quiz #1 (intro - shoulder) Flashcards
joint mobs definition
skilled passive movement by therapist on articular surfaces to decrease pain / increase joint mobility or ROM
physiological effects of joint mobilization
-fires articular mechanoreceptors
-fires cutaneous & muscular receptors
-abates or stops nociceptors (pain receptors)
-decreases or relaxes mm guarding
-causes synovial fluid movement & improves
nutrient exchange
-improves mobility & flexibility at joint
-maintains tensile strength of articular tissues
arthrokinematics
-motions you can feel
-movement that occurs INSIDE joint
(roll, spin, slide/ glide)
osteokinematics
-motions you can see
-movement of body parts OUTSIDE joint
(flex, ext, ADD, ABD, rotate)
close packed position
-articular bones have MAX area of contact
-joint stability = greatest
-max mobility
*injury: fracture / dislocation
open / loose packed position
-joint surfaces become separated
-little congruity & minimal surface contact
-joint stability = minimal
*injury: sprains, strains, swelling
capsular pattern of restriction
-predictable pattern of movement restriction
-when entire joint capsule is injured / affected
-order: most restricted to least
CONCAVE / CONVEX RULE
when concave surface moves on convex surface
roll & slide must occur in SAME direction
CONVEX / CONCAVE RULE
when convex surface moves on concave surface
roll & slide occur in OPPOSITE directions
joint distraction
two opposing joint surfaces separated from each other, moving toward loose/ open packed position
axial distraction
through long axis of joint
lateral distraction
perpendicular to long axis of joint
compression / approximation
two opposing joint surfaces move toward each other / approximated - toward close packed position
joint play
motion available between two articular surfaces in one direction
not under voluntary control
rules of joint play (pt.1)
-patient must be relaxed
-therapist must be relaxed & comfortable
-mobilize one joint, in one direction, & at one time
rules of joint play (pt.2)
-assessment of joint play should always be in loose packed position
-do not lever joint
-watch for patient discomfort
-always re-assess prior & after Tx
causes for joint dysfunction
-intra articular adhesions / pericapsular stiffness
-shortened mm groups around joint
-mm weakness & imbalance around joint
-pain
-nerve root adhesions
-soft tissue restrictions
indications for joint play
-most commonly associated with restoring ROM for peripheral & axial skeleton joints
-primary indication: decreased ROM due to immobilization, usually from fractures, ligamentous sprains, tendonitis, or adhesive capsulitis
-any condition involving fibrosis or pseudo-fibrosis (relative capsular fibrosis) of joint capsule is indicated for mobilization
CI’s joint play
hypermobility
joint effusion
inflammation
precautions joint play
-malignancy
-bone disease
-unhealed fracture
-excessive pain
-total joint replacements
-newly formed/ weakened CT
-systemic CT disease
-elderly (weakened CT)
methods of joint examination
-inspection
-palpation
-ROM (active vs passive)
-radiography (x-ray)
-CT scan
-MRI
-conventional & contrast Arthrography
-ultrasound Arthrography
inspection & palpation - looking for…
-swelling
-skin changes
-mm, above & below joint (wasting) compared to non injured side
-deformity, bones misaligned, valgus / varus
ROM
measurement of amount of movement around a specific joint
passive (relaxed) ROM
therapist makes motions of joint while patient is relaxed through unrestricted range
-patient does not contract mm
-anatomic barrier = end of PROM
active ROM
patient “actively” contracts voluntary mm crossing joint, moving joint through its ROM
-physiologic barrier = end of AROM
grading joint play
-when applying joint mobilizations: start with least stress on joint and go to more & more stress
-we use grading system for both sustained glides/ distractions & oscillations
-each grade has purpose & function within grading system for a therapeutic effect on joints
GRADE 1 - sustained glide / traction
-initiation of movement of opposing joint surfaces
-perpendicular to joint surfaces for a distraction joint mob/ parallel for a glide joint mob
non-corrective grade
GRADE 2 - sustained glide / traction
-movement of opposing joint surfaces is up to first tissue stop
-perpendicular to joint surfaces (distraction) or parallel (glide)
non-corrective grade
GRADE 3 - sustained glide / traction
-movement of opposing joint surface is up to & through first tissue stop
-stretches joint capsule - perform grade with caution
corrective grade
GRADE 1-3 purpose
GRADE 1 & 2: pain management, intro assessment to joint play & techniques
GRADE 3: corrective, stretch joint capsule, restore glide motions with joint
GRADE 1 - oscillations
small amplitude
between initiation of movement & tissue resistance - at the start of motion
5 cycles per second
GRADE 2 - oscillations
large amplitude
between initiation of movement & tissue resistance, not reaching end of ROM
performed at 2-3 cycles per second
GRADE 3 - oscillations
large amplitude
within tissue resistance & backing out again - to start of limited end of ROM
2-3 cycles per second
GRADE 4 - oscillations
small amplitude
within tissue resistance to end of limited ROM
5 cycles per second
GRADE 5 - oscillations (not in scope)
high velocity, small amplitude, non-oscillatory
starts at tissue resistance & follows through in a thrust manipulation - commonly called a thrust, adjustment, or manipulation
end feels
-when assessing passive movements, therapist applies overpressure at end of the range to determine quality of end feel
-sensation therapist “feels” in joint as it reaches end of ROM of each passive movement
normal end feels
bony: “hard” unyielding sensation that is painless
soft tissue approximation: yielding compression, or “mushy” feel
tissue stretch: firm springy type of movement with slight give, an elastic resistance, may be hard (capsular) or soft (elastic)
abnormal end feels
-early spasm: mm/ ligament tear, often acute
-late spasm: instability
-capsular: hard (chronic) & soft/ boggy (acute), caused by capsule damage
-empty: ligament rupture or tear, very painful
-bone to bone: osteophyte, early restriction in ROM
-springy block: internal derangement inside joint, common in meniscus, early restriction
GH mobilizations
- Anterior glide
- Long axis traction
- Posterior glide
- Inferior glide at 90 degrees of abduction
- Inferior glide at 90 degrees of flexion
- Lateral distraction
anterior glide - effect & precautions
EFFECT: increase extension, pain management
PRECAUTIONS: anterior joint capsule is looser & more lax so don’t over mobilize in this direction
long axis traction (axial distraction/ inferior glide) - effect & precautions
EFFECT: increase overall ROM, pain management
PRECAUTIONS: do not allow shoulder girdle to move inferiorly as it may compress brachial plexus between clavicle & first rib
posterior glide - effect & precautions
EFFECT: increase internal rotation & flexion, pain management
PRECAUTIONS: do not allow the humerus to externally rotate
inferior Glide at 90º of ABD - effect & precautions
EFFECT: increase ABD & flexion, pain management
PRECAUTIONS: with inferior joint instability use caution, may provoke pain
inferior Glide at 90º of flexion - effect & precautions
EFFECT: increase flexion & ABD, pain management
PRECAUTIONS: do not lever joint as this may damage capsule - take caution for inferior joint instability - try to minimize pain at humeral head while mobilizing
lateral distraction - effect & precautions
EFFECT: increase overall ROM, pain management
PRECAUTIONS: do not apply pressure to patient’s chest with forearms, may compress ribs, forearm should be just below breast tissue
scapulothoracic joint mobilizations
- Inferior glide/shoulder depression
- Superior glide/shoulder elevations
- Lateral rotation/upward glide
- Medial rotation/downward glide
- Distraction
- Compressions to subscapularis muscle
superior glide / shoulder elevation - effect & precautions
EFFECT: increase shoulder elevation & stability, pain management
PRECAUTIONS: use soft touch & light pressure to prevent mm guarding
inferior glide / shoulder depression - effect & precautions
EFFECT: increase shoulder depression & mobility, pain management
PRECAUTIONS: if brachial plexus is stretched/ compressed, it may cause symptoms during mobilization, discontinue - perform with care
lateral rotation (upward rotation) - effect & precautions
EFFECT: increase lateral rotation & elevation, pain management
PRECAUTIONS: use broad & soft contact for numerous bony prominences
medial Rotation (downward rotation) - effect & precautions
EFFECT: increase medial rotation & depression, pain management
PRECAUTIONS: use broad & soft contact for numerous bony prominences
distraction (scapulothoracic) - effect & precautions
EFFECT: increase overall thoracic mobility, pain management
PRECAUTIONS: do not perform if patient has winged scapula - too much pressure may cause mm guarding & pain
compressions to subscapularis - effect & precautions
EFFECT: increase scapulothoracic mobility, pain management
PRECAUTIONS: if painful, discontinue
