Range of Motion
The factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations:
Less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.).
More movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.).
Weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.).
Incoordination, impaired ability to execute skilled movements smoothly.
Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. For the purpose of arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints.
With any form of arthritis, painful motion is an important factor of disability, the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints. Muscle spasm will greatly assist the identification. Sciatic neuritis in not uncommonly caused by arthritis of the spine. The intent is to recognize painful motion with joint or periarticular pathology as productive of disability.
It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structions should be noted carefully as points of contact which are deseased. Fexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.