Mobs mostly shoulder Flashcards
Describe concave/convex rule in relation to joint mobs for convex on concave joint:
Convex on concave: The glide & therapeutic movement should be performed in the opposite direction of the bone movement (osteokinematics) of the physiologic movement.
Note: Roll follows osteokinematic movement regardless of whether bone surface is concave or convex. The direction of the gliding portion of movement depends on whether the moving surface is convex or concave. Joint mobs should correspond to the gliding movement of the joint.
Describe concave/convex rule in relation to joint mobs for concave on convex joint:
Concave on Convex: The glide & therapeutic movement should be performed in the same direction of the bone movement (osteokinematics) of the physiologic movement.
Note: Roll follows osteokinematic movement regardless of whether bone surface is concave or convex. The direction of the gliding portion of movement depends on whether the moving surface is convex or concave. Joint mobs should correspond to the gliding movement of the joint.
Define physiological movements:
Movements a patient can do voluntarily with muscle contraction.
Examples: flexion, extension, abduction, adduction, and rotation.
The word osteokinematics is used when these motions are used to describe bones.
Define Accessory Movements:
Movements within the joint and surrounding tissues which are necessary for full ROM but that cannot voluntarily be performed in isolation by the pt.
The terms component motions and joint play are used when these movements are described
Component motions
Motions in a related joint that accompany and allow active motions of the primary joint for normal function, but are not under voluntary control.
Example: the upward rotation of the scapula that accompanies shoulder flexion.
Joint Play
Motions that occur in the joint as a result of an outside force and require extensibility or “pliability” in the joint capsule.
Includes distraction/traction , gliding/sliding, compression , spinning , & rolling of joint surfaces.
Example, rotation of the metacarpophalangeal (MCP) joint during finger flexion is needed to functionally grip a ball.
Distraction/Traction
The separation of joint surfaces
Gliding/Sliding
When a constant point on one bony surface comes in contact with new points on the opposing bony surface
Compression
The approximation (forcing together) of opposing joint surfaces
always occurs when moving toward the close-packed position.
Spinning
Rotation of a moveable component about a stationary mechanical axis.
The same point on the moving surface creates an arc of a circle as the bone spins.
Rolling
movement in which points at intervals on the moving joint surface contact points at the same intervals on the opposing joint surface
Close-packed position
The most stable position of the joint.
Tension on the articular capsule and ligaments is maximal and the joint surfaces are most congruent. The joint capsule/major ligaments are taut causing joint surfaces to become firmly approximated. The surfaces cannot be pulled apart with traction and no degrees of freedom of movement are allowed.
Specific for each joint.
Loose Packed Position
- Position of minimum congruency
- Position minimum tissue tension (at least part of the joint capsule and ligaments are lax)
- Ideal position for evaluation of accessory motion
- Different for each joint
Capsular Pattern
- Characteristic pattern of AROM/PROM limitations for a given joint that suggests dysfunction of the entire joint capsule or synovial membrane.
- Only found in synovial joints controlled by muscles.
- Each joint has a specific pattern.
- Joint fibrosis, effusion , or whole joint inflammation (such as in OA) also common causes.
Non-capsular pattern of restriction
- A pattern of motion loss that does not follow the capsular pattern.
- Typically occur with intra-articular mechanical blockage or extra-articular lesions.
- Common causes: isolated ligamentous or capsular adhesions, internal derangement (such as torn meniscus), and extra-articular tightness (such as from muscle length deficits).
Indications for Joint Mobilizations (4)
- Joint hypomobility
- Joint pain
- Reflex muscle guarding
- Muscle spasm
Absolute Contraindications for Joint mobs (10)
- Acute inflammation/infection
- Vascular disease
- Advanced osteoarthritis
- Surg. repaired/reconstructed stuct w/o adequ heal
- Joint/capsular hypermobility
- Malignancy
- Vertebrobasilar insufficiency
- Spondylolysis/Spondylolisthesis
- Down’s Syndrome
- Recent Fractures
Relative contraindications / precautions for joint mobs (9)
- Hard neuro signs, such as true numbness or weakness
- RA (Rheumatoid Arthritis)
- Hypermobility
- Osteoporosis
- Total joint replacements
- Individuals with open growth plates
- Excessive pain
- Pregnancy
- Recent fractures with secondary hypomobility
How many grades of joint mobs are there?
5
Describe a Grade I Mob:
Small amplitude movement at the beginning of range
Describe a Grade II Mob:
Large amplitude movement in mid-range
(does not hit end range)
Describe a Grade III Mob:
Large amplitude movement that hits the end range
(reaches resistance)
Describe a Grade IV Mob:
Small amplitude movement that hits and stays near the end range
(stays within resistance)
Describe a Grade V Mob:
Small amplitude, high velocity thrust.
(beyond resistance)
Actually a true manipulation.
What are grade I and II mobs useful for? (3)
- promote relaxation/get used to therapist touch
- decrease pain
- increase synovial fluid/lubricate joint
(can be used alone in an irritable of inflamed joint, or before and after the grade III or IV mobs in a joint where pain results mainly form tissue stretching)
What are grade II, grade IV and grade V mobs used for? (1)
increase range of motion
What is the best rate for mob oscillations?
approximately two mobs per second
how long should each technique be applied for?
30-60 seconds
Each 30-60 second treatment is know as a __________.
set
How many “sets” of mobs are generally performed per treatment session? What is the specific choice within this range based on?
3-10 sets based on acuity and irritability of the joint.
What mobs have we learned for the SC joint? (2)
- AP Glide of Clavicle on Sternum
- Inferior Glide of Clavicle on Sternum
What mob did we learn for the AP joint?
(pretty sure this is a typo and should say AC joint)
AP Glide
(same hand position as the AC Anterior-Posterior Shear test)
What mobs did we learn for the Scapularthoracic (physiological) joint? (8)
- Elevation Glides
- Depression Glides
- Protraction Glides
- Retraction Glides
- Upward Rotation Glides
- Downward Rotation Glides
- Circumduction Glides
- Distraction Glides
What mobs did we learn for the GH joint?
- Caudal Glides (varying angles, we practiced in 30, 60?, 90, & 150 degrees)
- Lateral Distraction
- Anterior Glides
- Anterior Glides with External Rotation
- Posterior Glides
- Posterior Glides with Internal Rotation
What is the significance of doing the Anterior Glides WITH External Rotation & Posterior Glides WITH Internal Rotation?
It places the joint in a position so that the mobs will automatically be at grade 3 right off.
Draw the mobs chart that shows each grade on a continuum:
https://classconnection.s3.amazonaws.com/297/flashcards/2750297/jpg/mob_grades-1482E60FCF61A258DAD.jpg
(hyperlink is to attached picture)
GH joint: Capsular pattern
ER more limited than Abduction, which is more limited than IR
Often expresed this way: ER > Abd > IR
Capsular pattern for SC joint:
Pain at extreme ROM
SC joint, close-packed position
Max shoulder elevation
SC joint, open packed position:
0 degrees neutral position of shoulder
AC Joint, Closed Packed position:
30 degrees of abduction
AC Joint, capsular pattern:
Pain at extreme ROM
Which two joints affecting the shoulder have “pain at extreme ROM” as their capsular pattern?
SC & AC Joints
AC Joint, open-packed position
0 degrees, neutral shoulder position
GH Joint, close-packed position:
90 degrees abduction
&
90 degrees external rotation
GH Joint, open-packed position:
55 degrees abduction, 30 degrees horizontal adduction, (scaption)
