Class 1 - Terms, I&CI, Assess, S&S Curve, Excursion, End feel Flashcards
D) Osteokinematic mvmt
D) Arthrokinematic
Gross mvmt of bone @ jt: FLX
Mvmt occuring w/i jt: Slide, roll, glide
D) Passive accessory mobilization/manip
D) Muscle Energy Technique (MET)
EXTERNAL imposed small amplitude passive motion to produce a GLIDING/TRACTION @ jt.
Passive jt mvmt induced by ACTIVE contrax of Pt own Mm
D) Mobilization w/ mvmt
D) Passive Physiological Mobilization/manipulation
Passive Jt. Motion w/ AROM
PROM
Explain the concave convex rule and its significance to joint manipulation
Concave moving on convex, slide and roll occurs in same direction
Convex moving on concave, slide and roll is in opposite direction
What is a component or accessory joint motion?
Arthrokinematic mvmts that must/involuntarily accompany the osteokinamtic mvmt (roll of femur @ FLX of knee)
6 Abs CI to Jt Play
- Neoplasm
- Jt sepsis
- bact infection
- Acute inflammatory cond (e.g. Acute RA)
- Recent Fracture
- Acute (P) resp to manipulation
What are the corrective grades of oscillations, and what is the correct grade
of sustained glide?
G3-4 are corrective grade
G3: Large amplitude oscillation w/i tissue resistance and backing out. 2-3 cycles/second (Rhythmic)
G4: Small amplitude oscillation w/i tissue resistance. 5 cycle/s
Oscillatory mvment: Fast vs. slow
Choice of oscillatory vs sustained:
____ is used w/ all gliding test/mobil
Inhibit pain (fast and small amp) vs muscle guard (irrelgular rhythm w/ slow & large amp to trick Mm) for acute or to prep for stretch in chronic
Pt resp.
Traction Gr 1
How do we mv jt to avoid tension to capsule and ligaments
Oscillation purpose: Acute vs Chronic
Mgmt @ beginning or mid-pt of joint play amplitude
Acute: PROM mobilization, vs Chronic: intermittent @ initiation btw stretch & end to relax Mm
Stretch for capsular adhesion/tightness: first move jt to the limit ______
Must be _______ (cadence) b/c
Slack in taken up in jt play is ______ as mvmt performed
of pathologic amplitude and attempt to incr. amplitude
Rhythmic & slow, avoid Mm reflx contraction
Slack not released
Stops: used when_____
Tp uses their _____ as a stop which allows for _____ and for the pt, ____ (example)
Stretch limits of osteokinematic re: tight capsule
Body (trunk, forearm/thigh), progressive incr ROM, for pt indicates exact extent of mvmt to reduc anticipatory Mm guarding (thigh next to ghj for int/ext rot)
Indictations of Jt Mob (6)
Add:
Incr jt extensibility ROM - capsular adhesion
Decr (P)
Promote relaxation (oscillation)
Incr. Mm strength due to more aligned jt components
Incr positional fault
Jt nutrition
Meniscoid impingement, spinal jt disc herniation, SNS change, placebo
Preeacutions (4)
Dx not fully evaluated
Jt ankylosis (mobilize jt above & below)
Hypermobility
Local area: local jt/skin infection, malignancy, acute fracture
Inflammatory arthritis/effusion, dise compromising integrity of periarticular tissue, LT corticosteroid
Protect spasm
What to do when joint mobes results in (P)
Why do we do the MNRS of HOPMNRS
Chg position, hand placement, circulatory PROM to calm down S&S
Rule out specific conditions
Resting aka ____ defn
Most comfortable for ____
If resting can’t be done, place _____
Loose pack position: most lax/greatest accessory mvmt, anatomical resting position (most glide, roll, spin)
Pt w/ jt pain comfort
Least amt of tissue tension (asking actual resting position for pt - let go)
Accessory motion assesed by moving _____
Majority of jt mobes is _____
Tx plane
Example jt:
one bone on other = arthrokinematic
Perpendicular: Distraction or compression
Parallel to Tx plane - Glide (majority of jt mobes) (eg. GHJ & humerus)
Stress-strain curve:
Tensile force to tissue, goes through strains:
1st stage - Elastic, returns to original configuration post force
2nd stage - Plastic, permanent elongation of tissue post-force
3rd stage - failure/breaking = separation of elongated tiss, stress fracture
Necking pt (2.5) decrease in load accompanied by incr in deformation, breaking pt about to be reach
Jt play aka _____ defn
Accessory motion examination entails (3)
Excursion
Jt mobility eval using glide or traction re: available motion through tissue resist
Amt of excursion per direction
Presence of pain
Type of tissue resistance @ end of range for accessory motion
Grades of excursion:
0-6
0: No motion btw artic surf - ankylosed = CI
1-2: considerable to slight limitation in excursion, indicated
3: Normal excursion - not indicated
4-5: Slight to considerable increase in excursion. not indicated, treat w/ stabilization exercuses, education on posture/position to avoid
6: Unstable jt, CI for mobil, Tx w/ stabilization, pt edu re: posture & position avoid, taping, lower success
End Feel
resistance to mvmt felt when going to end pt of mvmt.
Patho depending on feel @ pt in ROM or movement
End feel
Defn:
Normal End feels:
Ligamentous - slight recoil (ABD of knee)
Capsular - firm (full gh EXT ROT)
Bony - no recoil/abrupt
Soft tissue approx: Knee/Elb FLX
Muscular - Rubbery feeling, less abrupt than capsular (hamstring stretch)
End feel:
Strictly pathological (3/5)
Mm spasm - usually P), some synov inflamm
Capsular -
Hard: tight resist to creep, chronic inflamm
Soft: w/ P), Mm guard - acute inflamm
Boggy: soft mushy feel, no syn inflamm (w/ capsular)
End feel:
Strictly pathological (2/5)
If bit of resistance before end P) it’s____
Internal derangement: springy (noncapsular from mechanical block - elbow/knee)
Empty - no restriction, stopped due to severe P) - acute bursitis of v. severe fracture. Mm do not contract
Mm spasm.
Ovoid joint/synovial
Sellar joint
Ex)
Surface A) entirely convex, B) entirely concave
Surface A) concave in one direction, and convex in perpendicular direction
Sterno-clavicular
Intervention:
Never perform in____
Start - resting position (safest), verify safety,
Next - move to position approximating restricted ROM
Close packed: capsule/lig max stretch (most tamped down with some twisting) & jt most congruous
Kaltenborn
Maitland
Sustained glide - 1-3, for tractions
Oscilation 1-5 grading system, glide intervention. 5 being out of scope.
Closed packed position
Resting position
Articular surfaces most aligned, jt capsule is twisted, surfaces approximated, no furter mvmt in the direction is possible.
Most synovial effusion, articular surfaces separated, capsule is relaxed
