peripheral manipulation Flashcards
manipulation uses a ___ velocity and ___ amplitude thrust that goes beyond the ________ barrier but stays within the ________
high velocity (fast) low amplitude (short distance) physiological barrier to anatomical limit
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?
about 30 mins
what are three theories that potentially explain the pain relief that can be felt with manipulation?
1) alteration of muscle tone (neurophysiological effect)
2) mechanical disruption of intra-articular lesions
3) psychological influences
what are the two types of manipulations?
distraction
glide
what are three indications for performing a manipulation?
- articular fixation (hard EF)
- articular adherence, scar tissue
- no more improvement with mobilizations
There are 14 contraindications for manips listed in our slides. How many can you remember?
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
what are two precautions for manips?
- diabetes (can cause connective tissue, vascular, and/or neurological diseases)
- asthma (corticosteroids can lead to osteoporosis)
what should be done right before performing a manipulation?
pre-manip hold: go to R2, hold 10 sec and ask for final approval while monitoring irritability and pt willingness to continue.
under what conditions would you decide not to perform a manipulative thrust?
- 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
describe the protocol for manipulation in order
- 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
what should you do after manipulating a joint?
ligament stress tests, and treat any instability with tape and/or HEP
what are some special considerations to keep in mind when you are intending to do peripheral manipulation to the wrist?
- scaphoid fractures can be missed on xray for first 2 weeks after injury
- carpal bone hypermobility
- nerve and blood vessel compression
what are some significant clues that would indicate a fixation of the wrist joint?
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
what are two special considerations for elbow manipulations?
- ULNT before
- joint hypermobility
what are some significant clues that would indicate a fixation in elbow abduction?
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
what are some significant clues that would indicate a fixation in elbow adduction?
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
what are some significant clues that would indicate a fixation of the radius in supination?
AROM: decreased pronation and hard EF
glides: decreased posterio-lateral glide and hard EF
what are some significant clues that would indicate a fixation of the radius in pronation?
AROM: decreased supination and hard EF
glides: decreased antero-medial glide and hard EF
what are some clues that would indicate a fixation of the talus anteriorly?
- 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
what are some clues that would indicate a fixation of the talus posteriorly?
- injury in full DF
- ROM: decr PF and hard EF, DF may be full but painful
- ## glides: decr ant glide and hard EF
what are some clues that would indicate a fixation of the calcaneous in pronation?
- 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
what are some clues that would indicate a fixation of the calcaneous in supination?
- 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
what are some clues that would indicate a fixation of the tibia medially?
- 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
what are some clues that would indicate a fixation of the tibia laterally?
- 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
