Joint mobilisation

Question 1

Why do we mobilise joints

Answer 1

Healthy joints
Dysfunctional joints e.g. Ankle sprain (ATFL)
Pathological joints e.g. Osteoarthritic shoulder (glenohumeral) joint

Question 2

mobilisation

Answer 2

‘passive movements performed in such a way that at all times they are within the control of the patient so that he can prevent the movement if he so chooses.’  small - large amplitude, low velocity.

Question 3

manipulation

Answer 3

‘sudden thrust or movement of small amplitude, performed at a speed that renders the patient powerless to prevent it.’  small amplitude, high velocity.

Question 4

physiological(osteokinematics) movements

Answer 4

those that patient can carry out actively

Question 5

accessory arthrokinematic movements

Answer 5

those that patient cannot perform himself but which can be performed on him by someone else
Possible because all joints have certain slackness in capsule & surrounding ligaments

Question 6

PROM

Answer 6

Passive movements –
Physiological movements that are performed by the therapist – at a single joint or at several joints in sequence to maintain joint range & muscle length
Not graded

Question 7

PPM

Answer 7

Passive Physiological Mobs (Graded)

Question 8

PAM

Answer 8

Passive Accessory Mobs (Graded)

Question 9

Arthrokinematics

Answer 9

(direction of glide)

Question 10

arthrokinematics is determined by

Answer 10

by morphology (shape) of joint surfaces

Question 11

Kaltenborn’s Convex-Concave rule

Answer 11

Arthrokinematics (direction of glide) is determined by morphology (shape) of joint surfaces

Question 12

AP accessory movements

Answer 12

anteroposterior glide

Question 13

PA accessory movements

Answer 13

posteroanterior glide

Question 14

Longitudinal caudad

Answer 14

caudad

in line with long axis of bone

Question 15

lat

Answer 15

Lateral distraction

or lateral glide

Question 16

ceph/comp

Answer 16

Longitudinal cephalad

Question 17

med

Answer 17

Medial glide

Question 18

rotator cuffs invest Glenohumeral GH

Answer 18

joint capsule and controls humeral head movements

Question 19

where does RTC centre

Answer 19

‘centres’ the humeral head to assist in stability of a very mobile joint

Question 20

RTC has an impact on

Answer 20

on HH gliding directions (think of cellophane)

Question 21

shoulder rotation

Answer 21

EXTERNAL ROTATION / EXTENSION

INTERNAL ROTATION / FLEXION (ELEVATION)

Question 22

in vivo

Answer 22

consider impact of tightening capsule and rotator cuff musculature

Question 23

Accessory Movement Exam can:

Answer 23

Identify & localise symptomatic joint
ASSESS - Define nature of joint motion abnormality
NORMAL vs. HYPOMOBILE vs. HYPERMOBILE
TREAT - Provide basis for selection of treatment techniques.

Question 24

Exam technique

Answer 24

Apply pressure close to joint line, examine unaffected side first for comparison.
note QUALITY 
RANGE of motion
Pain behaviour through range
Resistance

Question 25

grade I

Answer 25

Small-amplitude movement performed at the beginning of range

Question 26

grade II

Answer 26

Large-amplitude movement performed within a resistance-free part of the range.

Question 27

Grade III

Answer 27

Large-amplitude movement performed into resistance or up to the limit of the range.

Question 28

Grade IV

Answer 28

Small-amplitude movement performed well into resistance.

Question 29

Accessory movements in clinical settings

Answer 29

Position pt comfortably
Examine joint on unaffected side first & compare
Examine initially without feedback – helps learning
Use largest area of skin contact possible for max patient comfort
Keep thumbs straight

Question 30

how should force be applied

Answer 30

Where possible, clinician’s forearm should lie in direction of applied force
Apply force smoothly & slowly through range to either assess or treat (grades)