ASSESSMENT MUSCULOSKELETAL ASSESSMENT BY JULIAN HATCHER, MCSP

INTRODUCTION One of the major skills of a competent therapist is the ability to assess presenting conditions. One clinical model of assessment is that of the late Dr James Cyriax (1) which has subsequently been adapted by both the author, and by a number orthopaedic medicine clinical groups (2). The aim of this article is to give therapists the conceptual foundations of musculoskeletal assessment skills, using a logical system of questioning and physical testing, in order to diagnose musculoskeletal disorders.

FUNDAMENTALS OF ASSESSMENT X-rays Before progressing, let us look at some fundamentals of assessment. Firstly, how useful are x-rays (radiographs) when it comes to assessment and diagnosis? From a doctor’s perspective (certainly back in the 1950s when Cyriax was formulating his model), this was a major method of assessing the musculoskeletal system. Cyriax realised in his early professional career that there were many conditions where pain was present, yet the radiographic findings showed nothing. The problem with x-rays is that

they only show dense body tissues e.g. the bones (Figure 1). All soft moving tissues are radio-translucent. If pain arises from a soft tissue, then x-rays reveal only one of two things: n Nothing abnormal detected (NAD) - bones appear normal i.e. negative x-ray n x-ray shows some symptomless abnormality e.g. cervical spondylosis. In addition to this, it often requires two radiographs in order to interpret

MUSCULOSKELETAL ASSESSMENT

PART 1: AN OVERVIEW OF ASSESSMENT THE CYRIAX WAY

Patient conditions come in various clinical presentations. In addition to this variety of signs and symptoms, there are numerous ways of assessing these conditions and the tests and questions to be asked are many. Life can, however, be made a little simpler by using a model first advocated by the late Dr James Cyriax. This logical system starts with a detailed subjective history and is followed by applying the Cyriax principle of selective tissue tensioning. Each tissue is selectively stressed, whilst simultaneously preventing any tension to occur in other tissues. This can result in a good clinical impression of diagnosis in 90% of cases.

meaningful information as an x-ray is a two-dimensional image of a three dimensional structure. Figures 2a and 2b show a knee containing a loose body within the joint, however this only

BODY TISSUES

X-RAYS ONLY SHOW DENSE

Figure 1: Typical x-ray showing a fracture

www.sportEX.net

Figure 2a: Knee x-ray shows NAD

Figure 2b: The same knee from a lateral view showing loose body

9