WRITTEN FINAL - HINTS Flashcards
joint mob definition
skilled passive movement by therapist on articular surfaces to decrease pain or increase joint mobility or ROM
physiological effects of joint mobs
-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 a joint
roll, spin, slide/glide
osteokinematics
motions you can see, movement of body parts that occurs outside a joint
flexion/extension, ABD/ADD, rotation
closed packed position
-max area of contact
-max stability
-min mobility
capsular pattern of restriction
predictable pattern of movement restriction that occurs in a synovial joint when entire joint capsule is injured or affected
CONCAVE / CONVEX RULE
when a concave surface moves on a convex surface, roll & slide must occur in SAME direction
CONVEX / CONCAVE RULE
when a convex surface moves on a concave surface, roll & slide occur in OPPOSITE directions
joint distraction (axial & lateral distraction)
two opposing joint surfaces separated from each other, moving towards a loose or open packed position
axial distraction: through long axis of joint
lateral distraction: perpendicular to long axis of joint
compression / approximation
two opposing joint surfaces moved towards each other or approximated
towards a close packed position
indications for joint play
-restoring ROM for peripheral & axial skeleton joints
-primary indication = decreased ROM due to immobilization, usually from fractures, sprains, tendonitis, or adhesive capsulitis
-any condition involving fibrosis or pseudo-fibrosis (relative capsular fibrosis) of joint capsule
contraindications
hypermobility
joint effusion
inflammation
grading joint play
-always start with least stress on joint & go to more & more stress
-use grading system for both sustained glides or distractions & oscillations
GRADE 1 - SUSTAINED
-initiation of movement
-stop before first tissue stop
non-corrective - P.M.
GRADE 2 - SUSTAINED
-up to first tissue stop, not going past
non-corrective - P.M.
GRADE 3 - SUSTAINED
-up past first tissue stop until anatomical limit
corrective - stretched joint capsule, restore ROM
GRADE 1 - OSCILLATIONS
small amplitude
between initiation of movement & tissue resistance
5 cycles per second
GRADE 2 - OSCILLATIONS
large amplitude
between initiation of movement & tissue resistance
2-3 cycles per second
GRADE 3 - OSCILLATIONS
large amplitude
within tissue resistance & backing out again
2-3 cycles per second
GRADE 4 - OSCILLATIONS
small amplitude
within tissue resistance to end of limited ROM
5 cycles per second
normal end feels
-bony: “hard” unyielding sensation, painless
-soft tissue approximation: yielding compression, or “mushy” feel
-tissue stretch: firm springy type of movement with slight give, elastic resistance, may be hard (capsular) or soft (elastic)
abnormal end feels
-early spasm: caused by mm/ligament tear, often acute
-late spasm: caused by instability
-capsular: hard (chronic) & soft or boggy (acute), caused by capsule damage
-empty: caused by ligament rupture or tear, very painful
-bone to bone: caused by osteophyte, early restriction in ROM
-springy block: caused by internal derangement inside joint, common in meniscus, early restriction
capsular pattern of restriction of GH
1: lateral (external) rotation
2: ABD
3: medial (internal) rotation
GH - lateral distraction: hand placement
stabilizing hand: distal humerus at lateral supracondylar crest
mobilizing hand: grasp proximal humerus near axilla & mobilize laterally
GH - convex/ concave rule
convex head of humerus in concave glenoid cavity of scapula
= CONVEX on CONCAVE
GH - loose & closed packed position
LOOSE: 40-55º ABD, 30º of horizontal ADD (in scapular plane)
CLOSE: full horizontal ABD with lateral (external) rotation
humeroulnar/ trochlear - loose & closed packed position
LOOSE: 70º of elbow flexion, 10º of supination
CLOSE: extension & supination
humeroradial - loose & close packed position
LOOSE: full extension & supination
CLOSE: elbow flex 90º, forearm supinated 5º
proximal radioulnar - loose & closed packed position
LOOSE: 35º supination, 70º flexion
CLOSE: forearm supinated 5º
radiocarpal (wrist) - loose & closed packed position
LOOSE: neutral (halfway between flex & ext) with slight ulnar deviation
CLOSE: extension with radial deviation
midcarpal - loose & closed packed position
LOOSE: neutral or slight flexion with ulnar deviation
CLOSE: extension with ulnar deviation
intercarpal - loose & closed packed position
LOOSE: neutral / slight flexion
CLOSE: extension
carpometacarpal (CMC) - loose & closed packed position
LOOSE:
-thumb:midway between ABD & ADD, midway between flex & ext
-fingers: midway between flex & ext
CLOSE:
-thumb: full opposition
-fingers: full flexion
metacarpophalangeal (MCP) - loose & closed packed position
LOOSE: slight flexion
CLOSE:
-thumb: full opposition
-fingers: full flexion
interphalangeal (IP) - loose & closed packed position
LOOSE: slight flexion
CLOSE: full extension
AF - loose & closed packed position
LOOSE: 30º flexion, 30º ABD, slight lateral rotation
CLOSE: full extension, medial rotation, ABD
AF - capsular pattern of restriction
flexion, ABD, medial rotation
SI - loose & closed packed position
LOOSE: neutral
CLOSE: full nutation
tibiofemoral (knee) - loose & closed packed position
LOOSE: 25º flexion
CLOSE: full extension, lateral rotation tibia
talocrural (ankle, mortise) - loose & closed packed position
LOOSE: 10º plantar flexion, midway between inversion & eversion
CLOSE: max dorsiflexion
patellofemoral - loose & closed packed position
LOOSE: full extension
CLOSE: full flexion
subtalar/ talocalcaneal - loose & close packed position
LOOSE: midway between extremes of ROM
CLOSE: supination
talocalcaneonavicular, cuboideonavicular, alcaneocuboid, distal Intertarsal - loose & closed packed position, capsular pattern of restriction
LOOSE: midway between extremes of ROM
CLOSE: supination (inversion)
CAPSULAR PATTERN: dorsiflexion, plantar flexion, ADD, medial rotation
metatarsophalangeal - loose & closed packed position
LOOSE: 10º extension
CLOSE: full extension
interphalangeal (foot) - loose & closed packed position
LOOSE: slight flexion
CLOSE: full extension
TMJ - loose & closed packed position
LOOSE: mouth slightly open, lips together, teeth not in contact
CLOSE: teeth tightly clenches
spine - loose & close packed position
LOOSE: midway between flexion & extension
CLOSE: full extension
proximal radioulnar joint
synovial, pivot, diarthrosis, uniaxial
-convex radial head & slightly concave radial notch of ulna
-annular ligament, quadrate ligament
-pronation & supination
proximal radioulnar joint - anterior glide (radius on ulna)
E: increase supination of forearm
P: soft hand not to compress deep branch of
-stabilizing hand: on proximal ulna, posterior & medial surfaces
-mobilizing hand: on proximal radius, anterior (towards cubital fossa) may use thumb or palm to do mobilization
-place towel in patient’s hand to control degree of supination
proximal radioulnar joint - posterior glide (radius on ulna)
E: increase pronation of forearm
P: median nerve & brachial artery sit lateral to biceps tendon, soft hand approach not to compress them
-stabilizing hand: on proximal ulna with inside hand placed over olecranon
-mobilizing hand: on proximal radius, anterior aspect, glide proximal radius posteriorly
-stand & use body weight
distal radioulnar joint
synovial, pivot, diarthrosis, uniaxial
-head of ulnar & ulnar notch of distal radius
-articular disc (triangular fibrocartilage TFCC), dorsal & palmar radioulnar ligaments
-supination & pronation
triangular fibrocartilage complex (TFCC)
cartilage helps stabilize radius & ulna with hand or forearm movements
has a superficial & deep portion
distal radioulnar joint - posterior glide (radius on ulna)
E: increase supination of wrist & forearm, P.M.
P: do not compress radial & ulnar arteries
-stabilizing hand: on distal ulna & carpal bones
-mobilizing hand: on distal radius in posterior direction
-use rolled up towel or pillow to support wrist
distal radioulnar joint - anterior glide (radius on ulna)
E: increase pronation of wrist & forearm
P: do not compress radial & ulnar arteries
-stabilizing hand: stabilize distal ulna & carpal bones
-mobilizing hand: mobilize distal radius in anterior direction
-use rolled up towel or pillow to support wrist
tibiofemoral (knee) - anterior & posterior glide of tibia on femur: CI’s
anterior: CI’d for ACL injury/ damage
posterior: CI’d for PCL injury/ damage
tibiofemoral (knee) - medial & lateral gap: CI’s
medial: do not lever joint, do not let femur rotate medially
lateral: not in full extension, do not lever joint
tibiofemoral (knee) - medial & lateral glide of tibia: CI’s
do not allow femur to rotate medially
patellofemoral - superior & inferior glide: CI’s
do not compress patella/ force knee into extension/ hyper extension
patellofemoral - medial & lateral glide: CI’s
CI’d if previous dislocations, do not force knee into hyperextension, discontinue if painful
proximal tibiofibular - posterior & anterior glide of fibula: CI’s
do not apply too much pressure to fibular head due to common peroneal nerve nearby
distal tibiofibular - posterior glide of fibula: CI’s
do not apply too much dorsiflexion, relax achilles tendon
