I.
Introduction
A.
Definition-skilled passive movement
of a joint
B.
Overview
1.
One
"tool" in the therapists "tool box"
2.
Used only
after determined by a thorough evaluation that joint mobilization is
needed
3.
More
effective if combined with an active rehabilitation
program
C.
Indications
1.
Joint
hypomobility
D.
Contraindications
1.
Unstable
joint
2.
Hemiarthrosis-bleeding in the
joint
3.
Healing
fracture-involved or adjacent joint
4.
Acute
inflammation
5.
Boney
disease
6.
Cancer
7.
Infection
E.
Precautions
1.
Muscle
guarding
2.
Osteoporosis
3.
OA
4.
RA
5.
Hypermobile
joint
6.
Swelling
and inflammation
7.
Fracture
not fully healed or undiagnosed
F.
Anatomy
& physiology-know what you are mobilizing so you have an expectation
(patient also) as to what is going to happen
1.
Joints
a.
Type
i.
Saddle
(i.e. carpometacarpal jt. of the thumb)
ii.
Gliding
(i.e. intercarpal jts.)
iii.
Ball and
socket (i.e. glenohumeral jt.)
iv.
Pivotal
(i.e. radiohumeral jt.)
v.
Hinge
(i.e. humeroulnar jt.)
vi.
Ellipsoid
(i.e. metacarpal phalangeal jts.)
vii.
Bicondylar (i.e. interphalangeal
jts.)
b.
Cartilage
i.
Concave
surface cartilage is more dense around the
periphery
ii.
Convex
surface cartilage is more dense in the center
iii.
Cartilage
is bloodless
c.
Concave-Convex
principle
i.
Concave
on Convex
ii.
Convex on
Concave
iii.
Instances
where concave-convex principle does not apply
2.
Ligaments
and Capsule
a.
Ligaments
contain kinesthetic receptors
i.
Ruffini
endings
ii.
Golgi
tendon receptors
iii.
Pacinian
corpuscles
b.
Capsule
tissue is fibrous and is interlaced with ligaments and
tendons
c.
Ligaments
have great tensile strength
G.
Osteokinematics
1.
Classical motions (i.e. flexion, extension, pronation, supination,
etc.)
H. Athrokinematics
1.
Movement relationships within the joint (i.e. glide, spin, roll,
etc.)
II.
Examination-General
Principles
A.
Avoid
assumptions; start from scratch and do not assume
anything
1.
Avoid the
"I give you a hammer you look for a nail-syndrome."
B.
Thorough
1.
Examination format should
include
a.
Subjective-interview and intake
information (see syllabus)
C.
Motion
1.
Active/Passive
2.
End
feel
3.
Quality
D.
Absolutes
1.
Evaluate
involved and uninvolved sides
2.
Evaluate
before and after treatment
III.
Treatment
General Principles
A.
Prepare
the patient
1.
Relaxed
2.
Supported
3.
Clear
instructions on what to do, what not to do, and what to expect (i.e. pressure,
pulling)
B.
Prepare
yourself
1.
Wide base
of support
2.
Set up in
gravity assist position whenever possible
3.
Firm
relaxed hold, not tense
C.
Accuracy
1.
Forearm
alignment to help guide therapists’ direction of
force
2.
Palpate
during the mobilization with stabilizing hand
3.
Observe
proximal- when movement begins, you are moving something else and therefore
becoming less accurate
D.
Technique
1.
Slack
skin
2.
Use pads
of fingers, not tips
3.
Energy
conservation/joint protection methods
4.
Distractions
5.
Glides
6.
Tilts
7.
Rotations
E.
Mobilization
grades
1.
Grade
I
2.
Grade
II
3.
Grade
III
4.
Grade
IV
5.
Tip on
how to determine range and grade
a.
Stabilization hand compared to
mobilization hand
IV.
Joint
Mobilization
A.
Shoulder
Complex
1.
Sternoclavicular
joint
a.
Evaluation
b.
Treatment
i.
Posterior
glides
ii.
Inferior
glides
2.
Acromioclavicular
joint
a.
Evaluation
b.
Treatment
i.
Anterior
glides
ii.
Posterior
glides
3.
Scapulothoracic
joint
a.
Evaluation
b.
Treatment
i.
Superior
glides
ii.
Inferior
glides
iii.
Medial
glides
iv.
Lateral
glides
v.
Distraction
4.
Glenohumeral
joint
a.
Evaluation
b.
Treatment
i.
Lateral
distraction
ii.
Posterior
glides
iii.
Anterior
glides
iv.
Inferior
glides
B.
Elbow
1.
Radiohumeral
joint
a.
Evaluation
b.
Treatment
i.
Distraction
ii.
Approximation
2.
Humeroulnar
joint
a.
Evaluation
b.
Treatment
i.
Distraction
ii.
Valgus
tilt
iii.
Varus
tilt
C.
Forearm
1.
Proximal
radioulnar joint
a.
Evaluation
b.
Treatment
i.
Anterior
glides (radius on ulna)
ii.
Posterior
glides (radius on ulna)
2.
Distal
radioulnar joint
a.
Evaluation
b.
Treatment
i.
Distractions
ii.
Approximations
iii.
Anterior
glides
iv.
Posterior
glides
v.
Outward
roll
D.
Wrist
1.
Intercarpal
joints
a.
Evaluation
b.
Treatment
i.
Anterior
glides
ii.
Posterior
glides
2.
Radiocarpal
joint
a.
Evaluation
b.
Treatment
i.
Medial
glides
ii.
Lateral
glides
iii.
Anterior
glides
iv.
Posterior
glides
3.
Ulnocarpal
a.
Evaluation
b.
Treatment
i.
Ulnomeniscotriquetrial
glide
4.
Midcarpal
joint
a.
Evaluation
b.
Treatment
i.
Medial
glides
ii.
Lateral
glides
iii.
Anterior
glides
iv.
Posterior
glides
5.
Carpal
metacarpal joints (2-5)
a.
Evaluation
E.
Thumb
1.
CMC
a.
Evaluation
b.
Treatment
i.
Medial
glides
ii.
Lateral
glides
iii.
Anterior
glides
iv.
Posterior
glides
v.
Distraction
vi.
Rotations
(supination/pronation)
2.
Metacarpal phalangeal
joint
a.
Evaluation
b.
Treatment
i.
Medial
glides
ii.
Lateral
glides
iii.
Anterior
glides
iv.
Posterior
glides
v.
Medial
tilts
vi.
Lateral
tilts
vii.
Rotations
(supination/pronation)
F.
Fingers
1.
Metacarpal phalangeal
joints
a.
Evaluation
b.
Treatment
i.
Medial
glides
ii.
Lateral
glides
iii.
Anterior
glides
iv.
Posterior
glides
v.
Medial
tilts
vi.
Lateral
tilts
vii.
Rotations
(supination/pronation)
G.
Fingers
and thumb
1.
Interphalangeal
joints
a.
Evaluation
b.
Treatment
i.
Anterior
glides
ii.
Posterior
glides
iii.
Medial
tilts
iv.
Lateral
tilts
v.
Anterior-posterior unicondilar
glides
