manual functional analysis
TRANSCRIPT
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 +