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Joint Mobs > General Joint Mobs Intro > Flashcards

General Joint Mobs Intro Flashcards

1
Q

Define joint play

A

refers to the mvmt of “play” available when the joint is in some degree of loose-pack and can be assessed

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2
Q

define joint mobilization

A

a passive modality that moves a joint through its’ accessory mvmts (normally not under voluntary control), to restore pain-free physiological mvmt.

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3
Q

What are the sub-types for synovial diarthrotic joints? and what are their axis types?

A
  1. planar - biaxial
  2. hinge - monaxial
  3. pivot - monaxial
  4. condyloid - biaxial
  5. saddle - multi/triaxial
  6. ball and socket - multi/triaxial
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4
Q

Define osteokinematic

A

The gross or physiological mvmt of a joint (angular, special and rotation)

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5
Q

Define arthrokinematic

A

the mvmts occurring between the articulating surfaces themselves

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6
Q

Define accessory or component mvmts

A

the particular arthrokinematic mvmts, (like roll, glide/slide, spin, etc), that occur as one bone moves on another w/in the joint.

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7
Q

Define Roll

A

an accessory/component mvmt analogous to a wheel rolling on a surface; it always travels in the same direction as the angular/physiological mvmt of the bone itself.
ie. knee flexion, an angular mvmt, moves in a posterior direction; like wise, roll is posterior in knee flexion

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7
Q

Define glide/slide

A

a component/accessory mvmt where bone’s articulating surface slips on the other; similar to the way a puck slides on ice.
-the direction of slide is either the same or opposite of the physiological/osteokinematic mvmt, depending on the articular surface’s concave or convex nature.

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8
Q

Define spin

A

an accessory/component mvmt where the bone turns around a “mechanical axis” while maintaining a constant contact at a particular paint on the reciprocating bone. ie the radius on the humerus or a spinning top.

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9
Q

What do you base the tx plane off of during a joint mob?

A

the tx plane is based off the concave sides’ bone shaft.

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10
Q

When doing tractions or compressions are you treating perpendicular or parallel to the treatment plane?

A

You are treating perpendicular to the tx plane during traction and compression.

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11
Q

When you are doing glide/slide mvmts are you treating perpendicular or parallel to the treatment plane?

A

You are treating parallel to the treatment plane.

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12
Q

Where is the mechanical axis?

A

It is perpendicular to the treatment plane.

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13
Q

What is traction?

A

the application of a force to draw or pull articulating surfaces apart.

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14
Q

Define compression?

A

the application of a manual force to approximate or press articular surfaces together.

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15
Q

Define close-pack position.

A

the position of a joint when its articular surfaces are most closely approximated, or congruent, and involves a rotational component, where the joint capsule and peri-articular ligaments are tightened so that the joint is fixed or locked.

  • no mvmt is possible.
  • joint mobs are CI’d because it would cause damage.
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16
Q

Define loose-pack position.

A

any position of the joint other than closed-pack, where there is laxity in some part of the joint capsule; this laxity allows arthrokinematic mvmts to occur
-joint mobs are performed in this position (the restriction is identified, the therapist backs off 10 degrees and then performs a corrective mob).

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17
Q

Define resting position.

A

the maximum loose-pack position and is ideal for joint play assessment and early treatment.
-the synovial joint naturally assumes this position when injury causes maximal synovial effusion (filling of the joint capsule)

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18
Q

Define capsular pattern of restriction

A

when joint impairment affects the entire joint, the capsule of each joint undergoes a characteristic pattern of restriction in PROM - specific for each joint.

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19
Q

What is the concave-convex rule?

A
  • if a concave surface moves on a convex surface, glide occurs in the SAME direction as roll.
  • if a convex surface moves on a concave surface, glide occurs in the OPPOSITE direction to roll
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20
Q

What are some indications for joint mobs?

A
  • the purpose of joint mobs is to restore pain-free ROM*
  • post immobilization d/t sprains, strains, #, tendonitis, bursitis, etc
  • to resolve the sequence of fibrosis and relative capsular fibrosis, (aka capsular/ligamentous tightening and adherence) and intra-articular damage
  • pain control
  • to decrease reflex muscle guarding and restore muscle balance
  • improving joint nutrition, eliminating meniscoid impingement.
21
Q

What CI’s for joint mobs?

A
  • neoplasm or any non-diagnosed lesions
  • bacterial infection
  • recent #
  • acute/active inflammatory and infective arthritis, ie. rheumatoid arthritis
  • joint ankylosis
  • joint is in closed-pack position
  • active use of corticosteroids (Risk of Harm)
  • joint hypermobility
22
Q

What are some precautions for joint mobs? these would require omission or modification of tx and are therefore cautionary

A
  • joint effusion or inflammation where excess swelling would not allow any mvmt to occur
  • chronic or non-active inflammatory arthritis
  • diseases affecting the bones structural integrity. ie. osteoporosis
  • advanced diabetes - affects integrity of CT
  • degenerative joint disease, osteoarthritis; where mobilization may adversely affect bone spurs etc.
  • local intra-articular injection (corticosteroids)
  • hormone induced joint hyper extensibility, ie. relaxin on pelvic joints
  • guest has adverse response or is too painful.
23
Q

Explain the procedure for joint mobs.

A

(maintain a dialogue with client; position for safety and efficiency)

  • joint play/assessment is performed in loose-pack position.
  • only ONE bone is stabilized, ONE bone is mobilized, ONE mvmt is performed, ONE joint is mobilized at a time.
  • DO NOT lever a joint or allow roll to occur during the manipulation
  • joint mobs are a passive modality, combining assessment and treatment.
24
Q

How many grades of joint play are there?

A

Three.

25
Q

Describe when you use each grade of joint play

A

Grade I - for acute
Grade II - for subacute
Grade III - for chronic

26
Q

What is the “first stop” vs the “anatomical limit”?

A

First stop is the capsular limit.

the anatomical limit is the max distance you can go.

27
Q

Of the three grades of traction, which are corrective?

A

Grade III is corrective.

28
Q

Which grades of traction and joint mobilization do you use to modify/interrupt pain?

A

Grade I & grade II of traction and/or grade I & grade II of joint mobilization

29
Q

Define oscillation

A

a combination of amplitude and frequency, or size and rate; applied at a specific relationship to tissue resistance. usually 3x/sec or 5x/sec.

30
Q

How many grades of joint mobs are there?

A

Five. only four are within our scope of practice.

31
Q

Describe a grade I joint mob

A

small amplitude rhythmic oscillations that are performed at the beginning range of joint play, short of tissue resistance.

  • fast rate of oscillation (5x/sec)
  • grade I traction
  • acute stage of healing
  • non-corrective
32
Q

Describe grade II of joint mob

A

larger amplitude rhythmic oscillations that do not reach tissue resistance

  • slow rate of oscillation (3x/sec)
  • grade I traction
  • subacute stage of healing
  • non-corrective
33
Q

Describe grade III joint mob

A

large amplitude rhythmic oscillations that are applied through the first barrier of tissue resistance

  • slow rate of oscillation (3x/sec)
  • grade I traction
  • chronic stage of healing
  • corrective
34
Q

Describe a grade IV joint mob

A

small amplitude rhythmic oscillations performed at the limit of available motion and into tissue resistance, but short of anatomical limit.

  • fast oscillation rate (5x/sec)
  • grade I traction
  • chronic stage of healing
  • corrective
35
Q

Define amplitude in terms of a joint mob.

A

the size of the oscillation

36
Q

Define inert tissues

A

all structures that would not be considered contractile or neurological, such as joint capsules, ligaments, bursae, blood vessels, cartilage, and drura matter.

37
Q

what are the four classic patterns of inert tissue in terms of ROM?

A
  1. ROM full and no pain. - indicating no lesion of inert tissue
  2. pain and limitation of mvmt in every direction - indicates entire jt is affected suggesting arthritis or capsulitis.
  3. pain and limitation or excessive mvmt in some directions - ligament sprain, or local capsular adhesion; mvmts that stretch, pinch or move affect structure, causing the pain; could also indicate an internal derangment
  4. limited mvmt w/o pain - end feel is usually abnormal, bone-bone type; symptomless arthritis d/t osteophytes.
38
Q

What are the four classic patterns seen with contractile and nervous tissue in terms of ROM?

A
  1. mvmt is strong and Px-free - no lesion of contractile/nervous tissue
  2. mvmt is strong and Px-ful - local lesion of mm or tendon; could be first or second degree mm strain; avulsion # (partial); tendinosis, tendinitis, paratendonitis
  3. mvmt is weak and Px-ful - severe lesion around that joint such as a #
  4. mvmt is weak and Px-free - indicates complete rupture of a mm (3 degree strain) or its tendon or peripheral nerve/nerve root supplying that mm.
39
Q

Protective muscle spasm injury

A

Early muscle spasm

40
Q

Deep tissue instability

A

Late muscle spasm

41
Q

Abnormal end feels…. Tight muscles

A

Mushy tissue stretch

42
Q

Abnormal end feels…..upper motor neuron lesions

A

Spasticity

43
Q

Abnormal end feels……Frozen shoulder

A

Hard capsular

44
Q

Abnormal end feels…..synovitis soft tissue edema

A

Soft capsular

45
Q

Abnormal end feels…. Osteophytes

A

Bone to Bone

46
Q

Abnormal end feels…acute subacromial bursitis

A

Empty

47
Q

Abnormal end feels….meniscus tear

A

Spring Block

48
Q

Normal end feels….elbow extension

A

bone to bone

49
Q

Normal end feels….knee flexion

A

Soft tissue approximation

50
Q

Normal end feels…Examples of ankle dorsiflexion, shoulder lateral rotation, finger extension

A

Tissue stretch

Joint Mobs (2 decks)

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