Active Movement
How to Assess
- Ask the patient to move the joint themselves. Assess the neutral position and the range of motion, and ask whether range of motion is limited by pain, weakness or stiffness.
Significance
- Active movement is an indicator of the patient's ability to move the joint. It may be limited due to weakness, pain, mechanical stiffness or poor compliance.
Causes of Limited Active Movement
- Joint pain / stiffness - see below
- Upper motor neuron lesion - stroke, tumour, trauma, hypoxia, demyelination, deposition, inflammation
- Lower motor neuron lesion - trauma, compression, demyelination, neuromuscular disorders, diabetes
- Poor compliance
Passive Movement
How to Assess
- Move that patient's joint. Note the range of motion and whether it is limited by pain, swelling or stiffness. Note any crepitus.
Significance
- Passive movement is a measure of the objective range of motion of the joint. It may be limited by stiffness of the joint, or active resistance on the patient's part.
Interpretation
Decreased Knee Range of Motion
- Arthritis - rheumatoid, osteoarthritis, septic arthritis
- Bursitis - prepatellar, infrapatellar, pes anserine, iliotibial
- Tendonitis - patellar, biceps, semitendinosus, semimembranosus
- Tear - meniscus, ligament
- Loose intra-articular body
Patellar Crepitus
- Chondromalacia
- Patellar fracture
Snapping Knee Joint
- Dislocation - tibio-fibular joint, patello-femoral joint
- Discoid meniscus
- Menisceal cyst
- Snapping of tendons
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