Arthrokinematics and Joint Mobilization Flashcards
objectives
- Explain the difference between arthrokinematics and osteokinematics
- Explain the convex/concave rule and apply it to various examples in the body
- Describe open and loose pack positions of all major joints
- Define basic principles of joint mobilization
fyi
- Joint movement is commonly known as one bone moving on another to produce a certain motion
- All completed under voluntary control
- Isometric, Isotonic, Isokinetic movement (ther ex course)
- When performed actively, it is called Active Range of Motion or AROM
- When performed passively, it is called Passive Range of motion or PROM
- It’s what we measure with goniometry
Osteokinematic Motion
A subjective assessment of the quality of the feel when slight pressure is applied at the end of the joint’s PASSIVE range of motion
First described by Cyriax and he stressed the importance of how the end feel of the joint felt to the examiners hand
End Feel
a hard and abrupt limit to joint motion
- Bone on bone contact at the end of ROM
- Also called a hard end feel
- A lot like a “locked” feeling and there is absolutely no give
- Examples of bone on bone contact/end feel?
Bony or Hard
Normal End Feels
- Bony or Hard
- Firm End Feel
- Soft End Feel
Characterized by a firm sensation that has a slight give when the joint is taken to end range
- Most common end feel
- Felt with most soft tissue stretch (muscular, ligamentous and capsular stretch)
- Results from tension in the surrounding ligaments, capsules and muscles
- Examples
Firm End Feel
Soft tissue limits the abilities to achieve a true end feel
- Muscle bulk is compressed
- More prominent in the obese/bariatric population
- Difficult to assess a true bony joint ROM
- Examples
Soft End Feel
Abnormal End Feel
- Empty End Feel
- Abnormal Bony End Feel
- Springy Block
- Muscle guarding
Characterized by a loosey-goosey, open end feel or a lack of mechanical limitation of joint range of motion
- The range of motion does not stop:
- Muscular & Ligament tears
- Fracture & abscess
- Structural support is gone
- Examples of an empty end feel
Empty End Feel
sudden hard stop before reaching the end of normal ROM
- Occurs when there is an abnormal bony structure in the way, such as an osteophyte
Abnormal Bony End Feel
the joint bounces back at you, noted typically by a tear in the cartilage
- Different than a firm end feel
- Might also describe a “catching”
- Some other internal dysfunction could cause this
Springy Block
a reflex or muscle spasm limiting ROM, protective response noted with acute injury
- Fractures, recent surgeries
- What else could result in muscle guarding?
- Can also be called firm and include capsular, ligamentous and fascial shortening
Muscle guarding
The manner in which adjoining joint surfaces moving on each other or joint surface motion that occurs during osteokinematic motion
Arthrokinematic motion
osteokinematics (joint motion) which is ______ joint motion like flexion and extension
gross
Arthrokinematic motion is different from accessory motion.
- Arthrokinematic motion occurs no matter if movement is __________ or _________.
voluntary or involuntary
a joint movement that is necessary for a full range of motion but is not under direct voluntary control
Accessory Motion
Accessory Motion-Divided into two categories:
- Component movements
- Joint play movements
motions that accompany active motion but are not under voluntary control
- For example, the shoulder girdle (scapula, clavicle, sternum) must rotate upward in order for the shoulder joint to flex.
Component movements
Passive movements between joint surfaces done by applying an external force. Again, they are not under voluntary control.
- Glide, Spin and Roll
- Primarily considered for joint mobilization
Joint play movements
Described as the passive oscillatory motion or sustained stretch that is applied by an external force (likely…you) applied at a slow enough speed that the individual can stop the motion.
- Used to increase joint mobility and increase fluid movement
- Used to decrease pain
Joint Mobilization
mobilization is what grade?
1-4
manipulation is what grade
5
There are five ways to mobilize a joint:
- Traction or distraction
- Approximation or compression
- Shear
The next two are result from a combination of forces
- Bending
- Torsional or rotary force
external force is exerted on a joint causing the joint to be pulled apart
- Carrying a suitcase
- Hanging from a bar
- “pulling my finger”
Traction or distraction
external forces are exerted on a joint causing the joint surfaces to be pushed together
- Pushups
Approximation or compression
Traction assists with ___________ of the joint
flexibility
approximation assists with _________ of the joint
stability
parallel to the joint surfaces resulting in gliding motion at the joint
Shear forces
occurs when other than vertical force is applied and results in the compression on the concave side and distraction on the convex side
Bending
twisting resulting in the combination of compression and shearing
Rotary forces
- not performed regularly, typically happens on accident when working with a patient.
- The cracking of joints that are difficult to mobilize
- A forceful thrust within ashort range that cannot be stopped
- Also applied under anesthesia if too much pain is likely to occur d/t manipulation
- Total joint replacements gone bad
- Contractures from scars, muscular deficiency
Grade 5 Oscillatory Movements
All joints have a __________ and __________ surface component and these surfaces of the joints reflect the motions of the joint.
concave,convex
This joint has 2 bones forming a convex-concave relationship
- Most synovial joints are ovoid joints
- One bone end is typically larger than its adjacent bone end, permitting a larger ROM
Ovoid
Each joint surface is concave in one direction/convex in another
- CMC (carpometacarpal) joint of the thumb
- The roll and glide will depend on the motion of the joint that is being performed
Sellar ( or saddle shaped)
Arthrokinematically, when a joint moves, three types of motion can occur between the two surfaces
- Rolling
- Sliding or gliding
- Spinning
The combination of roll, slide and spin permits a large range of motion while using a ______ articular surface
small
fyi
If joints possessed only one of these motions(rolling,sliding, or spinning) the range of motion would be limited or joint surfaces would need to be larger to accomplish the same range of motion
fyi
the rolling of one joint surface on another
- The sole of your shoe on the floor
- A ball rolling along the floor
- New points on each surface makes contact
Roll
linear movement of a joint surface parallel to the plane of the adjoining joint surface
- A box sliding down a ramp
- One point on one surface contact new points on the other surface
Glide/Slide
The rotation of the movable joint surface on the fixed adjacent surface and the same point on each surface remains in contact with each other.
- Top spinning on a table
- Human example is pure rotation of the humeral head rotating in the glenoid fossa
Spin
fyi
Most normal joint movement has some combination of rolling, sliding and spinning
- The knee joint shows this most clearly
fyi
The arthrokinematic movement of joint surfaces relative to the movement of the shaft of the bones (osteokinematics) follows what principles?
convex-concave
If the bone with the convex joint surface moves on the bone with the concavity, the convex joint surfaces move in the ________________ direction to the bone segment (open chain glenohumeral joint)
opposite
If the bone with the concavity moves on the convex surface, the concave articular surfaces moves in the ____________ direction as the bone segment (open chain PIP)
same
this Describes how the differences in shapes of bone ends require that bone surfaces move in a specific way during joint movement
Concave/Convex Rule
THE LAW:
A convex joint surface will move on a FIXED concave surface in the opposite direction as the body is moving
concave
THE LAW:
A concave joint surface will move on a FIXED _______surface in the same direction as the body is moving
convex
Example – Concave moving
Fingers – the proximal phalanges have a concave surface where the metacarpals have a convex surface.
If the MC joint is fixed and not moving, and if the phalange extends and moves “up”, so does the joint surface
Example – Convex moving
Shoulder – the humeral head is convex and the glenoid fossa is concave. With the glenoid fossa being the fixed surface, the humerus joint surface will move in the opposite direction of the limb that is moving
So, as the surface of the head of the humerus is moving inferiorly, the upper extremity as a whole is moving superiorly
A difference in closed chain and open chain exercises can alter the direction of the_______ _________ __________.
joint surface movement
Open chain hip flexion
(convex moving on concave)
closed chain hip flexion
(concave moving on convex)
How well joint surfaces match or fit is called
Joint Congruency
When joints are most congruent, the articular surfaces have ____________ contact with each other, are compressed and the tissues holding them together are taught (ligaments, capsule, etc.)
- In this position they are most difficult to separate. This position is called the closed-pack position
maximum
This position occurs when the ligaments and capsules holding the joint are very taut and you can no longer achieve additional ROM.
Closed Pack Position
When a joint is swollen, it cannot be placed in a ________pack position
closed
- Closed pack position is used when testing for _____________ and joint _________ and__________
- Ligamentous
- stability
- integrity
FYI
Because of the nature of the position, joints are more susceptible to injury in a closed pack position
FYI
Closed Pack Position Points to remember:
- The maximum area of surface contact occurs
- The attachments of ligaments are farthest apart and under great tension
- Capsular structures are taut
- The joint is mechanically compressed and difficult to distract
- Resting position of the joint and the majority of the parts of the joint are lax and there is minimal congruency between the articular surfaces
- Easier for joint mobilization
- Allow for roll, spin and glide which are necessary for normal joint movement
- Accessory motions are better demonstrated in open/loose pack positions (involuntary movement that accompanies osteokinematic movement)
Open Pack/Loose Pack Position
Open Pack/Loose Pack Position Points to remember:
- Ligamentous and capsular structures are slack
- Joints can be distracted several millimeters
- Allows for necessary motions of spin, roll, and slide
- Decreases joint friction
- Best position for joint mobilization
Closed Pack Position
Temporalmandibular – clenched teeth
Facet – vertebral extension
Glenohumeral – abduction and lateral rotation
AC joint – arm abducted to 30˚
SC joint – maximum shoulder elevation
Ulnohumeral – Extension
Radiohumeral – elbow flexed 90˚, forearm supinated 5˚
Proximal radioulnar – supination 5˚
Distal radioulnar – supination 5˚
Radiocarpal (wrist) – extension with ulnar deviation
CMC- N/A
Metacarpophalangeal (fingers) – full flexion
Metacarpophalangeal (thumb) – full opposition
Interphalangeal – full extension
Hip – full extension and medial rotation
Knee – full extension and lateral rotation of the tibia
Talocrual (Ankle) – maximum dorsiflexion
Subtalar – supination
Midtarsal – supination
Tarsometatarsal – supination
Metatarsophalangeal – full extension
Interphalangeal – full extension
Open Pack Position The expectation is that these will be learned and memorized.
Facet (spine) – Midway between flexion and extension
TMJ – Mouth slightly open
Glenohumeral – 55˚ abduction, 30˚ horizontal adduction
AC joint – arm at rest by your side, normal physiological position
SC joint arm at rest by your side, normal physiological position
Ulnohumeral – 70˚ flexion, 10˚ supination
Radiohumeral – full extension with full supination
Proximal Radioulnar – 70˚ flexion, 35˚ supination
Distal Radioulnar – 10˚ supination
Radiocarpal (wrist) – neutral with slight ulnar deviation
Carpometacarpal (CMC) – Midway between abduction/adduction and flexion/extension
Metacarpophalangeal – slight flexion
Interphalangeal – slight flexion
Hip – 30˚ flexion, 30˚ abduction, slight lateral rotation
Knee – 25˚ flexion
Talocrual (ankle) – 10˚ plantarflexion, midway between inversion and eversion
Subtalar – Midway between extremes of joint movements
Midtarsal - Midway between extremes of joint movements
Tarsometatarsal - Midway between extremes of joint movements
Metatarsalphalangeal –Neutral
Interphalangeal – slight flexion
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Shoulder
- Flexion 0-180
- Extension 0
- Hyperextension 0-50
- Abduction 0-180
- IR 0-90
- ER 0-90
- Horizontal Abd (from 90 abduction position) 0-40
- Horizontal Add (from 90 abduction position) 0-130
Normal ROM Values in Degrees The expectation is that these will be learned and memorized
Elbow
- Flexion 0-140
- Extension 0
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Forearm
Supination from functional position 0-80
Pronation from functional position 0-80
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Wrist
- Flexion 0-80
- Extension 0-70
- Radial Deviation 0-20
- Ulnar Deviation 0-30
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Fingers
- MCP flexion 0-90
- MCP hyperextension 0-20
- MCP abduction 0-20
- MCP adduction 0
- PIP flexion 0-100
- DIP flexion 0-70
- IP extension 0
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Thumb
- CMC abduction 0-70
- CMC adduction 0
- CMC flexion 0-15
- CMC extension Norms are not related to the method of measurement we are using (vary from 20-80 degrees)
- MCP flexion 0-50
- MCP extension 0
- IP flexion 0-80
- IP extension 0-20
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Hip
- Flexion 0-120
- Hyperextension 0-20
- Abduction 0-40
- Adduction 0- 20 across midline
- ER 0-45
- IR 0-45
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Knee
- Flexion 0-150
- Extension 0
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Ankle
- DF 0-20
- PF 0-40
- Inversion 0-30
- Eversion 0-20
- Subtalar inversion 0-5
- Subtalar eversion 0-5
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Toes
- Great toe MTP flexion 0-30/45
- Great toe MTP hyperextension 0-50/70
- Great toe IP flexion 0-30/90
- Great toe IP extension 0
- PIP 2-5 flexion 0-35
- DIP 2-5 flexion 0-30
Normal ROM Values in Degrees The expectation is that these will be learned and memorized.
Cervical Spine (universal goniometer method)
- Flexion 0-40
- Extension 0-50
- Rotation 0-50
- Lateral bend 0-22
