manual functional analysis

Manual Functional Analysis Lecture 4

Manual Functional Analysis

2. Extended Examinations

Manipulation Techniques

Dynamic Tests

Manipulation Techniques

Traction

Translation

Passive Compression

Manipulation Techniques

Manipulation Techniques

Passive Compression

✤Superior✤Posterosuperior✤Posterior

Manipulation Techniques

Passive Compression

✤Superior

Manipulation Techniques

Passive Compression

✤Posterior

Manipulation Techniques

Passive Compression

✤Posterosuperior

Superior

Passive Compression

Passive Compression

Posterior

Passive Compression

Posterior

Affected Structure๏Inferior stratum ๏Superior stratum๏The genu vasculosum ๏Horizontal part of the lateral ligament

Passive Compression

Posterosuperior

Affected Structure๏Inferior stratum ๏Superior stratum๏The genu vasculosum ๏Horizontal part of the lateral ligament

Posterosuperior

Passive Compression

Lateral Condyle position

Passive Compression

Passive Compression

posterosuperior PainfulPosterior Non

Posterosuperior NonPosterior Painful

Superior Stratum

Inferior Stratum

Superior StratumInferior Stratum

Posterosuperior PainfulPosterior Painful

Passive Compression

Inferior Traction

Manipulation Techniques

Manipulation Techniques

Inferior Traction

Affected Structure

The medial wall of the joint capsule The lateral wall of the joint capsule The posterior wall of the joint capsule

Inferior Traction

Affected StructureThe posterior wall of the joint capsule

Inferior Traction

Differential Diagnosis

✤ Anterior Translation ✤ Joint Surface Tests✤ Passive Compression

No Painful Response

Inferior Traction

Painful Response

Joint Capsule

Medial TranslationMedial Wall of Capsule

Lateral TranslationLateral Wall of Capsule

Differential Diagnosis

Inferior TractionInferior Traction

Translation

Manipulation Techniques

Anterior Translation Medial TranslationLateral Translation

Medial Translation

Medial Wall of Capsule

Affected Structure

Medial Translation

Lateral Translation

Affected Structure

Lateral Wall of Capsule

Lateral Translation

Anterior Translation

Pain

Capsule Posetior Wall ExaminationJoint Surface Tests

Anterior Translation

Pain

Capsule Posetior Wall and Ligaments

Anterior Translation

Affected Structures

Endfeel

Muscle shortening Too Soft(with limitation)

Too Soft(with limitation)

CapsuleshrinkageToo Hard Too Hard

Capsule expansionToo Soft(without limitation)

Anterior disk displacement

Too Soft (with limitation)

Rebounding

Protrusion Traction Anterior Translation

Dynamic Compression

Dynamic Translation

Extended Examinations

Dynamic Tests

Dynamic Compression

Dynamic Compression during Active Movements

Joint Surface Tests

Joint Surface Tests

Pain

Pain

Joint Surface Tests

Pain

Joint Surface Tests

–Johnny Appleseed

Joint Surface Tests

Degenerative Changes

Joint Surface Tests

Dynamic Compression during Active Movements

Dynamic compression during jaw-opening

movement

Dynamic Compression

Dynamic compression during protrusive

Dynamic Translation

Maximal jaw opening during manual translation

Lateral manual translation with compression for the right joint

Dynamic Translation

• Osteoarthosis vs. osteoarthritis: the tests either proceed painlessly or they elicit pain • Temporal vs. condylar: symptoms appear either during protrusion or during jaw opening • Lateral vs. medial: symptoms appear either during lateral or during medial translation.

Joint Surface Tests

Isometric ContractionPassive Movement

Pain Dignosis

Joint CapsuleArticular Surfaces

Inferior Traction

Isometric Contraction Neg Passive Movement Pos

Joint

PainNo Pain

Inferior Traction

Medial Wall ofCapsule

Anterior Translation Lateral Translation Medial Translation

Lateral Wall ofCapsule

Bilaminar Zone Articular Surfaces

Joint CapsuleArticular SurfacesBilaminar Zone

PainNo Pain

initial / intermediate

Pain Final Pain

Passive Compression

Extended Examinations

posterosuperior PainfulPosterior Non

Posterosuperior NonPosterior Painful

Superior Stratum

Inferior Stratum

Superior StratumInferior Stratum

Anterior Translation

Bilaminar Zone

Final Pain

Posterosuperior PainfulPosterior Painful

Passive Compression

Extended Examinations

Active protrusion or jaw opening

Timing of clicking sound

Initial or intermediate Terminal

G1 G2 G3 G4

Lateral ligamentDisk hypermobility

Partial disk displacement

Total disk displacement

Cartilage hypertrophy Disk displacement with adhesion

Disk displacement with terminal repositioning

Condyle hypermobility

Disk Hypermobility 21

2

1

Dynamic Copression

Disk Hypermobility

Disk Hypermobility

Manual Translation

Medial Direction Lateral Direction

Disk Hypermobility

Manual Translation with Compression

Manual compression

Lateral ligament

Lateral ligament Differential Diagnosis

Lateral manual translation Medial manual translation

Lateral Translation with Compression

Lateral ligament

Differential Diagnosis

Partial Disk Displacement

2

1

12

Partial Disk Displacement

Differential Diagnosis

Manual Compression

Lateral Manual Translation Medial Translation

Partial Disk Displacement

Differential Diagnosis

Total Disk Displacement

Differential Diagnosis

2

1

1 2

Total Disk Displacement

Differential Diagnosis

Manual compression

Total Disk Displacement

Differential Diagnosis

Medial And Lateral Manual Translation

Cartilage Hypertrophy

Cartilage Hypertrophy

Differential Diagnosis

DynamicCompression

Jaw Opening

Disk displacement with adhesion

Differential Diagnosis

Disk displacement with adhesion

DynamicCompressionJaw Opening

Differential Diagnosis

Disk displacement with adhesion

Medial And Lateral Manual Translation

Anterior Disk Displacement with Terminal Repositioning

Anterior Hypermobility of The Condyle

Ant

erio

r Dis

k D

ispl

acem

ent w

ith T

erm

inal

Rep

ositi

onin

gGuided Retrusive Movement

Guided Retrusive Movement A

nter

ior D

isk

Dis

plac

emen

t with

Ter

min

al R

epos

ition

ing

Manual Translation to

The lateralThe lateral with Dynamic

compression The Medial

Cartilage hypertrophy

Disk displacement with adhesion

Lateral Ligament

Disk hypermobility

Partial disk displacement

Total disk displacement

- + - + Ø - Ø +