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Musculoskeletal 1 > Joint assessment and mobilization > Flashcards

Joint assessment and mobilization Flashcards

1
Q

What can joint injury result in

A

Joint dysfunction

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2
Q

Dysfunctions in joints

A
  • Increase and decreases in normal motion
  • Aberrant “trick” movements
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3
Q

What to do with hypomobility

A

mobilization /manipulation to joint, stretching, ROM

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4
Q

What to do with joint hypermobility

A
  • stabilization/strengthening activities
  • Muscles are the joints dynamic stabilizers
  • The static stabilizers may have been stretched (ligaments and capsule)
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5
Q

How can joint dysfunction lead to joint degeneration

A
  • Less fluid/nutrition in a tight joint
  • In a loose joint with too much movement can also cause degeneration
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6
Q

What are the goals of PT with joint dysfunction

A

Correct the dysfunction
Alleviate joint pain
Restore normal joint function

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7
Q

What are the classifications of movement

A
  • Osteokinematics: Goniometric ranges; AROM, PROM
  • Accessory movements:
    1. Joint play = end feel → gives you an idea of if the joint is normal, tight, or has too much mobility
    2. Component: Arthrokinematics: roll, glide, spin
    3. Grading system: Quantity (range) quality (end feel)
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8
Q

Joint mobility categories

A
  • quantity (range) and quality (end feel)
  • Hypomobility: Decreased ROM, Increased tissue resistance (capsule is tight)
  • Hypermobility: Increased ROM, Decreased tissue resistance (Capsule is lax)
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9
Q

Capsular pattern vs non capsular involvement

A
  • ROM is limitations specific to joints
  • AROM = PROM, both painful in same direction at end range
  • Resisted isometrics in their mid range is not painful (means that it is capsular not Musculotendious)
  • If resisted Isometrics is painful it is a musculotendinous issue
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10
Q

Joint play

A
  • small involuntary movements of joints
  • Detect restrictions in joint capsule
  • Needed to have full pain free voluntary movement
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11
Q

End fields

A
  • a test of joint play
  • End range passive test
  • Quality of resistance felt at end range (how stiff is this joint)
  • Joints and tissue
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12
Q

End feel specific to structures being stressed

A
  • Muscle, ligament, joint capsule
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13
Q

What does testing end feels aim to determine

A
  • Nature of pathology in the joint or soft tissue
  • Normal vs abnormal end feels
  • Hypermobility or hypomobility
  • Abrupt stop = adhesion, loose body, osteophyte (bone spur)
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14
Q

Normal end feels

A
  1. Bone to Bone:
    - Hard stop that is painless
    - Elbow extension
  2. Soft tissue approximation:
    - Yielding compression that stops the motion
    - Feels mushy
    - Elbow or knee flexion
  3. Normal Capsule:
    - Firm with some creep/give
    - Shoulder motions
    - Knee extension
  4. Elastic end feel
    - Tissue stretch
    - Normal muscle ie with DF stretch or PF
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15
Q
A
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16
Q

Abnormal end feels - describe

A
  1. Muscle (muscle spasms)
    - Increases resistance and less elastic end feel
    - Tightness or increase tone
    - Ex: tight hamstring
    - Similar to normal tissue stretch without elastic end feel
  2. Capsule:
    - Hard resistance without give/creep
    - Often where you would not expect
    - Leather like
    - Capsular pattern specific to a joint Ie the should: ER is limited more than abduction > IR> flexion
  3. Bone to bone:
    - Sudden hard bony block
    - At an abnormal place in the range
    - loose body: fragment of bone, articular cartilage, osteophyte
  4. Empty:
    - Pain before any tissue resistance felt
    - Acute subacromial bursitis
  5. Springy block
    - Springy rebound
    - Meniscus
    - Occurs where it is unexpected
  6. Swelling:
    - boggy/squishy/soft - joint effusion
  7. Capsule/ligament laxity:
    - Increased movement
    - Without normal resistance or firm arrest of motion
17
Q

Open pack position of joint

A
  • Ligament and capsule most lax
  • Bony surfaces least congruent
  • Joint volume greatest - more lubrication
  • Where people will hold a joint if it is painful or swollen
  • Requires more muscle action around the joint
18
Q

Close pack position of joints

A
  • Ligaments and joint capsule most taut
  • Bony surfaces most congruent
  • Joint volume least
19
Q

Joint mobilization

A
  • skilled passive movements directed at a joint (glides and tilts)
  • Graded movements at various ranges of the joint
  • Speed is slow enough that patients can stop the movement
20
Q

Principles of joint mobs

A
  • Joint play must be present for normal and pain free ROM
  • Joint play and end feel used assess and treat joints
  • Joint play and end feel - assess to see if limitations are from joint or other soft tissue (muscles or ligaments)
  • Accuracy may be limited by pain or muscle guarding
21
Q

Effects of joint mobs

A
  • pain relief and increase ROM
22
Q

Pain relief effects of Joint mobs/manips: neurophysiological effects

A
  • Stimulation of articular mechanoreceptors
  • Which stimulate A alpha and A beta fibers that inhibit transmission of nociceptive stimuli carries by A delta and C pain fibers
  • Via inhibitory interneurons at spinal cord level
  • Decreases pain
23
Q

Pain relief mechanical effects

A
  • Increase circulation
  • Relaxation of muscles around the joint
  • Promotes synovial fluid movement in joints
  • Nutrition exchange
24
Q

Psychological effets (pain relief of joint mobs

A
  • Laying of hands on people shows you are helping them and trying to decrease pain
  • Skills joint assessment and mobilization
  • Finding, reproduction and abating pian
  • Expectation effect: saying you will help someone can help them
25
Q

Increase ROM mechanical effects

A
  • capsular /ligament tightness; adhesions
  • Mechanical effect:
  • Stretches joint capsule and ligaments
  • Breaks adhesions
  • Increases ROM
26
Q

Joint manipulation

A
  • Skilled passive movement directed at a joint
  • High velocity, small amplitude at end range
  • Patients not able to prevent the movement
27
Q
  1. goals with joint mobilizations/manipulations
  2. adverse reactions to joint mobs and manipulations
A
  1. generally to increase ROM and decrease pain
  2. Increase in pain, Increase in swelling, Decrease in ROM, If so inappropriate technique and too forceful
28
Q

Distraction joint mobs and grades

A
  • done perpendicular to joint surface
  • Restores joint play
  • Grades:
    1: unweight joint surface
    2: taking up capsule slack
    3. Stretching capsule
29
Q

Arthorkinematics in relation to joint mobilizations

A
  1. Concave on convex:
    - Joint glide and roll in same direction
    - Mobilizing force imparted in same direction as moving segment
  2. Convex on concave:
    - Joint glide and roll occur in opposite directions
    - Glide is in opposite direction as moving segments
    - Mobilization force imparted in the opposite direction to the moving limb
30
Q

Joint mobs treatment grades

A
  • Grade 1: beginning of joint play range (25%)
    Slow small amplitude - neurophysiological/pain relief
  • Grade 2 - up to middle of joint play range (50%)
    Slow a bit larger amplitude than grade 1
  • Grade 3: from middle to end range (to restriction)
    Slow larger amplitude
  • Grade 4: at end range at restriction changes end feel, Slow small amplitude
  • Grade 5: mobilization/thrust manipulation, High velocity, Small amplitude motion, At end range
31
Q

Low grade mobilization

A
  • Low grades: 1-2
  • Pain relief - stimulate mechanoreceptors
  • Relax muscle guarding
  • Oscillations: 2-3 per sec, 3-4 times, 2 minutes
32
Q

High grade mobilizations

A
  • Higher grades 4 and 5
  • Modify connective tissue, change end feel
  • Increase ROM
33
Q

Sustaining the mobilization gains

A
  • Sustained stretched (low load prolonged stretch = hold at end range (TERT = 2 minutes minimum)
  • Best used in conjunction with high grade 3-4 mobilizations especially with hypomobility patients
  • Used to modify connective tissue and change end feel
  • Increase ROM
34
Q

Contraindications of mobilizations

A

Grade 1, 2 oscillations: few , done for pain relief
Higher grades 3-5

  • Likelihood of causing osseous or ligamentous damage (Ie disease, osteoporosis, cancer, CT disorders)
  • Ankylosis (fusion) of that joint
  • Excessive pain or guarding - serious pathology or fracture
  • Significant joint inflammation or effusion
  • Hypermobility
35
Q

Precautions for jt mobs

A
  • Pregnancy due to hormone relaxin
36
Q

Hyper mobility Beighton index criteria and scoring

A

Patient presents with excessive ROM in several joints:
- patient forward bends (without bending knee) can palm floor = 1 point
- Knees show hyperextension each side = 1 pt
- Elbows show hyperextension - each side 1 pt
- Thumb can be ent to touch forearm - each side 1 pt
- Little finger be bent past 90º - each side 1 pt
Generalized hypermobility present if
- + score > than 5/9 currently or historically
- Max score i s 9

37
Q

General treatment principle related to restoring joint function

A
  • Restore joint mobility
  • Then restore muscle length
  • Then restore strength
38
Q

Joint assessment and mob rules

A
  • Patient relaxed and therapist relaxed
  • One hand stabilize the other hand mobilizes
  • Joint in open pack position
  • Joint assessment or mob technique - consider: treatment plan, direction, velocity and amplitude
  • Distractions perpendicular to treatment plan
  • Glides: parallel to treatment plan
  • One movement in one direction, performed one at a time
  • Compare to opposite side to determine mobility
  • Rationale for use of mobilizations - low vs high grades
    -Reassess after treatment technique (increased joint play, glides, ROM)
39
Q
A

Musculoskeletal 1 (42 decks)

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