Evaluation Of Joint Function.

Evaluation of joint function is a mainstay of the osteopathic examination. The major function of the joint, regardless of its size or location, is motion. Therefore, this aspect must be evaluated thoroughly because any decrease in joint function leads to compensation and dysfunction on other levels as a simple concomitant of the homeostatic process. Range of motion exists and may be palpated in any joint of the body, whether on a gross level (e.g., the hip joint), a less gross level (e.g., the individual vertebral facets), or a subtle level (e.g., the relatively microscopic motion documented in the cranial sutures). A clinician's failure to palpate this motion should not be interpreted as lack of motion in the system.

On a gross level, the patient is examined for joint motion in standing, sitting, and supine/prone positions. The axial skeleton is evaluated for motion range using side bending, rotation, and anteroposterior movement (forward-to-backward bending), as is the sacrum and sacrococcygeal joint. The same evaluation is done for the ribs, clavicles, scapulae, bones of the pelvis, lower and upper extremities, and cranium. In addition, bones without joints (e.g., the hyoid) may be evaluated. The form in which this range of motion is expressed follows specifically defined osteopathic terminology, which is addressed later.

Because of the intimate link between structure and function, the body's motion preferences (i.e., the way the tissues move with least resistance) may lead to a deeper understanding of the state of the autonomic nervous system. Many clinicians are unaware that much of the autonomic innervation is directed to the musculoskeletal system, which comprises 60% of the body. When this is evaluated during examination, findings may lead a physician to suspect changes in the internal milieu of the patient merely from examining the musculoskeletal system.

The further a physician journeys in the realm of osteopathy, the more he or she will encounter this method of clinical reasoning. This method, which is based on basic applied anatomy and neurophysiology, has been substantiated in the laboratory by researchers such as Denslow, Korr, and others