Physiotherapy Assessment and Evaluation
Assessment is a hypothesis-driven sequence
History first (mechanism, onset, irritability, 24-hour behavior, red flags), then observation, palpation, and objective testing. Every test should answer a question you have already formed.
Objective data you must know cold
- ROM: limited AROM and PROM in the same direction points to joint/capsular restriction; PROM noticeably greater than AROM suggests weakness, pain inhibition, or tendon rupture.
- End-feels: normal are soft (tissue approximation), firm (capsular/ligamentous - most common), and hard (bone-to-bone). Abnormal: empty, springy block (meniscus), spasm, boggy (edema).
- Capsular patterns (Cyriax): shoulder - external rotation most limited, then abduction, then internal rotation; hip - internal rotation, flexion, abduction, extension.
- Manual muscle testing: 0 no contraction, 1 trace, 2 eliminates gravity, 3 antigravity full ROM, 4 antigravity plus moderate resistance, 5 normal.
- Neurologic screen: C5 lateral arm, C6 thumb, C7 middle finger, C8 little finger; L4 medial leg, L5 dorsum of foot, S1 lateral foot. Reflexes: biceps C5–6, brachioradialis C5–6, triceps C7, patellar L3–4, Achilles S1.
Traps
The exam loves grade-4 versus grade-3 vignettes, "firm" versus "hard" end-feels, and questions implying a positive special test equals a diagnosis. Tests shift probability; they do not confirm pathology alone. Also watch for capsular versus noncapsular patterns and for naming the wrong nerve root level.
Rule of thumb
SnNout / SpPin: a highly sensitive test that is negative helps rule out; a highly specific test that is positive helps rule in. Screen with the sensitive test, confirm with the specific one.