oxford scale physiotherapy

Oxford Scale

5 = Normal (100%) Complete ROM against gravity with maximal resistance

4 = Good (75%) Complete ROM against gravity with moderate resistance

3+ = Fair +        Complete ROM against gravity with minimal resistance

3 = Fair (50%)   Complete ROM against gravity

3 - = Fair -         Some but not complete ROM against gravity

2 + =   Poor +    Initiates movement against gravity


2 =  Poor         Poor (25%) Complete ROM with gravity counter-balanced

2 - =  Poor -    Initiates motion IF gravity is counter-balanced

1 =   Trace      Flicker of contraction but not joint movement

0 =    Nothing    No contraction palpated

ACTIVE / PASSIVE insufficiency muscle

PASSIVE/ACTIVE insufficiency

Passive Insufficiency - Occurs with 2 joint muscles and refers to the fact that these muscles cannot stretch maximally across both joints at the same time!

Example: Hamstrings may limit hip flexion when the knee is in full extension since they are maximally stretched in this position.

However... If the knee is flexed passively then the hip will be able to flex further - because the stretch on the hamstrings has been slackened.

Active Insufficiency - 2 joint muscles cannot contract maximally across both joints at the same time!

Example: Make a fist (finger flexors) you can make a strong fist when your wrist is in a neutral of slightly extended position. But when you flex your wrist with a clenched fist you loose some of the grip. This is because the finger flexors are unable to shorten any more than they have and so begin to extend and lose grip strength.

Fracture Neck of Femur ( FNoF )

Assignment for Christmas Holiday by Mr TamilVanan (O.o)
- Physiotherapist management for fracture neck of femur.

Anatomical factors
The structure of the head and neck of femur is developed for the transmission of body weight efficiently, with minimum bone mass, by appropriate distribution of the bony trabeculae in the neck. The tension trabeculae and compression trabeculae along with the strong calcar femorale on the medial cortex of the neck of the femur form an efficient system to withstand load bearing and torsion under normal stresses of locomotion and weight bearing.
In old age, osteoporosis of the region occurs. The incidence of fracture neck of femur is higher in old age.

Two broad groups of fractures are recognised in the neck of femur :
(1) Intracapsular fractures
(2) Extracapsular fractures.

Classification (Garden).
stage I : incomplete fracture of the neck











stage II : complete without displacement











stage III: complete with partial displacement











stage IV : this is a complete femoral neck fracture with full displacement











Clinical Features
The patient is usually an elderly person with a history of a fall and inability to walk. On inspection, the injured led lies in a position of external rotation and there is shortening of the leg. The attachment of the capsule to the distal fragment prevents excessive external rotation of the leg. On palpation, there is tenderness over the anterior and lateral aspects of the hip joint. The greater trochanter is elevated on the injured side. All movements are extremely painful except in the rare case of an impacted type of fracture.

Management Conservative Treatment

This consists of the application of continuous skeletal traction. For cases with marked coxa vara, continuous skeletal traction through the upper tibia is applied and the leg is immobilised in the Bohler Braun splint and the foot end of the bed is raised. Traction with 12 to 15 Ibs is sufficient. The coxa vara gets corrected and the fracture unites in about 12 weeks. When the coxa vara is not marked, skin traction in Thomas' splint will be sufficient. Excepting the fact that the patient occupies a hospital bed for about 3 months, there is no other serious defect in this conservative method and the results are highly satisfactory.

Operative Treatment

This consists of manipulative reduction and internal fixation. The internal fixation is done by a nail plate as shown in the figure. The McLauglin two piece nail plate has been commonly used. The use of a single piece angled nail plate (Jewett) has been found to be mechanically superior and gives good results. More recently the use of compression hip screw and plate system has enabled earlier mobilisation of the hip and weight bearing.

HaPpy ReaDiNg (O.o)