joint mobility assessment kristofferson g. mendoza, ptrp department of physical therapy college of...
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Joint Mobility Joint Mobility AssessmentAssessment
Kristofferson G. Mendoza, PTRPDepartment of Physical TherapyCollege of Allied Medical ProfessionsUniversity of the Philippines Manila
PT 142: Assessment in Physical TherapyPT 142: Assessment in Physical Therapy
All Rights Reserved 2009
Learning ObjectivesLearning Objectives
By the end of the learning session, the student should be able to:
Explain relevant concepts in joint mobility assessment
State principles and guidelines related to the proper use of joint mobility assessment techniques
Identify indications and precautions as to the use of joint mobility assessment
Given a simulated patient care situation, interpret the results of the joint mobility assessment
Record in an acceptable format the findings gathered from the joint mobility assessment
Given a simulated patient care situation, demonstrate joint mobility assessment techniques with correct procedure and patient care skills
Given a simulated patient care situation, communicate the assessment rationale, procedure, and results clearly and concisely
Review of Review of Relevant Relevant ConceptsConcepts
Joint Mobility AssessmentJoint Mobility Assessment
Amount of Available Amount of Available ROMROM
integrity of joint surfaces
amount ofjoint motion
mobility and pliability of the soft tissues around the joint degree of soft tissue
approximation that occurs
amount of scarring present
age and gender
Amount of Joint Amount of Joint MotionMotion
shape of articulating surfaces
health of surrounding tissues
health of thejoint
load-deformation history of the joint
physiologic motion is limited by a physiologic barrier
tension develops within the surrounding tissues (joint capsule, ligaments and connective tissue)
additional amount of passive range of motion can be performed
accessory motion can be observed • when resistance to active motion is applied• when the patient’s muscles are completely relaxed
the anatomic barrier cannot be exceeded without disrupting the joints integrity
= Normal Range of = Normal Range of MotionMotion
Physiologic Physiologic MotionMotion
(Osteokinematic)(Osteokinematic)controlled by contractile
tissues
Accessory Accessory MotionMotion
(Arthrokinematic)(Arthrokinematic)controlled by inert
tissues
++
Limitation of MotionLimitation of Motion
Physiologic Physiologic MotionMotion
(Osteokinematic)(Osteokinematic)controlled by contractile
tissues
Accessory Accessory MotionMotion
(Arthrokinematic)(Arthrokinematic)controlled by inert
tissues
++
Assessment Assessment ProcedureProcedure
Joint Mobility AssessmentJoint Mobility Assessment
Assessment Procedures Assessment Procedures
Pain Assessment Active Motion Test Passive Motion Test (Endfeel) Passive Accessory Mobility Test (PAM
Test) Passive Accessory Intervertebral
Mobility Test (PAIVM Test)
Passive Accessory Passive Accessory Mobility TestMobility Test
tests the accessory joint motion
determines if joint accessory motion is hypomobile, normal or hypermobile
Passive Accessory Passive Accessory Mobility TestMobility Test
gives information about the integrity of the inert structures
accessory motion are involuntary
muscles cannot restrict the glides of a joint (with just a few exceptions)
PositioningPositioning
avoid closed-packed positions
use open-packed positions (resting position)
or place the joint at the end of available motion (especially the spine)
Use of GlidesUse of Glides
Base direction of glide on
the direction of the limited physiologic motion and
the convex-concave rule
Use of GlidesUse of Glides
Perform 2 to 3 glides (ideally 1 only)
Test the unaffected extremity (or spinal segments) first
to provide baseline information
to avoid traumatizing the patient
Use of Distraction and Use of Distraction and CompressionCompression
Provides additional information as to the structure causing the problem
Perform 2 to 3 distractions / compressions (ideally 1 only)
Use of Distraction and Use of Distraction and CompressionCompression
Test the unaffected extremity (or spinal segments) first
to provide baseline information
to avoid traumatizing the patient
PrecautionsPrecautions
same as the precautions and contraindications of PJM and spinal mobilization
Interpretation of Interpretation of ResultsResults
Joint Mobility AssessmentJoint Mobility Assessment
Hypomobility vs. Hypomobility vs. HypermobilityHypermobility
hypomobile jointhypomobile joint lesser movement compared to what is normal or compared to the same joint on the opposite extremity
hypermobile jointhypermobile jointmore movement compared to what is normal or compared to the same joint on the opposite extremity
Hypomobility vs.Hypomobility vs.HypermobilityHypermobility
hypomobile jointhypomobile joint has insufficient motion for it to be functional
hypermobile jointhypermobile jointhas insufficient stability to prevent damage from occurring
HypermobilityHypermobility
generalized hypermobilitygeneralized hypermobilitymultiple joint laxity; greater mobility in all joints e.g. acrobats, gymnasts, genetic
diseases
localized hypermobilitylocalized hypermobilitysingle joint involvementreaction/compensation to neighboring joint stiffness or injury
HypermobilityHypermobility
generalized hypermobilitygeneralized hypermobilityno intervention warranted
localized hypermobilitylocalized hypermobilityneed to address the neighboring hypomobility
Joint Instability vs.Joint Instability vs.HypermobilityHypermobility
an an unstable jointunstable joint is is
different from a different from a hypermobile jointhypermobile joint
aa hypermobile joint hypermobile joint has has insufficient stabilityinsufficient stability to prevent to prevent
damage from occurring damage from occurring but its but its stability is preservedstability is preserved under normal under normal
conditionsconditions and and remains functionalremains functional in weight bearing in weight bearing
and within certain limits of motionand within certain limits of motion
Joint Instability vs.Joint Instability vs.HypermobilityHypermobility
an an unstable jointunstable joint is is
different from a different from a hypermobile jointhypermobile joint
anan unstable joint unstable joint involves involves disruptiondisruption of the of the osseous osseous andand
ligamentous structuresligamentous structures of that joint of that joint resulting to resulting to loss of functionloss of function
Interpreting GlidesInterpreting Glides
If the joint glide is unrestricted
integrity of both the joint surface and the periarticular tissue is good
the patient’s loss of motion must be the result of contractile tissue
intervention: soft-tissue mobilization
Interpreting GlidesInterpreting Glides
If the joint glide is unrestricted and excessive
excessive motion may indicate: pathological hypermobility instability may be normal for the individual
intervention: stabilizing techniques to support the joint
through muscle action and mobilization of hypomobile neighboring joint
Interpreting GlidesInterpreting Glides
If joint glide is restricted
LOM is caused by the joint surface and periarticular tissues (but contractile tissue may still be affected)
intervention: joint mobilization
once intervention is done, osteokinematic motions are assessed again. if movement is still limited then the muscles are at fault
Interpreting DistractionInterpreting Distraction
if distraction is limited, it may indicate a contracture of connective tissue
if distraction increases pain, it may indicate a tear of connective tissue and may be associated with increased range
if the distraction decreases pain, it may indicate an involvement of the joint surface
Interpreting Interpreting CompressionCompression
if the compression increases pain, a loose body or internal derangement of the joint is present
if compression decreases pain, the joint capsule may be affected
DocumentationDocumentation
SourcesSources
Kisner C, & Colby LA (2002). Therapeutic exercise: Foundations and techniques (4th ed.). PA: FA Davis.
Dutton (2004). Orthopaedic examination, evaluation, & intervention. NY: McGraw-Hilll
Magee (2002). Orthopedic physical Assessment (4th ed.). Phil: Saunders.
Uy, J. (2002). Cervical Mobilization Seminar Handout.
Thank You Thank You
PT 142: Assessment in Physical TherapyPT 142: Assessment in Physical Therapy Joint Mobility AssessmentJoint Mobility Assessment
Kristofferson G. Mendoza, PTRP
kmendoza.ptrp@yahoo.com
All Rights Reserved 2009
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