Clearing Tests for All Joints | Clinical Physio

Welcome back to Clinical Physio! I’m Carl, and today we’re diving into the essential practice of **joint clearing** as part of your objective physiotherapy assessment.

### Why is Joint Clearing Important? Joint clearing is crucial for determining whether there are other joints or regions that could be contributing to a patient's symptoms, aside from the initially suspected area. By doing this, we reduce the risk of misdiagnosis and ensure effective treatment. For instance, treating shoulder pain might be ineffective if the true source of discomfort lies in the cervical spine.

### Remember the Clinical Physio Rhyme As a handy guide during your assessments, remember our Clinical Physio rhyme: **"Always Above and Below, Consider Spreading and Neuro."** Let's break this down further.

### Understanding the Rhyme #### **1. Always Above and Below** This means whenever a patient presents with pain in one joint, you need to assess the joints above and below that area. - **How to clear?** - Perform active range of motion (ROM) testing with overpressure, or - Conduct passive ROM testing with overpressure for the relevant joints. You can choose the method that best fits the situation, as long as the joint is stressed enough to rule it out as a source of symptoms.

### Joint Clearing from Head to Toe Here’s a breakdown of which joints to clear based on where the pain is presenting: | **Pain Location** | **Joints to Clear** | |------------------------|-----------------------------------------------------| | Cervical Spine Pain | Thoracic Spine, Shoulder | | Shoulder Pain | Cervical Spine, Elbow | | Elbow Pain | Shoulder, Wrist | | Wrist Pain | Elbow | | Thoracic Spine Pain | Cervical Spine, Lumbar Spine | | Lumbar Spine Pain | Thoracic Spine, Hip | | Hip Pain | Lumbar Spine, Knee | | Knee Pain | Hip, Ankle | | Ankle Pain | Knee |

### 2. Consider Spreading and Neuro When patients report symptoms that spread or exhibit neurological signs—like pins and needles, numbness, weakness, or red flags—you need to perform a **neurological examination** of the limb showing the symptoms. Additionally, assess the closest spinal structure, depending on whether it’s an upper or lower limb issue: - **For Upper Limb:** Check the Cervical Spine. - **For Lower Limb:** Check the Lumbar Spine.

### Examples to Illustrate Clearing Let’s clarify with a few case studies: #### **Case 1: Knee Pain** - **Assessment:** The patient has isolated knee pain with no other symptoms. - **Clearing:** Check the hip and ankle with range of motion testing with overpressure. Since no spreading or neuro symptoms are present, nothing else is required. #### **Case 2: Greater Trochanter Pain Spreading to Ankle** - **Assessment:** Pain from hip to ankle. - **Clearing:** Need to clear the Lumbar Spine and perform a neurological examination of the lower limb due to symptom spreading. #### **Case 3: Neck Pain with Numbness in Hands** - **Assessment:** No shoulder or elbow pain, but numbness in both hands. - **Clearing:** Clear the Thoracic Spine and Shoulder while performing a neurological examination of the upper limb, including the Cervical Spine assessment. #### **Case 4: Lumbar Pain with Pins and Needles Down to Ankle** - **Assessment:** Lower back pain with spreading symptoms. - **Clearing:** Clear the Thoracic Spine and Hip, along with a lower limb neurological assessment.

### Conclusion Understanding and implementing joint clearing as part of your assessment process is vital in physiotherapy. Remember to always consider the surrounding joints and be attentive to any neurological symptoms that may indicate a need for further examination. Keep practicing, and don’t hesitate to revisit this information as you go through your assessments! For more insightful content, join our membership at Clinical Physio and check out our website and Instagram.