Copyright © 2024 Oliviahansonphysiotherapy All Rights Reserved
MSK
PHYSIO
REVSION
NOTES
1
, Copyright © 2024 Oliviahansonphysiotherapy All Rights Reserved
Musculoskeletal
Range of movement:
AROM Looks at both PROM: • Looks at Inert Objective • Goniometer
Inert+ contractile structures measure: • Pain: VAS scale
• PQRSS
• End feel
When joint testing think!
PQRSS P Pain Pain or symptom reproduction
Q Quality What’s the quality of movement through range? Eg stiff or jolty
R Range of movement How far as the patient got with the movement? measure.
R Resistance Any resistance during range ? What’s stopping me from going further?
S Spasm Is there any spasm during range ?
Inert structure Contractile
Tissues that do not actively contract providing Tissues in the body that have the ability to
passive support and stability to joints contract and generate force.
• Ligaments • Muscles
• Joint capsule • Tendons
• Cartilage
• Bursae
• Fascia
Normal End Feels:
What Description Example
Bone-to-bone HARD: when two bones meet Elbow extension
Soft Tissue SOFT: when two soft tissues come into contact with each other. Elbow flexion
Approximation
Capsular FIRM: slight give with end feel typically caused by tension in the Hip extension
joint capsule or ligaments.
Ligamentous FIRM: due to tension in ligaments and joint capsules. Ankle inversion
Abnormal End Feels:
What Description Indicates
Bone-to-bone A hard, sudden stop that feels abnormal due to the presence of bony Osteoarthritis
growth. osteophytes
Spasm A sudden, involuntary stop of movement caused by muscle guarding or Inflammation
muscle spasm. Acute sprain
Empty No resistance felt, but the movement is stopped due to pain rather joint
than mechanical restriction. inflammation
fractures
Springy A rebound sensation felt at the end of the range cartilage or
meniscus injury
Soft excessive compression of soft tissues Swelling, joint
effusion
2
, Copyright © 2024 Oliviahansonphysiotherapy All Rights Reserved
Strength testing:
Isometric • Test in midrange Isotonic • Test through range
• Can test for Contractile lesion • Can test both Contractile + inert
structures highlighting weaknesses in
different parts of the range
Oxford Scale Cyriax scale
Grade Muscle activity Indications of ….
0 no contraction 1 Strong & painless: No contractile tissue injury.
1 flicker of contraction 2 Strong & painful:
Minor injury to muscle, tendon, or attachment
2 active movement, with gravity 3 Weak & painless:
eliminated Possible complete muscle/tendon rupture or
nerve issue.
3 active movement against gravity 4 Weak & painful:
Serious injury, such as a fracture
4 active movement against gravity & 5 All movements painful:
resistance Likely due to intermittent claudication.
5 normal power 6 Painful on repetition:
Possible gross lesion, such as a capsular injury.
Red Flags
Red flags are signs or symptoms that suggest a potentially serious underlying condition.
They may indicate fractures, infections, tumours, systemic diseases, or neurological issues requiring
further investigation or immediate referral.
General Cervical (Artery Disease) Lumbar (cauda equina)
• Unexplained Weight Loss 1. Dysphagia: difficulty swallowing • saddle anaesthesia
• Night Sweats 2. Dysarthria: difficulty with • saddle paraesthesia
• Systemically unwell (fever) speech • bladder retention
• Fatigue 3. Dizziness
• sexual dysfunction
• Persistent or Severe Pain 4. Diplopia: double vision
• History of Trauma 5. Drop attacks: fall to ground
• Persistent night pain 1. Nausea
• Progressive symptoms 2. Nystagmus
• Past history of cancer 3. Numbness
3
, Copyright © 2024 Oliviahansonphysiotherapy All Rights Reserved
Hip red flags to look out for:
Avascular necrosis Death of bone tissue due to lack of blood supply. Symptoms include severe
night pain, often linked to drug or alcohol use.
Metastasis cancer spread to the hip from other body parts. Associated with
unexplained weight loss, night pain, and a history of cancer.
Stress Fractures Common in women, presenting as an aching pain in the anterior thigh and
inability to hop.
Fractured NOF Typically caused by trauma or fall. Symptoms include severe hip pain,
inability to move the leg, shortened or externally rotated leg, and an
inability to bear weight.
Shoulder red flags to look out for:
History of Trauma Look for recent injuries or accidents that may suggest a fracture.
Swelling, Heat, Could indicate infection or inflammatory arthritis; investigate further if
Redness present.
Previous History of Especially PBKTL cancers (Prostate, Breast, Kidney, Thyroid, Lung), as
Cancer metastasis can cause pain.
Smoking History Smoking can increase the risk of lung cancer (e.g., Pancoast tumor) causing
referred shoulder pain. Watch for accompanying respiratory symptoms like
cough or shortness of breath.
4
MSK
PHYSIO
REVSION
NOTES
1
, Copyright © 2024 Oliviahansonphysiotherapy All Rights Reserved
Musculoskeletal
Range of movement:
AROM Looks at both PROM: • Looks at Inert Objective • Goniometer
Inert+ contractile structures measure: • Pain: VAS scale
• PQRSS
• End feel
When joint testing think!
PQRSS P Pain Pain or symptom reproduction
Q Quality What’s the quality of movement through range? Eg stiff or jolty
R Range of movement How far as the patient got with the movement? measure.
R Resistance Any resistance during range ? What’s stopping me from going further?
S Spasm Is there any spasm during range ?
Inert structure Contractile
Tissues that do not actively contract providing Tissues in the body that have the ability to
passive support and stability to joints contract and generate force.
• Ligaments • Muscles
• Joint capsule • Tendons
• Cartilage
• Bursae
• Fascia
Normal End Feels:
What Description Example
Bone-to-bone HARD: when two bones meet Elbow extension
Soft Tissue SOFT: when two soft tissues come into contact with each other. Elbow flexion
Approximation
Capsular FIRM: slight give with end feel typically caused by tension in the Hip extension
joint capsule or ligaments.
Ligamentous FIRM: due to tension in ligaments and joint capsules. Ankle inversion
Abnormal End Feels:
What Description Indicates
Bone-to-bone A hard, sudden stop that feels abnormal due to the presence of bony Osteoarthritis
growth. osteophytes
Spasm A sudden, involuntary stop of movement caused by muscle guarding or Inflammation
muscle spasm. Acute sprain
Empty No resistance felt, but the movement is stopped due to pain rather joint
than mechanical restriction. inflammation
fractures
Springy A rebound sensation felt at the end of the range cartilage or
meniscus injury
Soft excessive compression of soft tissues Swelling, joint
effusion
2
, Copyright © 2024 Oliviahansonphysiotherapy All Rights Reserved
Strength testing:
Isometric • Test in midrange Isotonic • Test through range
• Can test for Contractile lesion • Can test both Contractile + inert
structures highlighting weaknesses in
different parts of the range
Oxford Scale Cyriax scale
Grade Muscle activity Indications of ….
0 no contraction 1 Strong & painless: No contractile tissue injury.
1 flicker of contraction 2 Strong & painful:
Minor injury to muscle, tendon, or attachment
2 active movement, with gravity 3 Weak & painless:
eliminated Possible complete muscle/tendon rupture or
nerve issue.
3 active movement against gravity 4 Weak & painful:
Serious injury, such as a fracture
4 active movement against gravity & 5 All movements painful:
resistance Likely due to intermittent claudication.
5 normal power 6 Painful on repetition:
Possible gross lesion, such as a capsular injury.
Red Flags
Red flags are signs or symptoms that suggest a potentially serious underlying condition.
They may indicate fractures, infections, tumours, systemic diseases, or neurological issues requiring
further investigation or immediate referral.
General Cervical (Artery Disease) Lumbar (cauda equina)
• Unexplained Weight Loss 1. Dysphagia: difficulty swallowing • saddle anaesthesia
• Night Sweats 2. Dysarthria: difficulty with • saddle paraesthesia
• Systemically unwell (fever) speech • bladder retention
• Fatigue 3. Dizziness
• sexual dysfunction
• Persistent or Severe Pain 4. Diplopia: double vision
• History of Trauma 5. Drop attacks: fall to ground
• Persistent night pain 1. Nausea
• Progressive symptoms 2. Nystagmus
• Past history of cancer 3. Numbness
3
, Copyright © 2024 Oliviahansonphysiotherapy All Rights Reserved
Hip red flags to look out for:
Avascular necrosis Death of bone tissue due to lack of blood supply. Symptoms include severe
night pain, often linked to drug or alcohol use.
Metastasis cancer spread to the hip from other body parts. Associated with
unexplained weight loss, night pain, and a history of cancer.
Stress Fractures Common in women, presenting as an aching pain in the anterior thigh and
inability to hop.
Fractured NOF Typically caused by trauma or fall. Symptoms include severe hip pain,
inability to move the leg, shortened or externally rotated leg, and an
inability to bear weight.
Shoulder red flags to look out for:
History of Trauma Look for recent injuries or accidents that may suggest a fracture.
Swelling, Heat, Could indicate infection or inflammatory arthritis; investigate further if
Redness present.
Previous History of Especially PBKTL cancers (Prostate, Breast, Kidney, Thyroid, Lung), as
Cancer metastasis can cause pain.
Smoking History Smoking can increase the risk of lung cancer (e.g., Pancoast tumor) causing
referred shoulder pain. Watch for accompanying respiratory symptoms like
cough or shortness of breath.
4
