9/11a Joint Integrity/Mobility Lab

Question 1

Joint Mobility

Answer 1

the ability for the joint to be moved passively

Question 2

when active is less than passive, what is the issue?

Answer 2

Force production issue of the muscle

Question 3

What are scenarios when you would have a force production due to active being less than passive?

Answer 3

• Atrophy of muscle
• muscle weakness
• nerve recruitment, peripherally or centrally
• muscle is mechanically tethered
• patient motivation issue

Question 4

Is there a difference between accessory motion and joint play?

Answer 4

NO

they both are synonymous and mean the small motions at the joints can’t be done in an isolated way

Question 5

What is the purpose of accessory motion and what is an example?

Answer 5

• Often used when testing the integrity of a particular ligament/capsule.
• Distraction motion is when you pull your finger and it is completely relaxed
• Completely passive
• Testing the integral structures of the joint, but not extraarticular

Question 6

Patient has knee flexion issue, what are some reasons why he/she doesn’t have full range?

Answer 6

• Ligaments around the joint have lost length/flexibility
• Joint capsule structures may have lost length/flexibility
• Quad muscle is tight so there is less motion when you bend the knee
• patient is SCARED
• Muscle guarding

Question 7

Does an accessory motion test help you understand a strain or a sprain?

Answer 7

Sprain - over stretching of a ligament/capsule

Testing accessory motion helps us to delineate sprains

Question 8

Sprain vs Strain

Answer 8

Sprain - over stretching of ligament/capsule

Strain - over stretching of a muscle

Question 9

Can you get an accessory motion test when a muscle is flexed?

Answer 9

NO - needs to be completely passive

Question 10

Key items of accessory motion tests?

Answer 10

• Motion
• Pain
• End Feel

Question 11

Different grades of sprains

Answer 11

Grade 1 - overstretching, majority of fibers intact (a lot of pain)
Grade 2 - partial tear (a lot of pain)
Grade 3 - complete tear (not as painful if it is the only tear)

Question 12

How do you gain a sense of normality on a patient in motion accessory testing?

Answer 12

Normal - the standard range
Too Little - hypomobile
Too Much - hypermobile
COMPARE to the other side of the body
Different ends of motion based on gender and age

Question 13

When would you expect more motion in patient?

Answer 13

female>male

young>older

Question 14

End feel

Answer 14

at the end of passive ROM (physiologic ROM), what is stopping the motion?

Question 15

Soft end feel

Answer 15

non-distinct tissue approximation, usually yields tissue damage

Question 16

Hard

Answer 16

Boney end feel, hard stop

Question 17

Firm

Answer 17

Hard/Capsular end feel, leather shoe lace - pulls to the end and resists

Question 18

Empty

Answer 18

Nothing mechanically stops the patient except for a grimacing look on the patients face - serious condition

Question 19

Guarding/spasm/pain

Answer 19

something mechanically stops the PT bc the patient turns around on the joint

Question 20

Are laxity and instability the same?

Answer 20

NO,
laxity - more motion than normal, longer than normal CT
Instability - symptomatic manifestation when you feel a joint “give out”
When there is instability, there may be laxity
When there is laxity, there may or may not be instability

Question 21

General term for extra fluid

Answer 21

swelling

Question 22

difference between effusion and edema

Answer 22

• Effusion: fluid within the joint capsule, can push the fluid around but NOT out of the capsule (internal to the joint)
• Edema: fluid between tissue layers anywhere in the body and able to release the fluid out of the layer. Either the joint was violated OR there was another issue occurring

Question 23

Treatment often associated with altered joint play

Answer 23

Hypo: JT mobilization
Hyper: RICE and progressive return to activity; muscle strengthening; surgical stabilization

Question 24

MP Joint Traction

Answer 24

Metacarpalphalangeal joint traction:

• Extended (loose packed, ligaments relaxed) has the most mobility
• Activated to 20% has the second most mobility
• Flexed MP at 90 (close packed, ligaments are tight around the joint) least mobility

Question 25

Radiocarpal wrist distraction

Answer 25

radius and ulna are stabilized at the elbow and the PT provides a longitudinal traction force

Question 26

Knee anterior glide tests

Answer 26

• Anterior Drawer 90 deg: supine with hip at 45 and knee at 90, PT tests around proximal tibia and draws it forward
• Lachman’s Test 30 deg: patient supine with knee flexed 20-30 deg, PT stabilizes lateral distal femur and translates proximal tibia to the femur
• Prone Lachman’s Test: patient prone with knee at 20-30deg, PT applies anteriorly directed force to proximal tibia to translate anteriorly

Question 27

Ankle anterior drawer

Answer 27

patient distal tibia stabilized, PT translates calcaneous and talus forward on the tibia