Name shakir farid

Semester # 6th

Roll # 418

Submitted to madam uzma

Q 1 Define the following

What is a Disability?

A disability is defined as a condition or function judged to be significantly impaired relative to the usual
standard of an individual or group. The term is used to refer to individual functioning, including physical
impairment, sensory impairment, cognitive impairment, intellectual impairment mental illness, and
various types of chronic disease.

Disability is conceptualized as being a multidimensional experience for the person involved.

Body structure and function (and impairment thereof)

Activity (and activity restrictions)

Participation (and participation restrictions)

Disabilities can affect people in different ways, even when one person has the same type of disability as
another person. Some disabilities may be hidden, known as invisible disability. There are many types of
disabilities, such as those that affect a person's:

Vision

Hearing

Thinking

Learning
Movement

Mental health

Remembering

Communicating

Social relationships

Fuctional disability:-

A functional concept of disability, defines a disability as any long-term limitation in activity resulting
from a condition or health problem. This is the World Health Organisation (WHO) definition and is the
recommended international standard for data collection on disability. The use of this standard ensures
that the results are comparable with those from other countries

(2) Principal of ethics:-

Following are the principal of ethics:-

1. Respect for Persons.

2. Beneficence

3. Justice

(3) Pain and tenderness?

Pain:-

Highly unpleasant physical sensation caused by illness or injury.

2 Tendernes:-

The quality of being succulent and easily chewed.

(4) clearance test:-

Official authorization for something to proceed or take place.

(5) Antalgia:-

Antalgia from the Greek ‘away from’ and ‘pain’ is how your body tries to reduce the pain caused by
acute disc injury by leaning the spine away from the side of the injury.

Q 2 Explain closed pack postion of hip and knee specifiying bony and ligaments ?
Close pick position:-

The joint position in which articulating bones have their maximum area of contact with each other. It is
in this position that joint stability is greatest. The close-packed position for the knee, wrist, and
interphalangeal joints is at full extension, and for the ankle joint at full dorsiflexion.

(i) Close pick position of hip:-

TO THE HIP (ILIOFEMORAL) JOINT

Axes of motion

Arthrokinematics

Ligamentous restraint

Hip biomechanics and the control of posture

AXES OF MOTION

JOINT

AXIS

MOTION

CLOSE-PACKED POSITION

hip

(iliofemoral)

lateral

flex/ext

combined extension, internal rotation, and abduction

AP

abd/add

longitudinal

ER/IR

lateral axis: projects to body's surface near greater trochanter

vertical (mechanical) axis of hip: a line that connects femur's points of contact with acetabulum and tibia
(Kendall, McCreary, & Provance, 1993, p.230).

a rare transverse plane view that shows the hip's longitudinal axis

HIP ARTHROKINEMATICS

In an open chain, when the convex femoral head moves on a stationary acetabulum,

FLEXION

femoral head rolls anteriorly and glides posteriorly on acetabulum

EXTENSION

femoral head rolls posteriorly and glides anteriorly

ABDUCTION

femoral head rolls laterally and glides medially

ADDUCTION

femoral head rolls medially and glides laterally

LIGAMENTOUS RESTRAINT

LIGAMENT

ELONGATES WITH AND LIMITS

Iliofemoral

extension and internal rotation

Ischiofemoral

extension and internal rotation

Pubofemoral
abduction and internal rotation

The majority of the three ligaments' fibers are elongated at the joint's close-packed position in
combined extension, internal rotation and abduction.

(ii) Close pick position of knee:-

The close-packed position for the knee, wrist, and interphalangeal joints is at full extension, and for the
ankle joint at full dorsiflexion. Any movement away from the close-packed position takes a joint into the
loose-packed position in which the area of contact and joint stability is reduced.

Q 3 Define end feel ?what will be normal and abnormal end feel at major joints of lower limb and upper
limb ?

End feel:-

The end feel is a type of sensation or feeling which the examiner experienced when the joint is at the
end of its available passive range of motion.

Normal end feel for lower limb:-

(i) Hip Flexion

120 degree

Hip extension

20 degree

Hip abduction

45 degree

Hip adduction

10 degree

Hip medial rotation

40 degree

Hip letral rotation

45 degree

Knee flexion

135 degree
Knee extension

0 degree

Talocrural dorsiflexion

20 degree

Talocrural planterflexion

50 degree

Tarsal inversion

35 degree

Tarsal eversion

15 degree

Normal end feel for upper limb:-

Shoulder flexion

180 degree

Shoulder extension

50 degree

Shoulder abduction

180 degree

Medial rotation

60 degree

Lateral rotation

90 degree

Elbow flexion

140 degree

Elbow extension

0 degree
Forearm supination

90 degree

Forearm pronation

90 degree

Wrist flexion

80 degree

Wrist extension

80 degree

Wrist abduction

20 degree

Wrist adduction

30 degree

Abnormal end feel:-

The Abnormal end feels are generally described as

Soft: Occurs sooner or later in the ROM than is usual or in a joint that Soft tissue edema normally has a
firm or hard end. Feels boggy, with a fluid shift.

Firm: Occurs sooner or later in the ROM than is usual, or in a joint that normally has a soft or hard end.

Hard: Occurs sooner or later in the ROM than is usual, or in a joint that normally has a soft or firm end. A
grating or bony block is felt]

Empty: No real end because pain prevents reaching the end of ROM.No resistance is felt except for the
patient’s protective muscle splinting or muscle spasm.

Q 4 Identify the weak musculature in following condition ?

(i) Genu-vilgum:-

PYLE DISEASE
Pyle disease is a bone dysplasia characterised by genu valgum, metaphyseal anomalies with broadening
of the long bones extending into the diaphyses and giving the femora and tibiae an 'Erlenmeyer flask''
appearance, widening of the ribs and clavicles, platyspondyly and cortical thinning.

PYLE DISEASE Is also known as Metaphyseal Dysplasia|Metaphyseal Dysplasia, Pyle Type

Related symptoms:

Scoliosis

Muscle weakness

Pain

Abnormality of the skeletal system

Mandibular prognathia

(ii) excesive pelvic rotaion during gait:-

If you have an anterior pelvic tilt you may notice that the muscles in the front of your pelvis and thighs
are tight, while the ones in the back are weak. Your gluteus and abdominal muscles may also be weak.
All of this can cause: lower back pain.

(iii) Drop foot:-

Foot drop is caused by weakness or paralysis of the muscles involved in lifting the front part of the foot.
Causes of foot drop might include:

Nerve injury. The most common cause of foot drop is compression of a nerve in your leg that controls
the muscles involved in lifting the foot (peroneal nerve). This nerve can also be injured during hip or
knee replacement surgery, which may cause foot drop.

A nerve root injury — "pinched nerve" — in the spine can also cause foot drop. People who have
diabetes are more susceptible to nerve disorders, which are associated with foot drop.
Muscle or nerve disorders. Various forms of muscular dystrophy, an inherited disease that causes
progressive muscle weakness, can contribute to foot drop. So can other disorders, such as polio or
Charcot-Marie-Tooth disease.

Brain and spinal cord disorders. Disorders that affect the spinal cord or brain — such as amyotrophic
lateral sclerosis (ALS), multiple sclerosis or stroke — may cause foot drop.

(iv) Torticollis:-

Torticollis is the tilt and/or rotation of the head because of tight and weak neck muscles. It occurs when
the muscle that runs up and toward the back of the neck (the sternocleidomastoid muscle) becomes
tight, weakened, or thickened.

(v) Difficulty in walking On inclined surface:-

Your hip flexor muscles work together to flex your hip joint, or to bring your knee toward your chest.
Your illiopsoas — the psoas major, psoas minor and iliacus — muscles are the major muscles involved in
hip flexion. When these muscles are injured or tight, they can be sensitive to incline walking.

Q 5 write the special test for following joints providing information about test ?

(i) Hip

(ii) knee

(iii) shoulder

(i) special for Hip joint:-

Clinical Examination:-

(i) Hip Examination

(ii) Special Tests

(iii) Hip Quadrant Test

(iv) FABER Test

(v) Leg Length Test

(vi) Trendelenburg Test

( Vii)Thomas Test

(viii) Ober's Test

(x)Fulcrum Test

(Xi) Labral Tests

(i) Avascular Necrosis

(ii) Coxa Vara / Coxa Valga

(iii) Femoroacetabular Impingement

(iv) Greater Trochanter Pain Syndrome

(v) Hip Bursitis

(v) Trochanteric Bursitis

(vi) Iliopsoas Bursitis

(vii) Ischial Bursitis

(viii) Hip Labral Disorders

(ix) Hip Dysplasia

(x) Hip Osteoarthritis

(xi) Iliotibial Band Syndrome

(xii) Legg-Calve-Perthes_Disease

(xiii) Meralgia Paraesthetica

(xiv) Piriformis Syndrome

(xv) Slipped Capital Femoral Epiphysis

(xvi) Snapping Hip Syndrome

Procedures:-

(i) Total Hip Replacement

(ii) Small Incision Total Hip Replacement

(iii) Hip Resurfacing

(v) Hip Arthroscopy

(vi) Arthroscopic femoro–acetabular surgery for hip impingement syndrome

(vii)Open femoro–acetabular surgery for hip impingement syndrome

(viii) Peri-Acetabular Osteotomy

(ix) Femoral Osteotomy

Special test for knee:-

Inspection:-

Skin

Discoloration, wounds, gross deformity, or previous scars

Soft Tissues

Swelling, muscle atrophy, symmetry

Bony

Length - compare to contralateral side

Position - genu varum or valgus; flexion contractures

Gross deformity or malalignment

Gait

Varus thrust

can indicate LCL or PLC insufficiency or injury

Antalgic (painful)

shortened stance phase on affected side

Patella tracking

Flexed knee gait

from tight achilles tendon or hamstrings

Bony

joint line

tenderness to palpation medially or laterally

patella

translation

facet pain to palpation

tibial tubercle

Soft tissue structures

pes anserine bursea

patellar tendon

quadriceps tendon

iliotibial band

collateral ligaments

popliteal fossa

pain with Baker's cyst or popliteal aneurysm

Swelling

pre-patellar bursitis

intra-articular effusion

patella balloting

milking

traumatic hemarthrosis

Neurovascular:-
Motor

knee flexion - sciatic nerve

knee extension - femoral nerve

foot plantarflexion - tibial nerve

foot dorsiflexion - deep peroneal nerve

Sensory

medial thigh - obturator nerve

anterior thigh - femoral nerve

posterolateral leg - sciatic nerve

dorsal foot - peroneal nerve

plantar foot - tibial nerve

Pulses

popliteal

dorsal pedis

posterior tibial

Reflexes

patellar (L4)

hypoactive / absent is concerning for L4 radiculopathy

hyperactive may indicate UMN injury

ROM:-

Flexion

125-135 deg

Extension

0-10 deg hyperexension

10-15 deg internal and external tibial rotation

Special Tests:-

Anterior Cruciate Ligament

Posterior Cruciate Ligament

Collateral Ligaments

Lachman's Test

Valgus & Varus Stress Test

Apley's Compression Test

Squat Walk Test

Bounce Home Test

Steinmann's Test

Patellar Apprehension Test

McMurray's Test

Special test for shoulder:-

Shoulder Exam:-

In examining a patient with a painful shoulder we should start with a general inspection, looking for
musculoskeletal abnormalities and any associated functional deficits. Then, we can carry on some
specialized tests that will help us uncover any lesions of the muscular or ligamentous structures of the
joint.

Inspection:-

The physical exam of the shoulder starts by observing the patient removing his or her shirt. This is our
first opportunity to notice any functional impairments of the shoulder joint.

General Inspection:-
Once the patient has uncovered the upper trunk and extremities we can move to a general inspection of
the front, the side and the back of each shoulder. Our goal is to identify any abnormalities in the muscle
bulk or any asymmetrical bony defects.

Cervical Spine Exam:-

Before proceeding with the examination of the shoulder it is very important to complete a full
examination of the cervical spine to make sure that no spinal pathologies are contributing to the
presentation. We should at the very least check for cervical spinal tenderness, by palpating the cervical
spinous processes, and the range of motion of the neck in flexion, extension and rotation.

Range of Motion:-

We should then test the range of motion (ROM) of the shoulder in different directions. If movement in a
specific direction is painful or limited, this may signify that pathology is present in a specific structure of
the shoulder. For all these maneuvers, have the patient standing in front of you.

Forward Flexion:-

Starting with the patient having the forearm fully extended at the elbow with the arm attached to the
side of the trunk, ask the patient to flex the arm at the shoulder by moving the upper extremity
anteriorly and then superiorly, until it is above the head.

Abduction:-

Ask the patient to abduct both arms by elevating them laterally until they are above the head, at 180°.

Cross-body Adduction:-

Have the patient flexing the upper extremity forward to 90°. From this position, ask the patient to
maximally adduct the shoulder by moving the arm horizontally all the way to the other side. Make sure
to test one side at a time.

External Rotation:-
Ask the patient to flex the elbow at 90° with the arm attached to the trunk and the palms supinated.
Then have the patient externally rotate the shoulder by bringing the forearms laterally.

Extension:-

Starting with the patient having the forearm fully extended at the elbow and the palms supinated, ask
the patient to extend both arms at the shoulder by moving the upper extremities posteriorIy.

Internal Rotation:-

First ask the patient to flex the elbows at approximately 45° with the fists clenched and the thumbs up,
then ask to position both hands behind the back until the thumb touches the apex of the homolateral
shoulder. This maneuver tests for the functional integrity of the internal rotation of the shoulder.

Scapular Motion:-

Before completing the inspection of the shoulder it is good practice to repeat all the maneuvers that test
for range of motion while observing the movement of the scapulae. Any asymmetries in the rhytm of
scapular movement would indicate pathology in the anterior aspect of the shoulder.

Specialized Tests:-

Rotator Cuff Pathology

Supraspinatus

Infraspinatus and Teres Minor

Subscapularis

Gerber’s Lift Off Test

Serratus Anterior

Shoulder Impingement:-

Neer's Test

Empty Can Test

Hawkins-Kennedy Test.
Bonus question:-

Write how you will assess a patient when you are in clinical set up with justification of each setup to
be performed.The patient had major compalin of pain in lumber region radianting to legs.he has no
history of fall.

Answer:-

Assesment.

Ubaid is 32 year patient by occupation he is a weight lifter he come to clinic refer by nuro physisian with
complain of lower back pain mainly in lumber region.

Past medical history:-

In past medical history in xrays and mri finding L3,L4 disc compression because of that pain expand radiate till
lower limb.

Detail assesment:-

Rom

Muscle grading

Contracture all are normal

Orthotic prescription:-

As orthotic prescription Lso or prefebricated lumber belt also advise to do phsiotheraphy traction and to
continue medicine as prescribe by neuro physician.

Thank you