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Therefore active test movements are not very useful in the extremities.Īn active test movement, however, can provide us some information on the patient’s willingness to perform the movement. So, if a patient states he has pain or limitation on performing an active movement we cannot make the clinical distinction between a lesion of a contractile or an inert structure. It is useful to determine if the patient has an “intert” and/or “contractile” lesion (keep in mind, in the spine we apply a different logic).ĭuring an active movement both contractile and inert structures are “in action”. When we suspect a local problem in the extremities we mostly use a combination of passive and resisted tests. In other words, when you are confronted with a patient who suffers from a shoulder problem, can you make the clinical distinction between :

Does the result have an impact on the chosen treatment strategy?.

Is it a “specific” or rather “aspecific” diagnosis?.

Can we establish a useful and relevant diagnostic hypthesis?.

Are the patient’s symptoms the result of a local problem or are they referred?.

What’s the purpose of our functional examination? In the extremities very often we can reach quite a specific and useful diagnosis, whereas in the spine, the diagnosis very often is aspecific. The Cyriax testing procedure in both situations is different and there are some good reasons to do so. When it comes to functional examination I believe it is very important to point out that there is a difference in examination strategy of the joints in the extremities, compared to examining a spine patient.

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In this blog article I just want to go back to solid basics, which of course is not an end-point but rather a starting point in objective clinical reasoning.īy the way, I invite to you discover the free Orthopaedic Medicine Academy download platform, where you will find free ebooks, films, assessment forms and case studies on orthopaedic medicine

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I am still surprised that many therapists around the world seem to “fly high in the sky where the sun is always shining” driven by a series of complicated theories and procedures but we may not forget that “flying without knowing how to run, makes the landing quite painful”. > Objective clinical reasoning is a key element to reach more therapy success, click here What about the validity and relevance of all those different procedures?Īpparantly many of us like stick to our own beliefs, which is more comfortable of course. It’s not difficult to find 100 different “tests” which are used e.g. Avoid “artificial hypercomplication” in basic musculoskeletal functional examination proceduresĪs musculoskeletal therapists we have an “armageddon” of different test procedures at our disposal, very much dependant of which methods or approaches you are familiar with or you like.