peripheral manipulation

Question 1

manipulation uses a ___ velocity and ___ amplitude thrust that goes beyond the ________ barrier but stays within the ________

Answer 1

high velocity (fast)
low amplitude (short distance)
physiological barrier to anatomical limit

Question 2

cavitation can cause a clicking sound as gases within synovial fluid are released and a bubble forms. How long does it take for this fluid to be reabsorbed?

Answer 2

about 30 mins

Question 3

what are three theories that potentially explain the pain relief that can be felt with manipulation?

Answer 3

1) alteration of muscle tone (neurophysiological effect)
2) mechanical disruption of intra-articular lesions
3) psychological influences

Question 4

what are the two types of manipulations?

Answer 4

distraction

glide

Question 5

what are three indications for performing a manipulation?

Answer 5

• articular fixation (hard EF)
• articular adherence, scar tissue
• no more improvement with mobilizations

Question 6

There are 14 contraindications for manips listed in our slides. How many can you remember?

Answer 6

1) incomplete S/A or O/A,
2) no conversation or 3) approval of technique
4) inadequate equipment
5) pht not comfortable with technique
6) pt not able to relax, too emotional
7) pt has pain with pre-manip hold
8) pt has constant p
9) unconsolidated #
10) luxation < 6wks
11) cancer giving osseous metastases
12) active infection
13) congenital abnormalities to joint being treated
14) osteoporosis

Question 7

what are two precautions for manips?

Answer 7

• diabetes (can cause connective tissue, vascular, and/or neurological diseases)
• asthma (corticosteroids can lead to osteoporosis)

Question 8

what should be done right before performing a manipulation?

Answer 8

pre-manip hold: go to R2, hold 10 sec and ask for final approval while monitoring irritability and pt willingness to continue.

Question 9

under what conditions would you decide not to perform a manipulative thrust?

Answer 9

• if you do not feel compfortable
• if pt does not feel comfortable or does not want to continue
• if you feel inappropriate EF
• condition is irritable

Question 10

describe the protocol for manipulation in order

Answer 10

• ask yourself if manipulation will help
• CI/precautions
• ensure you are comfortable with technique, ask pt if they are comfortable with it too (explain what you are doing)
• get pt to relax then find R2 and to pre-manip hold
• only manipulate if no CI and no pain
• go back to R2 and manipulate

Question 11

what should you do after manipulating a joint?

Answer 11

ligament stress tests, and treat any instability with tape and/or HEP

Question 12

what are some special considerations to keep in mind when you are intending to do peripheral manipulation to the wrist?

Answer 12

• scaphoid fractures can be missed on xray for first 2 weeks after injury
• carpal bone hypermobility
• nerve and blood vessel compression

Question 13

what are some significant clues that would indicate a fixation of the wrist joint?

Answer 13

MOI: injury in full flexion or extension
observation/palpation: may see dimple or protuberance
ROM: decreased and hard EF and pain
glides of carpal bones: decreased NZ and hard EF

Question 14

what are two special considerations for elbow manipulations?

Answer 14

• ULNT before

- joint hypermobility

Question 15

what are some significant clues that would indicate a fixation in elbow abduction?

Answer 15

MOI: injury from fall, pt may c/o tennis elbow, DeQuervains, wrist pain.
obs: increased carrying angle, hand in slight flexion and ulnar deviation
AROM: decr flexion and supination, decr hand extension and radial deviation
PROM: decr add with hard EF, decreased combined movement with flex/add/sup with hard EF
glides: decreased NZ of lateral glide and hard EF

Question 16

what are some significant clues that would indicate a fixation in elbow adduction?

Answer 16

MOI: injury from fall,
Obs: decreased carrying angle, hand in slight extension and radial deviation
AROM: decreased elbow extension and pronation, decreased wrist flexion and ulnar deviation
PROM: abduction hard EF and decr
glides: decr medial glide and hard EF

Question 17

what are some significant clues that would indicate a fixation of the radius in supination?

Answer 17

AROM: decreased pronation and hard EF
glides: decreased posterio-lateral glide and hard EF

Question 18

what are some significant clues that would indicate a fixation of the radius in pronation?

Answer 18

AROM: decreased supination and hard EF
glides: decreased antero-medial glide and hard EF

Question 19

what are some clues that would indicate a fixation of the talus anteriorly?

Answer 19

• plantar flexion and inversion injury
• ROM: decr DF, squat in WB, PF full but may be painful
• talar swing test: decreased and hard EF
• glides: decr post glide and hard EF

Question 20

what are some clues that would indicate a fixation of the talus posteriorly?

Answer 20

• injury in full DF
• ROM: decr PF and hard EF, DF may be full but painful
• ## glides: decr ant glide and hard EF

Question 21

what are some clues that would indicate a fixation of the calcaneous in pronation?

Answer 21

• inury in pronation
• ROM: decr supination hard EF, pronation may be full but painful
• glides: anterior joint medial glide decr hard EF AND/OR posterior joint lateral glide decr hard EF

Question 22

what are some clues that would indicate a fixation of the calcaneous in supination?

Answer 22

• inury in supination
• ROM: decr pronation hard EF, supination may be full but painful
• glides: anterior joint lateral glide decr hard EF AND/OR posterior joint medial glide decr hard EF

Question 23

what are some clues that would indicate a fixation of the tibia medially?

Answer 23

• injury, hit on lateral tibia
• may see tibial plateau more medial with observation or palpation
• ROM: combined movement with abduction decr with hard EF and pain
• glides: decreased lateral glide and hard EF

Question 24

what are some clues that would indicate a fixation of the tibia laterally?

Answer 24

• injury, hit on lateral femur
• may see tibial plateau more lateral with observation or palpation
• ROM: combined movement with adduction decr with hard EF and pain
• glides: decreased medial glide and hard EF