Definitions /viva related
Pain grading (total 4)
Grade I (mild) Pain that can easily be ignored.
Grade II (moderate) Pain that cannot be ignored, interferes with function and needs
attention or treatment from time to time.
Grade III (severe) Pain that is present most of the time, demanding constant
attention or treatment.
Grade IV (excruciating) totally incapacitating pain.
Assessment of joint tenderness (total 4)
Grade 1: The patient says the joint is tender
Grade 2: The patient winces
Grade 3: The patient winces and withdraws the affected part
Grade 4: The patient will not allow the joint to be touched
ROM:
‘knee flexion 0–140°’ means that the range of flexion is from zero (the knee
absolutely straight) through an arc of 140 degrees (the leg making an acute angle
with the thigh).
Similarly, ‘knee flexion 20–90°’ means that flexion begins at 20 degrees (i.e. the
joint cannot extend fully) and continues only to 90 degrees.
Muscle power is usually graded on the Medical Research Council scale:
Grade 0 No movement.
Grade 1 Only a flicker of movement.
Grade 2 Movement with gravity eliminated.
Grade 3 Movement against gravity.
Grade 4 Movement against resistance.
Grade 5 Normal power.
Superficial reflexes
The superficial reflexes
abdominal (T7–T12), cremasteric (L1, 2) and anal (S4, 5) reflexes.
These are corticospinal (upper motor neuron) reflexes.
Absence of the reflex indicates an upper motor neuron lesion (usually in the spinal
cord) above that level.
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Babinski sign – a type of withdrawal reflex which is present in young infants and
normally disappears after the age of 18 months.
Varus means that the part distal to the joint is displaced towards the median plane,
Valgus means that the part distal to the joint is displaced away from the median
plane. Seen from side.
spinal curves which convex posteriorly in the thoracic region (kyphosis), and
convex anteriorly in the cervical and lumbar regions is called lordosis. Seen from
side.
Scoliosis: is an apparent lateral curvature of the spine. ‘Apparent’ because,
although lateral curvature does occur, the commonest form of scoliosis is actually a
triplanar deformity with lateral, anteroposterior and rotational components. Two
broad types of deformity are defined: postural and structural.
Most cases have no obvious cause i.e. idiopathic scoliosis; other varieties are
congenital or osteopathic (due to bony anomalies), neuropathic, myopathic
(associated with some muscle dystrophies) and some connective-tissue disorders.
‘Fixed flexion deformity’ it means that extension cannot be completed. The joint
may be able to flex fully but not extend fully – at the limit of its extension it is still
‘fixed’ in a certain amount of flexion.
WHAT IS SPASTICITY? Spasticity is defined as an involuntary, velocity-dependent,
increased resistance to stretch. The amount of resistance to stretching is partly
determined by the speed with which a spastic muscle is stretched, and manifests as
pain, tightness, or posturing
WHAT IS A CONTRACTURE? Fixed resistance to passive stretching of a joint due
to shortening (due to a decrease in the number of sarcomeres in series along the
myofibrils,) /wasting (atrophy) of muscle fibers, tendons, or the development of scar
tissue (fibrosis) of the joints.
JOINT STIFFNESS: The term ‘stiffness’ covers a variety of limitations of joint
movement. three types of stiffness in particular: (1) all movements absent; (2) all
movements limited; (3) one or two movements limited.
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