Accessory movements

Question 1

how to perform

Answer 1

informed consent, patient in position
stabilising hand proximally, mobilising hand distally
weight in a direction
PA, AP, medial, lateral, distraction, longitudinal/compression, rotation
grades 1-4, rep twice

risk - aggravation of symptoms, soft tissue injury if application is incorrect, destabilizing the joint if hypermobile, disrupt healing
adapt - direction, force & intensity, hand positioning, dependent on feedback

Question 2

contraindications / precautions

Answer 2

MSK: osteoporosis, radiography, surgery, unstable artificial joint, cancer
CR: infection
CV: disease, anti-coagulant drugs
N: pain, no consent
dependency, fear, pregnancy, previously failed response, eating disorder, bone density issues

Question 3

purpose of technique
what you measuring + why?

Answer 3

Identify a symptomatic joint, source of symptoms
Define the nature of the joint motion abnormality
Alter local muscle and nerve tissues, assess end feel, bony blocks, tissue extensibility
Provide a basis for the selection of treatment

can limit ROM of physiological movement

Question 4

how to know if normal

Answer 4

feel movement and end feel, changes in symptoms
compare to other side
abnormal RoM, quality, pain, resistance, muscle spasm

Question 5

principles of application

Answer 5

patient care - stabilized, warm, comfortable
isolate movement
fix proximally, move distally
physio position - safe, efficient
correct force magnitude in right direction & angle - gentle and gradual
communication, feedback
concave-convex rule

Question 6

structures assessed
what ones + how?

Answer 6

joint capsule, synovial membrane, ligaments, articular cartilage
muscles and tendons - manually by putting external force on a joint