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Semester 2 PM Exam 2 > Joint Manipulation > Flashcards

Joint Manipulation Flashcards

1
Q

Define

A

The skilled passive movement of a joint and/or the related soft tissues at varying speeds and amplitudes
Includes small aplitude, high velocity therapeutic movement

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2
Q

Non-thrust manipulation

A

Slow/patient can stop the movement

Oscillatory or sustained

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3
Q

Thrust manipulation

A

High velocity, low amplitude motion that the patient cannot prevent

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4
Q

Physiological manipulation

A

Osteokinematic
Can be performed actively by the patient
Angular movement of the bones

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5
Q

Accessory manipulation

A

Arthrokinematic
Movement of joint and surrounding tissue necessary for physiological motion but cannot be performed actively
“joint play” - movements not under voluntary control but necessary for full painless joint function

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6
Q

Close packed position

A 
Max tautness of major ligaments
Max surface congruity
Minimal joint volume
Max stability of the joint
Limited angular glide here
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7
Q

Open packed position

A 
Slackening of major ligaments
Minimal surface congruity 
Minimal joint surface contact
Max joint volume
Minimal stability of the joint
Most joint play available here
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8
Q

Concave on Convex

A

Glide and roll in same direction

Glide in same direction as physiological motion

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9
Q

Convex on concave

A

Roll and glide in opposite directions

Glide in opposite direction of physiological movement

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10
Q

Type I mechanoreceptors

A

Ruffini
Superficial capsule
Monitor joint position, velocity, mm tone

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11
Q

Type II mechanoreceptors

A

Pacinian
Deep capsule
Monitor joint acceleration, produce inc mm tone

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12
Q

Type III mechanoreceptors

A

Similar to GTO
in ligaments
monitor direction of movement, inhibit tone

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13
Q

Type IV mechanoreceptors

A

Nociceptors in capsule and ligaments

Prduce mm contraction

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14
Q

Neurophysiological effects

A

o Pain modulation, endorphine release
o Stimulate mechanoreceptors that may inhibit transmission of nociceptive stimuli at spinal cord or brain stem levels
o Reflex muscle relaxation, muscle facilitation

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15
Q

Biomechanical effects

A

o Circulatory effects/help maintain nutrient exchange and decrease swelling
o Cause synovial fluid motion bringing nutrients to avascular portions of articular cartilage
o Mechanically elongates tissues

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16
Q

Contraindications - absolute

A 
	Malignancy
	Bone disease
	Unhealed fracture
	Undiagnosed pain
	Active infection
	Joint Ankylosis (fused)
	Cauda equine lesions
	Indication of spinal cord involvement
	Osteoporosis
17
Q

Contraindications - relative

A 
	Systemic CT disease
	Progressive neuro signs
	Pregnancy
	Anticoagulant medication
	Osteopenia
18
Q

Pain dominant

A 
o	Joint in neutral position )open/loose packed)
o	Reduce or eliminate pain
o	Short of P1 (onset of pain)
o	Accessory motion
o	Grades I and II
o	Address treatment soreness
o	Reassess pain
19
Q

Stiffness dominant

A 
o	Physiological motion near L/Accessory movement near L
o	Produce pain of stiffness
o	Move resistance up in range
o	Grades III, IV, V
o	Address treatment soreness
o	Reassess ROM
20
Q

Inflammation

A

pain before res
Grade I or II
No stretching
Pain reduction

21
Q

Granulation/fibroblastic phase

A

pain concurrent with res
Grade II or IV
Gentle stretching
Treat stiffness

22
Q

Maturation phase

A

Pain after res
Grade II IV or V
Aggressive stretching/break adhesion

23
Q

Rate/Duration

A

Oscillations - 2 to 3 per second for 1 to 2 min
Sustained - 7 to 10 sec with 3 to 5 sec rests
address treatment soreness
until patient/PT sense change
Vary speed/angle

24
Q

Force and direction

A 
Apply force as close to joint surfaces as possible 
Increase patient comfort
- position for comfort
- inc contact area
- relax your hands
- suport limb
- approp body mechanics
Consider convex.concave rule
Consider tx plane
Vary direction and angle based on comprable sign and resistance encountered
25
Q

Tx progression

A 
Pain vs stiffness dom
Based on pt response
Modify grade
Modify physiological position
Comine phys with access
Comine motions
26
Q

Assess

A

before during and after
before subsequent intervention
retrospectively

27
Q

Audible/Cavitation

A

Sudden dec in intracapsular pressure causes dissolved gases in synovial fluid to be released into joint cavity
Followed by elasic recoil of synovial capsule

Semester 2 PM Exam 2 (4 decks)

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