phys med- midterm Flashcards
joint mobilization
up to but does not excess anatomic end ROM
can be in physiologic or non physiologic directions (i.e. flexion vs longitudinal traction)
graded mobilization/ oscillation
take joint to end range or point of pain and hold against resistance until feel releasee (up to 10 secs)
can add movement/oscillation
continuous vs progressive stretching
continuous: hold for 10 secs
progressive: stretch, relax, stretch
traction/ distraction - what are the effects?
pull one body in relation to another
help with mechanoreceptors, inhibit afferent nerve impulses, improve fluid exchange blood and lymph
strain- counterstrain
when muscle strained, the antagonistic muscle may cause continued pain (need antagonistic to be normal length)
put involved muscle in maximal shortening then stretch and then neutral
myofascial release
reduce muscle spasm, etc
apply force against soft tissue barriers and use deep long gliding strokes over fascia
active myofascial release
put muscle in shortened position, apply pressure, the stretch tissue through active or passive motion
proprioceptive neuromuscular facilitation (PNF)
hold-relax-stretch
trigger points
tender spots in a shortened muscle band
reduce circulation and nervee conduction
local and referred pain’
active or latent pain
myofascial trigger point pathophysiology
- increase ACH at motor end plates
- sarcomere shorten
- increase metabolic demands, decreases oxygen perfusion,
- energy crisis, hypoxia, ischemia
- release inflammatory molecules
- sensitize nervous innervation
trigger point theory (travel and simmons)
vapoocoolant spray when tissue is stretched and acu needles into trigger point (they used wet needles)
ischemic compression
deep pressure over tender muscle modular
can use over trigger points
massage goals
enhance tissue extensibility
deep: increase blood flow and cutaneous temperature
massage effects which systesm
nervous
muscular
circulatory
lymphatic
effleurage (massage technique)
gliding or stroking over large area with broad contact
superficial or deep
warms tissue
use to start and end a session
petrissage (massage technique)
kneading/pinching
grasp skin while applying cross-fibre stroking or stretching
alternate: traction, squeeze and relax
for vascularity and fluid exchange
reduce swelling and fluid accumulation
create hyperemia (increase blood flow)
decreases muscle tone via spindle cells and Gogli tendon receptors
may break adhesions
roulomont (massage technique)
skin rolling
lift skin from underneath fascia
tapotement (massage technique)
tapping or vibration
perpendicular to muscle fibers
reflexive physiologic effects in 2-5 mins: hyperaemia, improved muscle tonicity, reflex stimulation of cutaneous receptors
friction (massage technique)
side to side or small circular movements
move skin over subq. tissue and muscle
NO LUBE
performed over ligaments or myofascial lesions
release adhesions, edema, pain…
TMJ motions
jaw open/close (rotate and glide)
jaw protract/retract
side gliding (TMJ forward, medial and down when chin rotates laterally)
upper c -spine motions
flexion extension at occipitoatlantal
rotation at atlantoaxial
lower c spine motions
flexion extension at C5/6
TMJ distraction
move mandible inferior and perpendicular to joint surface of temporalis
TMJ anterior glide
grade 1 traction
TMJ medial glide
x
sternocostal joint for
more movement during elevation of arm
acromioclavicular joint prevents
excessive movement of the joint, strengthen joint capsule
glenohumeral joint
glenoid labrum fro firbocartilagious rim to increase surface area for humerus contact
scapulohumeral rhythm
first bit is glenohumeral then rest is with scapula
muscles for arm
flexion
extension
abduction
adduction
internal rotation
external rotation
Flexion
Anterior deltoid, coracobrachialis, pectoral major (clavicular)
Extension
Latissimus dorsi, teres major, posterior deltoid
Abduction
Middle deltoid, supraspinatus, serratus anterior (scapular stability)
Adduction
Pectoral major, latissimus dorsi
Internal Rotation
Latissimus dorsi, teres major, anterior deltoid subscapularis, pectorals major
External Rotation
Posterior deltoid, infraspinatus, teres minor
muscles fro
scapular stabilization
scapular retraction
scapular elevation
Scapular Stabilization
Trapezius, serratuis anterior, rhomboids
Scapular Retraction
Rhomboid major and minor
Scapular elevation
Trapezius, levator scapulae
adhesive capsulitis is when
tendons and the bursa - supraspinatus and deltoids become “stuck together”
immobile - capsule tightens and fibrosis
caused by degenerative joint disease, RA< immobilization,..
impingement syndrome
narrowed space btw acromion and humerus –> pinch long head of biceps and/or rotator cuff (supraspinatous)
rotator cuff injury cause
falling on outstretched hands (FOOSH) injuries, impingement in coracoacromial arch, minor or repetitive stretch
most common rotator cuff injury
supraspinaotus
GH distraction
x
GH glides (4)
inferior, posterior, anterior, posterolateral
GH posterolateral glide purpose
decrease pain, increase pain free ROM in flexion and abduction
traction used in GH glides
grade 1 traction
overall purpose of distraction
increase accessory motion
increase ROM
decrease pain
scapulothoracic distraction
medial and inferior movement of scalp and lift it away from ribs
4 scapulothoracic glides
superior
inferior
medial
lateral
sternocostal glides(4)
superior (glide clavicle up)
inferior (push clavicle down)
posterior
anterior
acromioclavicular glides (2)
posterior
anterior
elbow is what type of joint an which motions
modified hinge joint
flex, extension, supination, pronation
lateral epicondylalgia
inflam and pain as extensors rub against lateral epicondyle and radial head during contraction
micro tears in tendon
local pain or goes down forearm (extensors)
carpal tunnel syndrome
nerve compressed?
from?
median nerve compressed through flexor retinaculum/transverse carpal ligament
i.e. from genetics, repetitive hand use, extreme wrist flexion or extension over time, pregnancy, other health conditions
decreased MCP (metacarpalphalangeal) ROM
I,e, after fracture, arthritides
humeroulnar distraction
pt supine and upper arm held against table while forearm on dr shoulder, pull ulna from humerus
humeroulnar medial glide
pt supine
mobilizing hand on lateral proximal radius –> move ulna in medial direction indirectly through the radius
grade 1 traction
humeroulnar lateral glide
pt supine
grade 1 traction and move ulna lateral
humeroradial distraction
pt supine
pull radial head distal and perpendicular to radial joint surface
humeroradial posterior glide
pt is supine and shoulder is medial rotated
Grade 1
humeroradial anterior glide
pt supine and shoulder medial rotated
posterior glide of proximal radius
supine
stabilize posterior proximal ulna
mobilize on anterior radial head and then push it posteriorly
anterior glide of proximal radius
pt supine
push radial head anterior and stabilize ulna head
posterior glide of distal radius
pt sitting
stabilize distal ulna and place hand on anterior distal radius and push posterior
anterior glide of distal radius
(near hand)
push radius anteriorly from posterior side and stabilize anterior ulna
wrist distractions
stabilize ulna and radius on table and then pull proximal row of carpals distally and perpendicular to joint surface
wrist posterior glide
pt sitting and forearm on tx table with hand off the table
hold radius and ulna on table and move proximal row of carpals posteriorly
wrist anterior glide
move proximal row of carpals anteriror
stabilize radiu and ulna on tx table
wrist medal glide
move proximal carpals medial
stabilize r and ulna on tx table
wrist lateral glide
move proximal carpals lateral
midcarpral joints
grab proximal row and distal row of carpals
distraction
posterior, anterior, medial and lateral glide
inter metacarpal joints
posterior and anterior glide
1st MCP
stabilize head of 1st MCP and mobilize proximal 1st phalanx
dsitraction
medial and lateral glide
MCP joints
stabilize head of metacarpal and mobilize proximal phalanx
distraction
posterior
anterior
medial
lateral
interphalangeal joint
distraction
posterior
anterior
