Hypermobility/Instability - Exam 2 Flashcards
what are the 4 variables of stabilization?
joint integrity (i.e, cartilage)
passive stiffness (i.e. ligaments)
neural input
muscle function
abnormal movement resulting in P! changes what?
instantaneous axis of motion
what is functional instability? can PT help this?
instability that can be stabilized with muscle activity and/or positioning
PT can help
what is mechanical instability? can PT help this?
instability that cannot be completely stabilized with muscle activity or positioning
PT cannot help - not a good outcome
what are causes of hypermobility?
traumatic or recurrent sprains (i.e IDD)
age related disc changes
repetitive extension activities
creep due to poor posture
adjacent joint hypomobility
connective tissue disorder (generalized hypermobility)
what is the most common site for hypermobility?
C5-C7
what are the “tests” to assess for benign joint hypermobility syndrome?
stand and touch palms to floor
each knee that hyperextends
each elbow that hyperextends
each thumb that touches the forearm
each little finger with 90 MCP hyperextension
what are the major criteria for benign joint hypermobility syndrome?
greater than or equal to 4/9
arthralgia > 3 months in 4 or more joints
what are the minor criteria for benign joint hypermobility syndrome?
less than or equal to 3/9
arthralgia > 3 months in 1-3 joints or LBP > 3 months
soft tissue injury in >equal to 3 locations
tall, slim body type
abnormal skin
droopy eyes
vericose veins, hernias
Confirmed BJHS if:
2 major criteria present
1 major and 2 minor criteria present
4 minor criteria present
what would a patient tell you if they have functional instability?
predictable pain (every time i do ..)
spine and referred pain, possibly paresthesias from nociplastic pain
decreased pain positional changes and support
increased pain with prolonged positions, looking up, sudden and strenuous ADLs, impact activities
catching (randomly moving into position that creates pain)
easy self manipulation (cracking back)
what would a PT find in a scan for functional instability?
ROM?
combined motion?
resisted/MMT?
neuro?
stress tests?
ROM:
acute - limited with aberrant motion
primarily limited and painful with extension because of increased anterior vertebral shearing followed by SB
PROM > AROM, esp in non-WB vs WB
increased creasing of the neck
combined motion: inconsistent block
Resisted/MMT:
acute - painful
most often strong and painless (global muscles not affected)
neuro: negative
stress tests: + PA, compression/distraction not telling much
what would a PT find in a biomechanical exam for functional hypermobility
accessory motion?
linear stability tests?
accessory motion:
finds hypomobility best
possible hypomobility if hypermobile joint is stuck like the drawer example
possible adjacent hypomobility
linear stability tests: +
excessive anterior shearing
stabilized by muscle activation because it would activate the local muscles
what are mechanical instability symptoms?
same as functional instability except worse and with:
- unpredictable pattern of provoking activities
- worsening symptoms with more frequent episodes
- increased pain with even trivial and lesser ADLs
what are mechanical instability signs?
same as functional instability except worse and with:
+ stress tests that wont stabilize fully with repositioning or muscle activation
even in closed pack position, the joint will move
