The Elbow

Literature

Petersen CM, Hayes KW
J Orthop Sports Phys Ther 2000 Sep;30(9):512-21

Construct validity of Cyriax's selective tension examination:

association of end-feels with pain at the knee and shoulder.

STUDY DESIGN: Descriptive

OBJECTIVES: To examine the relationship between pain and normal and abnormal-pathologic end-feels
during passive physiologic motion assessment at the knee and shoulder. We theorized that
abnormal-pathologic end-feels would be more painful than normal end-feels.

BACKGROUND: End-feel testing and pain intensity information are part of physical therapy
musculoskeletal patient examinations. End-feels are categorized as normal or
abnormal-pathologic. No previous studies have examined the relationship between pain
during end-feel testing and the type of end-feel.

METHODS AND MEASURES: Two physical therapists examined subjects with unilateral
knee or shoulder pain.
Each subject was examined twice. Passive physiologic motions, 2 at the knee and 5 at the shoulder,
were tested by applying an overpressure at the end of range of motion using standardized positions.
Subjects reported the amount of pain (0-10) immediately after the evaluator recorded the
end-feel. Analyses included one-way ANOVAs and post-hoc Tukey's Honestly Significant
Difference tests.

RESULTS: Some abnormal-pathologic end-feels were significantly more
painful than the normal end-feels at both the knee and the shoulder for all physiologic
motions. Among the abnormal-pathologic end-feel categories there were no statistical
differences in pain intensity, although small samples in some categories may be responsible
for this finding.

CONCLUSION: Abnormal-pathologic end-feels are associated with more pain
than normal end-feels during passive physiologic motion testing at the knee or shoulder.
Dysfunction should be suspected when abnormal-pathologic end-feels are present.