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CP2 > Joint MObs (wk 1) > Flashcards

Joint MObs (wk 1) Flashcards

1
Q

Loss of motion at a joint could be due to what reasons? (6)

A

a. Pain and muscle guarding
b. Joint hypomobility (Grade ¾ Joint Glides)
c. Joint effusion (inflammation)
d. Contractures or adhesion in joint capsule or supporting structures
e. Combination

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2
Q

What are the objectives of manual therapy? (5)

A

a. Pain modulation
b. Address tissue extensibility
c. Address muscle guarding
d. Peripheral effects (improve circulation, fluid/waste uptake, improve healing, etc.)
e. Improve tolerance for other interventions

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3
Q

How do you assess the effectiveness of manual therapy?

A

Test re-test

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4
Q

What position of the joint do you perform assessment?

A

quality and quantity of joint movement in resting position

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5
Q

Open pack position of z joint?

A

midway between flexion/extension

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6
Q

Open pack position of TMJ?

A

Mouth slightly open

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7
Q

Open pack position of GH?

A

55 deg abduction, 30 hor add, slight ER

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8
Q

Open pack position of AC/SC?

A

Arm by side

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9
Q

Open pack position of ulnohumeral?

A

70 flex

10 supination

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10
Q

Open pack position of radiohumeral?

A

full ext

full supination

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11
Q

Open pack position of Proximal radioulnar?

A

70 flex

35 supination

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12
Q

Open pack position of distal radioulnar?

A

10 supination

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13
Q

Open pack position of Wrist?

A

flight flex and ulnar deviation

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14
Q

Open pack position of CMC?

A

midway between abduction/adduction and flexion/extension

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15
Q

Open pack position of MCP?

A

slight flexion

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16
Q

Open pack position of IP?

A

SLIGHT FLEXION

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17
Q

Open pack position of Hip

A

30 flex
30 abduction
0-5 ER

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18
Q

Open pack position of Tibiofemoral?

A

25 flex

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19
Q

Open pack position of patellofemoral?

A

full extension

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20
Q

Open pack position of talocrural (ankle)

A

10 plantarflexion

midway between inversion and eversion

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21
Q

Open pack position of subtalar/midtarsal/tarsometatarsal?

A

Midway between extremes of ROM

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22
Q

Open pack position of MTP?

A

Neutral

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23
Q

Open pack position of IP of foot?

A

Slight flexion

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24
Q

What 3 characteristics are you assessing in joint mobility assessment?

A
  1. Gross quantity (hyper, hypo, normal)
  2. End-feel (firm, hard, empty)
  3. Provocation (painful, painless)
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25
Q

Manual therapy techniques involving movement of articulating surfaces with intention of: (6)

A
  1. Regaining normal ROM
  2. Improving joint capsule extensibility
  3. Regaining normal distribution of forces and stresses on a joint
  4. Reducing pain
  5. Lubricating joint surfaces
  6. Providing nutrition to joint structures
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26
Q

T/F Manual therapy is most effective when combined with a comprehensive treatment plan

A

True

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27
Q

Absolute or relative contraindication:

Osteoporosis

A

Relative Contraindications

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28
Q

Absolute or relative contraindication:

Malignancy in area of treatment

A

Absolute Contraindications

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29
Q

Absolute or relative contraindication:

Fusion of the joint

A

Absolute Contraindications

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30
Q

Absolute or relative contraindication:

Arthroplasty

A

Relative Contraindications

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31
Q

Absolute or relative contraindication:

Practitioner lack of ability

A

Absolute Contraindications

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32
Q

Absolute or relative contraindication:

Hypermobility

A

Relative Contraindications

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33
Q

Absolute or relative contraindication:

Upper cervical spine instability

A

Absolute Contraindications

34
Q

Absolute or relative contraindication:

Fracture at the joint

A

Absolute Contraindications

35
Q

Absolute or relative contraindication:

Excessive pain or swelling

A

Relative Contraindications

36
Q

Absolute or relative contraindication:

Neurological deterioration

A

Absolute Contraindications

37
Q

Absolute or relative contraindication:

Infectious arthritis

A

Absolute Contraindications

38
Q

Absolute or relative contraindication:

Spondylolisthesis

A

Relative Contraindications

39
Q

Absolute or relative contraindication:

Cervical arterial dysfunction

A

Absolute Contraindications

40
Q

Proposed biomechanical mechanism for joint mobilizations:

A

i. Motion improvement
ii. Positional improvement
iii. Increase joint capsule extensibility

41
Q

Proposed nutritional mechanism for joint mobilizations:

A

i. Synovial fluid movement

ii. Improve nutrient exchange

42
Q

Proposed neurophysiological mechanism for joint mobilizations:

A

i. Stimulates mechanoreceptors to inhibit pain impulses
ii. Gate control theory
iii. Descending pathway inhibition theory
iv. Peripheral inflammatory modulation

43
Q

What region do you have to get to in order to cause long term changes to tissue?

A

Plastic region (microtears)

44
Q

What are the 4 types of joints mobs?

A

a. Distractions
b. Oscillation mobilizations
c. Sustained hold mobilizations
d. Mobilization with Movement

45
Q

What is the joint play movement of compression?

A
  • approximation of joint surfaces

- force perpendicular to joint plane

46
Q

What is the joint play movement of traction/distraction?

A
  • separation of joint surfaces

- force perpendicular to the joint plane

47
Q

What is the joint play movement of gliding?

A

force direction parallel to joint surface

48
Q

What is grade 1 of the kaltenborn distraction?

A

piccolo (loosen)

49
Q

Describe the amount of stress on the joint capsule and the purpose of a grade 1 (piccolo) kaltenborn distraction:
When will these distractions be used?

A

i. Very small amplitude of traction force
ii. Minimal stress on the joint capsule
iii. Reduces compression forces on articular surfaces
iv. Pain reduction
v. Used with gliding mobilizations

50
Q

What is grade 2 of the kaltenborn distraction?

A

slack (take up the slack - tighten)

51
Q

Describe the amount of stress on the joint capsule and the purpose of a grade 2 (slack) kaltenborn distraction:
When will these distractions be used?

A

i. Slack in joint capsule and surrounding tissues is taken up
ii. Can help to determine the sensitivity of the joint
iii. Used to alleviate pain, assess joint play, and/or reduce muscle guarding

52
Q

What is grade 3 of the kaltenborn distraction?

A

Stretch

53
Q

Describe the amount of stress on the joint capsule and the purpose of a grade 3 (stretch) kaltenborn distraction:
When will these distractions be used?

A

i. Designed to stretch joint capsule and soft tissues surrounding the joint to increase mobility
ii. Used to assess end feel or increase movement

54
Q

What is the primary goal of grade 1/2 maitland joint mobilizations?

A

reduce pain and muscle guarding, improve joint lubrication/nutrition

55
Q

T/F No direct mechanical effect on restrictions while using grade 1/2 mobilizations

A

True

56
Q

T/F Grade 1/2 maitland joint mobilizations are often used before and after grade 3/4.

A

True

57
Q

What is the theory behind grade 1/2 maitland joint mobilizations?

A
  1. Reduces pain by improving joint lubrication and circulation to tissues related to the joint
  2. Rhythmic oscillations possibly activate articular and skin mechanoreceptors which play role in pain reduction
58
Q

What is the primary goal of grade 3/4 maitland joint mobilizations?

A

stretching joint capsule and associated structures (ligaments, muscles attaching in the area)

59
Q

What is a grade 5 maitland joint mobilizations?

A

High velocity thrust of small amplitude at end of available range but within its anatomical range

60
Q

Primary goal of grade 5 maitland joint mobilizations?

A

decrease pain and muscle guarding

61
Q

If you are using sustained hold mobs to target pain, what range of motion do you hold at?

A

beginning range to mid range

62
Q

If you are using sustained hold mobs to target joint mobility, what range of motion do you hold at?

A

end range.
- Address tissue extensibility directly to allow motion (when enough force applied for enough time according to stress-strain curve for collagen)

63
Q

Resting position of joint used for what 3 things?

A
  1. assessment
  2. acute stage
  3. during grade 1/2 oscillations
64
Q

Joint mob oscillation frequency and duration?

A
  1. 1-3/seconds

2. Typically: 1-5 sets for 15-60 seconds each

65
Q

Joint mob sustained holds frequency and duration?

A
  1. Typically: 1-5 sets for 5-30 seconds each

2. More commonly used to treat ROM (end range sustained holds)

66
Q

Ex: What direction would I mobilize the femur to improve hip extension?

A

Anterior glide mobilization in max hip extension ROM

67
Q

EX: What direction would I mobilize the acetabulum to improve hip extension?

A

mobilize acetabulum and stabilize femur = concave on convex = to improve extension at hip joint = posterior roll and posterior glide = mobilize acetabulum posterior to improve extension

68
Q

Mobilization with movements golden rule:

A

should be painless, if pain occurs either need to change direction of force, correct pressure, or not use MWMs

69
Q

Mobilization with movements guidelines: (3)

A

i. Should be pain free
ii. Apply 10 times before reassessing joint motion
iii. Overpressure should be applied at end range of AROM

70
Q

Ex: MWM increase shoulder flexion?

A

apply posterior mobilization while patient is actively flexing shoulder

71
Q

EX: What direction of joint glide would you perform in non-weight bearing to improve ROM in ankle dorsiflexion?

A

posterior glide

72
Q

EX: What direction of joint glide would you perform in non-weight bearing to improve ROM in tibiofemoral flexion?

A

posterior glide

73
Q

EX: What direction of joint glide would you perform in non-weight bearing to improve ROM in GH IR?

A

posterior glide

74
Q

EX: What direction of joint glide would you perform in non-weight bearing to improve ROM in Radiocarpal extension?

A

anterior glide

75
Q

Ex: What grade(s) of joint mobilization glides would you want to perform for GH hypomobility w/o pain?

A

3/4

76
Q

Ex: What grade(s) of joint mobilization glides would you want to perform for GH pain w/o hypomobiltiy?

A

1/2

77
Q

Ex: What grade(s) of joint mobilization glides would you want to perform for Gh hypomobility with pain?

A

1-4

78
Q

Ex: What are working to improve if grade 3 gh distraction is performed?

A

general mobility

79
Q

Ex: What are working to improve if grade 2 inferior patellofemoral mob is performed?

A

pain with flexion

80
Q

Ex: What are working to improve if grade 3 anterior hip (femur on acetabulum) mob is performed?

A

mobility with hip extension/ER

81
Q

Ex: What are working to improve if grade 3 posterior radiohumeral mob= is performed?

A

mobility extension

CP2 (20 decks)

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