Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PTS FINAL > Joints Treatment MT3 > Flashcards

Joints Treatment MT3 Flashcards

1
Q

what should be treated?

A

signs and symptoms (info from subj assess and PE) and not diagnosis
1st distinguish the problem stucture ( prim and secondary joint) = differential diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

e.g of treatment protocol when the patient has OA of the knee?

A

NB- dont focus on OA but go back to individual pt in front of you
?main problems?
?what bothering the patient?
?main complaints about condition affecting him?

overall:
what is S&S that pt present with at that moment
might change each session

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the focus of the treatment theme?

A

treatment of the primary joint structures

by: using manual joint mobilisation i.e moving the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the primary joint structures?

A 
capsules
ligaments
cartilage
articulation surfaces
=present at prim site of joint

treatment process:
mobilise the capsule & associated structures
facilitate the gliding & sliding & rolling of jnt structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

in context treatment:

A

cannot be isolated to joint alone, it will always, to greater or lesser extent, influence muscle/ nerve tissues

(seldom found that only joint structures are affected, therefore attention must be given to all the subsytems of body during the eval- clinical reasoning is very NB)

e.g which struct affected when do AP on fibula head?
popliteal nerve
hamstring
gastrocnemius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is main AIM of mobilisation?

A

to ensure maximum and painfree function of the NMS system
-within the abilities of the client

you want to get your pt to point where he/she can do what they really want to do (FN is main aim)

Fn goals between people will differ/ between age
=need to change treatment plans according to fn goals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

treatment based on ICF

A 
1. Impairment
pain, stiffness, spasm
treat these to influence:
2. (Dis) ability/ function
e.g cannot drive car/ cant step up or down
3. participation
e.g cannot perform work or play soccer

so we want to re-edu the fn to influence his participation & facilitate participation= reach max potential for the pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the 5 pillars of health care?

A 
prevention 
promotion
treatment
rehabilitation
referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the role of joint mobilisation within the 5 pillars of health care?

A
  1. Accurate evaluation
    ID: impairments, disabilities, participation restrictions of specific pt
    1.1 prevention
    assist to find methods to prevent injury or ways to chnage the way the person using the device
    1.2 promotion
    e.g advice pt to lose weight/ ergonomics
    1.3 treatment
    joint mobilisation techniques
    1.4 rehabilitation
    appropriate exercises, to return to everyday activities
    1.5 referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can be faulty at the joint?

A 
pain
hypomobility
muscle spasm
hypermobility
instability
abnormal resistance
abnormal quality of movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the causes of joint abnormality?

A 
capsular stiffness
abnormal biomechanics
pain
muscle spasm
muscle weakness
muscle stiffness
muscle imbalance

pathology (degeneration, inflammation)
cant be treated with MT but can be indirectly treated with MT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the AIMS of treatment?

A 
to decrease abnormal joint factors (PRS)
to increase joint mobility
to improve tissue fluid dynamics (reduce swelling)
to correct muscle imbalances
to reduce postural stress
aids in functional recovery
to advice and educate

muscle imbalance and postural stress treated?
e.g shoulder and thorax
losen the thorax to provide the R for scapular muscles to re-align T.
the m contract better after the joint has been mobilised by correcting proprioceptive input and optimal jnt position aid in opt correc recruitment of the m surrounding the joint
therefore the scapula m will have improved fn on scapula & aid/ assist shoulder move

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what do you have in your basket/toolbox to achieve these treatment aims:

A 
EPT
immobilisation
exercise
advice and educate
re-education (HOL)
strengthening 
mobilisation :soft tissue
Mobilisation

techniques chosen specific to individual pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is manual joint mobilisation?

A

(he who works with his hands is a laborer; he who works with his hands and his mind is a craftsman; he who works with his hands and his mind and his heart is and artist.

consider the pt and their life & environment & what are your trying to achieve for them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the different philosophies of joint Rx

A
  1. Maitland

2. Mulligan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

types of techniques for joint mobilisation:

A
  1. Active movement (assisted or not)
    could be physiological movement =osteokinematic move
    -bone move through range around axis of joint
    e.g Fl, Ext; abd/add & internal/ ext rotation
  2. passive movement
    PAM= access/ arthrokinematic- occur at any joint: small movement (roll, glide, slide)
    PPM
  3. combination of the above

NB consider the rhythm when applying these techniques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the types of techniques for joint mobilisation?

A 
active movement (assisted or not)
-mulligan
PAM
-maitland, mulligan
PPM
-maitland, mulligan
combinations of above
-maitland, mulligan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

the usefulness of PPM

A 
local circulation
joint nutrition
pain relief
ROM= improve and maintenace
Relaxation

e.g
paralysis= have some effects on bone health & contracture at the joint (quadriplegia/ paraplegia)- immobility/ lack of move: soft tissues can start to contract & use PPM to maintain ROM, prevent contraction at joints
diabetes= may develop diabetic neuropathy: nerve damage-> cause dec in ROM in ankle (tighten collagen of soft tissues in this area- painful movements) =PPM: pain relief, improve or maintain ROM
immobilisation in bed (cones callipers)= PPM: maintain joint range, prevent stiffness, help relaxation
joint pain= PPM help with circulation & jnt nutrition & relieve of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the usefulness of PAM

A 
improve joint mobility (ROM)
improve joint play (arthrokinematics)
pain relief
joint nutrition
confirm/ refute joint involvement (Assessment)

e.g
stiff knee post immobilisation (can glide patella to relieve joint pain)
tennis elbow (change grip or strengthen muscles)
cervical pain (facet) - locked or stuck; use PAM
nerve root injuries (targets nerve space/ neural dynamics) ; pain relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

usefulness of PAM in more detal:

A 
joint play (arthrokinematics) = if the joint cannot glide effectively, limit jnt ROM; capsule stiff and m weaken
compression of joint surfaces can increase intra articular joint pain: graded compression can be used to treat pain
distraction of joint surfaces can decrease intra articular joint pain: distraction can thus be used as treatment for pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the treatment plane of the joint?

A

is an imaginary line that runs through the joint; parallel with the concave surface & at 90 deg angle to the axis of rotation of the convex surface

NB as it influences your treatment direction/ angle

this means that if the concave surface moves, the treatment plane moves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how does the treatment plane influence the treatment direction?

A

if apply a PAM e.g glide= it will be parallel with the treatment plane

e.g knee= lateral or medial glide

if do compression or distraction= it will be perpendicular to treatment plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

why is the concave-convex rule NB?

A

it influences your choice of technique
choice of technique is dependent on the biomechanics of the joint

direction of the glide:
when the convex surface moves, the direction of the glide is opposite to the direction of the moving lever arm
e.g the treatment plane does not move
because the concave part of joint is not moving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

convex-concave rule carried on:

A

If the concave part of the lever arm moves= the direction of the glide within the joint is in the same direction as the moving lever arm

in this e.g
the treatment plane moves, because the concave surface of jnt moves
means that when apply treatment= you will also have to change direction of treatment according to how concave jnt arm is aligned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q
  1. why is the concave-convex rule NB?
A

we use it to work out which glide we should use for treatment by manual mobilizations

for treatment, we use the direction of glide that is associate with the problematic movement

thus
work out which PAM is needed from the restricted physiological movement
& then use that glide as 1st choice to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Knee Fl

A

the pt can only do 60 deg of knee fl because it is painful
therefore we use post glide on tibia to treat it
because when doing knee flexion the tibia which is the concave surface moves in a post direction

so treat at 60 deg for stiffness by applying a glide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

shoulder abduction

A

if painful at 100 deg we use inferior glide on the humeral head, because the moving lever arm is convex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MAITLAND key aspects

A 
patient centeredness
way of thinking- reasoning
specific evaluation
techniques
assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what MAITLAND concept?

A

not mechanics of technique, But in it’s approach to the patient and his particular problem. Attention to detail in exam, treatment and response.

concepts/guidelines of assessment and treatment
sound foundations of basic biological knowledge
the necessity of high level of skill
the evolution of the concepts:
the necessity for detailed exam
and for the exam/ treatment/ re-exam approach

30
Q

evaluation (need a thorough)

A

subjective (interview) assessment

objective (physical) assessment

31
Q

techniques of MAITLAND

A

a technique is the brainchild of ingenuity:

  • dynamic =need to progress as the pt progresses
  • techniques for Ev vs Rx
  • adaptation of techniques (can use exam tech as treatment tech when modified)
  • PAM & PPM as Rx
  • always evaluate your technique efficacy
32
Q

what is unique to MAITLAND concept?

A

oscillatory/ repetitive method of technique application
rhythm of technique
grades of movement
compression as treatment technique

33
Q

what does Oscillations: rhythm mean?

A

reps of same technique= e.g AP glide of tib on femur- should be smooth & uniform, even rhythm
slow come up and then down
(up & down movement; equal in size; time of each wavelength is the same)

34
Q

rhythm of the techniques?

A

rhythm can be (slow, fast, sustained) -> smooth, staccato/flicking, broken

35
Q

oscillations: amplitude of technique?

A

how big the wave is

36
Q

grades of movement?

A 
not only decision making tool
but also communication tool
& determined by:
-determining the resistance (R)
-the amplitude (A) of the movement performed
37
Q

types if passive movement

A 
physiological/ accessory
or combined 
-PPM
-PPM &PAM
-PAM
38
Q

when doing MAITLAND treatment

A

PPM or PAM or combinations
grade of movement
rhythm of movement
with or without compression/ distraction

39
Q

compression vs distraction for Rx

A

there is a time in Rx when joint surfaces should be kept apart (avoid contact) -> while still being able to Rx by PM
to avoid aggravation (e.g. joint very irritable/ SIN/ severe P
very small distraction (<1mm)

equally (and more commonly) there is a time for moving a joint while compressing the joint surfaces

  • for ‘chronic’ symptoms (‘chronic’ i.t.o current Sx’s i.e. not necessarily ‘long term’ problem)
    e. g shoulder P where P is provoked by lying on affected shoulder (so the longer before pain starts= the longer the compression force applied)
40
Q

which factors influence your choice of treatment?

A
  1. patient diagnosis (e.g RA, OA, post #)
    history, stability of the condition, stage of healing
    symptoms and signs (pain vs spasm vs stiffness)
    response during/ after treatment
41
Q

what are the phases of conditions of Maitland?

A

Phase 1: pain and stiffness
phase 2: intra-articular, peri-articular
phase 3: arthritic conditions
phase 4: impacted #
phase 5: hypermobility
phase 6: loose fragment in joints (e.g meniscus/ cartilage)

42
Q

MAITLAND phase 1:

A

pain and stiffness
-patients with readily recognizable combinations of signs and symptoms can be divided into FOUR main clinical groupings for the purposes of selection and progression of mobilization techniques

43
Q

phase 1 has 4 groups:

A

group 1: pain
group 2: stiffness
group 3: 3(a) P>S; 3(b) S>P
group 4: momentary pain

44
Q

Group 1: pain dominant factor

movement is limited by pain only

A 
key features:
pain present with rest 
pain starts early in ROM
pain limits the movement early in ROM
if SIN-> take precautions not to cause flare up during Ev and Rx
45
Q

Group 2: stiffness

A

key features:
stiffness limits the movement
pain be present only at the end of ROM (stretch)

46
Q

Group 3: pain & stiffness occur simultaneously and is related each other

A 
key features:
pain intensity inc proportional to inc in stiffness (felt as resistance)
3(a) P>S
3(b) S>P
joint factors occurs together TROM
47
Q

Group 4: pain is dominant, but pain is momentary

A

key features:
no observable dec ROM with general movement
pain is associated with certain movements/ positions (only)
sudden ‘bite/jab’ of P-> reproduced with combination movements/ sustained combination movements (quadrant positions)

48
Q

Rx guidelines- group 1: pain

A

general:
NB
determine SIN (get from interview)
determine P1 or point where pain increases
correct positioning of painful joint is imperative
too much movement may even lead to pain after stopping the movement (latent pain)
Rx needs to be ‘gentle’
choice of rhythm:
slow & smooth

49
Q

what are the group 1 treatment rules?

A
  1. P1< 60% of normal ACTIVE mvmt
  2. P>60% of normal ACTIVE mvt
  3. P1>75% of normal ACTIVE mvt
50
Q

If, P1 <60% of N act mvt:

A

Rx in p-painfree position/neutral
joint well supported while treat
outside (not in) P
do only PAM’s or shaft rotation (spin) where possible, i.e joints that can spin)
choose one direction of movement (as a start)
big amplitude movements- Gr2 and progress to Gr 3

51
Q

If, P1>60% of N act mvt:

A

Rx in a painfree position (but more than neutral)
Rx in a painfree ROM (outside of pain)
can do PAM’s: Gr II or *III
can do PPM: Gr II or *III
*if possible can start in resistance
progress: choose joint position to treat further in ROM

52
Q

P1>75% of N act mvt:

A

Rx in 10-20% of pain (=in discomfort)
Rx near to the EOR
can do:
PAM: Rx in R (even do GrIII+ or IV+, if indicated)
PPM: Rx in R(even do GrIII+ or IV+, if indicated)
combination: PAM in a passive physiological position
-e.g GH PA in 150 deg fl)
therefore bring up arm to 150 deg fl & then a PA glide on GH joint to help with last part of movement

53
Q

dosage for Group 1 conditions:

A

dosage is time contigent (depend on time)
If SIN/ if irritable
= 3 sets of 10 sec each
(10 sec of oscillations & you will repeat 3 times= more or less 1 oscillation per second)

if not SIN
=3 sets of 30 sec each
more or less 1 oscillation per second

re-evaluate after each set

54
Q

Rx Guidelines- group 1: Pain

A

choice of technique:

  • choice of direction of glide (PAM) -> acc to biomechanical rule (convex-concave rule)
  • choose most limited PAM
  • at later stages-> progress to most painful PAM
55
Q

Rx Guidelines - Group 1: Pain

where in the ROM should I do the moblisation?

A

If SIN or if irritable- perform the technique far away from P1
if pain increases quickly with movement- perform the technique far away from P1
e.g: Act Sh F (L)= 0-60 deg (8/10 pain)
treat in neutral or 10 deg of fl

56
Q

Rx Guidelines- Group 1: Pain

what amplitude should I choose?

A

where in the ROM P starts
how P inc (behaviour)
irritability

But in practice… “the larger the amplitude that can be performed when treating pain, the more effective it will be”

  • SIN or irritable condition= small A
  • when you mobilise closer to P1= small A
  • when you mobilise further from P1= large A
57
Q

Re-evaluation

How do you know that the pain (group 1) improved?

A
  1. Pain occurs later in ROM that before
  2. pain intensity dec (8/10 -> 7/10)
  3. speed with which pain increases is slower (dec)
    so that they can do more move before the pain starts
    then you will know pain improved & techniques are working
58
Q

Re-evaluation

How do I adapt my technique after re-evaluation?

A 
If Sx are better
-repeat same procedure
-progress to bigger A
-progress to deeper in R
If Sx are worse
-decrease A (smaller)
-decrease ROM (do earlier in ROM)
No change
-repeat procedure
-or try another technique
59
Q

Rx guideline- Group 2: Stiffness

A

General:
mobilise needed @ point of limitation
in all indicated directions

any PPM and all PAM that is limited may be used in EOR of physiological movements as stretching techniques

60
Q

Rx Guidelines- Group 2: stiffness

A

Option 1:
identify limited physiological movement
take to EOR
whilst keeping joint @ limit, use PAM as stretch technique
perform small amplitude oscillatory stretching movements (GrIV+/GrIV ++)
choose PAM acc to biomechanics

61
Q

Rx Guidelines- Group 2: stiffness

Option 2

A 
identify limited physiological movement
take it to EOR
perform small amplitude oscillatory stretching movements (Gr IV+/GrIV++)
smooth or staccato rhythm
you are using the PPM as Rx treatment
62
Q

Rx Guidelines- group 2: stiffness (dosage)

A

dosage=
4x60 sec OR
4x45 sec

(stretch the capsule)

63
Q

Rx Guidelines- Group 2: stiffness

aftercare of joint after stretching it

A 
treatment pain (Rx P)
common due to stretching of structures
how to treat Rx pain?
PPM
in direction you stretched in 
gr III or Gr III-
30sec x 3 oscillations
=to get rid of the pain metabolites can apply heat for the pain/ EPT
64
Q

Group 3: Pain & Stiffness

A

determine which is dominant: pain or stiffness

determine the exact relationship between stiffness and pain (movement diagram)

65
Q

Group 3(a): Pain > Stiffness

A 
general:
the movement is limited by pain
But there are some underlying stiffness
Usually not SIN
therefore can treat in R
Rx and progress with group 1 (pain)
treatment direction of movement need to correlate with functional problem

BUT
dosage= 3x30 sec

if no change in Sx:
try active mobilisation (e.g Mulligan)
OR
Rx as Group 3(b) but consider pain- just touch on pain

66
Q

Group 3(b) : Stiffness > Pain

A

treat almost like for Group 2
stiffness limits the movement, but there is pain not associated with stretching the tissues

treat 5-10 degrees short of EOR
within R (always GrIII or IV) (and - or +)
Rx focussed on addressing R
Respect pain: can touch P1- but don't go into it
dosage: 30 sec x 3
67
Q

Group 3(b): Stiffness > Pain

A

progression:
when pain decreases- move further into ROM

may need to treat:
Rx Pain
muscle spasm

68
Q 
Group 3(b): Stiffness > Pain
what if there is muscle spasm?
A
  1. evaluate:
    joint well supported?
    your handgrips correct and firm
  2. dont force through spasm
    do small A PPM against the spasm (can try with PAM also)
    try to move further in ROM
  3. Can use continuous stretch (stretch out the muscle in spasm)
69
Q

Group 4: momentary Pain

A

must get a positive * sign (i.e must reproduce the pain)
usually a combination movement (e.g Quadrant)
can be a sustained position with compression (kneeling)

Rx:
use the combination movement that reproduced the symptoms (e.g knee fl/ add)

use Gr IV and Gr III (tot ++) (vary between the two grades)

70
Q

Group 4: momentary

Dosage

A

1 x 60 sec
In pain

treat for treatment pain

PTS FINAL (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions