between 30° and 70° of ﬂexion. The pressure was not inﬂuenced by either pronation or supination. The capsular pattern of the elbow joint is proportionally more limitation of ﬂexion than extension but without involvement of pronation or supination.
Med. Rehab. 2, 247–256. , 2002. Disc stimulation and patterns of referred pain. Spine 27 (24), 2776–2781. , 2006. Referred shoulder pain preceding abdominal pain in a teenage girl with gastric perforation. Pediatr. Emerg. Care 22, 807–809. , 1996. Intertester reliability of the Cyriax evaluation in assessing patients with shoulder pain. J. Orthop. Sports Phys. Ther. 23, 34–38. , 2007. Chemical radiculitis. Pain 127, 11–16. , 2003. Lower extremity pain of lumbar spine origin: differentiating somatic referred and radicular pain.
The Orthopaedic Clinical Examination by Reider