Joint mobilization exam prep
hip ER glide
anterior
Hip flexion glide
posterior and inferior
Total program
1.Warm the tissues 2.Relax the muscles Hold-relax inhibition techniqueGrade I or II joint oscillation techniques 3.Joint mobilization stretches Position and dosage for level of tissue tolerance 5.Passive stretch periarticular tissues 6.Patient actively uses new range Reciprocal inhibitionActive ROMFunctional activities 7.Maintain new range; patient instruction Self-stretchingAuto-mobilizationActive, resistive ROMFunctional activities using the new range
Loose packed position for wrist? (radiocarpal)
10° of supination (distal radioulnar joint) and neutral flexion/extension with slight ulnar deviation (radiocarpal joint)
tibiofelmoral/patellofemoral joint extension glide
Anterior tibiofemoral glide and superior patellofemoral glide
Ankle dorsiflexion
Anterior/posterior glide of tibiofibular joint Posterior glide of tibiotalar joint
Wrist extension
Anterior (dorsal)glide radiocarpal joint
Forearm supination
Anterior glide (ventral) of radius on ulna
Elbow flexion glide humeroradial joint
Anterior glide of radius on humerus
Ankle plantarflexion
Anterior glide of tibiotalar joint
Elbow flexion glide humeroulnar
Anterior glide of ulna on humerus Distraction
Elbow extension glide humeroulnar
Posterior glide of ulna on humerus Distraction
tibiofemoral/patellofemoral joint flexion glide
Posterior tibiofemoral glide and inferior patellofemoral glide
patellofemoral joint
Concave femur on convex patella patella moves distally during flexion pattella moves proximally during extension
Pelvofemoral joint what is concave/convex open packed/loose packed position capsular pattern
Concave pelvis on convex humerus (opposite) Close packed: full extension with internal rotation. Loose packed: 30° flexion, 30° abduction, slight external rotation. Capsular pattern: internal rotation, flexion, abduction (order varies).
Radiohumeral joint what is concave/convex open packed/loose packed position capsular pattern
Concave radial head slides convex humerus (same) anteriorly on the rounded capitulum of the humerus during elbow flexion and posteriorly during elbow extension. Close packed position: 90° elbow flexion with 5° forearm supination Loose packed position: movement away from close packed position. Capsular pattern: greater limitation in flexion than extension
Tibiotalar (Talocrural)
Concave tibula/fibula Convex talus (opposite) Loose packed position 10° of plantarflexion and neutral inversion/eversion. Treatment plane. The treatment plane is in the mortise, in an anterior-posterior direction with respect to the leg.
Distal radioulnar what is concave/convex
Convex distal ulna on concave radius (same) distal radius around the ulna for supination/pronation Resting position. The resting position is with the forearm supinated 10°. Treatment plane. The treatment plane is the articulating surface of the radius, parallel to the long axis of the radius.
tibiofemoral joint concave/convex closed/loose packed position capsular pattern
Convex femur on concave tibia (same) Close-packed position: full knee extension with external rotation of tibia. Loose-packed position: about 25° flexion . Capsular pattern: greater limitation in knee flexion than extension.
Proximal radioulnar what is concave/convex open packed/loose packed position capsular pattern
Convex radius on concave ulna (opposite) during supination radial head moves posterior Closed packed position: full pronation and full supination Loose packed position: 70° elbow flexion with 35° supination Capsular pattern: pronation and supination equally limited Treatment plane. The treatment plane is in the radial notch of the ulna, parallel to the long axis of the ulna.
Subtalar
Convex: anterior/middle talus Concave: anterior/middle calcaneus Same direction Convex: posterior calcaneus Concave: posterior talus Opposite direction Resting position. The resting position is midway between inversion and eversion. Treatment plane. The treatment plane is in the talus, parallel to the sole of the foot.
For joint mobilization/manipulation techniques, _____ is used to control or relieve pain when applied gently or to stretch the capsule when applied with a stretch force. For patient comfort a slight ______force is used when applying stretch gliding techniques.
Distraction Distraction
General ankle motion
Distraction of tibiotalar joint
Distal Radioulnar Dorsal/Volar Glides
Dorsal glide to increase supination; volar glide to increase pronation
Wrist ulnar deviation
Lateral (radial) glide radiocarpal joint
Calcaneal inversion
Lateral glide of subtalar joint
Oscillation technique
Grade I. Small-amplitude rhythmic oscillations are performed at the beginning of the range. They are usually rapid oscillations, like manual vibrations. Grade II. Large-amplitude rhythmic oscillations are performed within the range, not reaching the limit. They are usually performed at two or three per second for 1 to 2 minutes. Grade III. Large-amplitude rhythmic oscillations are performed up to the limit of the available motion and are stressed into the tissue resistance. They are usually performed at two or three per second for 1 to 2 minutes. Grade IV. Small-amplitude rhythmic oscillations are performed at the limit of the available motion and stressed into the tissue resistance. They are usually rapid oscillations, like manual vibrations.
Scapulothoracic joint
Functional joint, not true joint (no joint capsule or bony articulation)
Kalten born grading
Grade I (loosen). Small-amplitude distraction is applied when no stress is placed on the capsule. It equalizes cohesive forces, muscle tension, and atmospheric pressure acting on the joint. Grade II (tighten). Enough distraction or glide is applied to tighten the tissues around the joint. Kaltenborn15 called this "taking up the slack." Grade III (stretch). A distraction or glide is applied with an amplitude large enough to place stretch on the joint capsule and surrounding periarticular structures.
What are contraindications/precautions for joint mobility?
Hypermobility Joint Effusion-joint swelling(effusion) due to trauma *rapid swelling indicates bleeding* Inflammation-stretching increases pain/muscle guarding gentle oscillating or distractions might help with pain
Wrist radial deviation
Medial (ulnar) glide radiocarpal joint
Calcaneal eversion
Medial glide of subtalar joint
Wrist flexion
Posterior (volar) glide radiocarpal joint
Forearm pronation
Posterior glide (dorsal) of radius on ulna
Elbow extension humeroradial
Posterior glide of radius on ulna
Patient reponse to joint mobility
Stretching maneuvers usually cause soreness. Perform the maneuvers on alternate days to allow the soreness to decrease and tissue healing to occur between stretching sessions. The patient should perform ROM into any newly gained range during this time. If there is increased pain lasting longer than 24 hours after stretching, the dosage (amplitude) or duration of treatment was too vigorous. Decrease the dosage or duration until the pain is under control. The patient's joint and ROM should be reassessed after treatment and again before the next treatment. Alterations in treatment are dictated by the joint response.
In extremity joint mobilization, the treatment plane is always identified by the concave component of the joint to be mobilized. T or F
T
acromioclavicular joint what is concave/convex open packed/loose packed position capsular pattern
The clavicular articular surface is oval and slightly convex while the acromial surface is accordingly concave. Opposite Close-packed position: 90° shoulder abduction Loose-packed position: arm at side
A joint mobilization to restore extension of the humeroradial joint should be applied in which direction? A) Posterior B) Anterior C) Medial D) Lateral
a
Carpometacarpal (CMC) concave/convex
The trapezium is concave, and the proximal metacarpal is convex for palmar abduction/adduction (metacarpal moving perpendicular away from and toward the palm of the hand). The trapezium is convex, and the proximal metacarpal is concave for radial abduction/adduction (metacarpal moving in the plane of the hand away and toward the radius; previously called flexion/extension) Resting position. The resting position is midway between radial abduction/adduction and between palmar abduction/adduction. Treatment plane. The treatment plane is in the trapezium for abduction-adduction and in the proximal metacarpal for flexion-extension. Ulnar glide to increase radial adduction. Radial glide to increase radial abduction. Dorsal glide to increase palmar abduction. Volar glide to increase palmar adduction.
Which of the following represents the highest level of evidence? A)Randomized controlled trial (RCT) B) Case Report C) Case Study D) Narrative essay summarizing a topic
a
Talocrural Dorsal (Posterior) Glide Talocrural Ventral (Anterior) Glide
To increase dorsiflexion. To increase plantarflexion.
Distal Tibiofibular Articulation: Anterior (Ventral) or Posterior (Dorsal) Glide
To increase mobility of the mortise when it is restricting ankle dorsiflexion.
Your patient is demonstrating a capsular pattern of restriction at their glenohumeral joint. Which of the following mobilizations will restore abduction ROM most effectively? A) Inferior humeral glide B) Superior humeral glide C) Posterior humeral glide D) Traction
a
Ulnohumeral joint what is concave/convex open packed/loose packed position capsular pattern
Ulna is concave, convex humerus (same) posterior glide during extension Close packed position: full elbow extension with forearm supination Loose packed position: about 90° flexion and 10° supination Capsular pattern: greater limitation in flexion than extension
What is the loose packed position for the glenohumeral joint?
about 45° scaption(arm in neutral position with 30 degrees of flexion)
hip extension glide
anterior
Intertarsal and Tarsometatarsal Joints
articulating surfaces are concave and convex in the same direction. For example, the proximal articulating surface is convex, and the distal articulating surface is concave. The technique for mobilizing each joint is the same intertarsal and Tarsometatarsal Plantar Glide increase plantarflexion accessory motions (necessary for supination).
The talotibial joint consists of the concave distal tibia moving on the convex talus in open chain.. When applying joint mobilizations, osteo and arthrokinematic movement occur in the same direction. A) Both statements are true B) Both statements are false C) The first statement is true and the second is false D) The first statement is false and the second is true
b
Which glide will best restore inversion at the subtalar joint? A) Medial glide B) Lateral glide C) Traction D) Posterior glide
b
Which of the following glides will help restore humeroradial extension? A) Anterior B) Posterior C) Traction D) Compression
b
You are trying to select your best evidence for your PTA 113 research project. Of the following, which would you consider to be your "best evidence"? A) A randomized controlled trial with 2 subjects published in 1985 B) A case series of 10 patients that offers treatment summaries on the intervention that you are investigating C) A systematic review of RCT's done on a geriatric population (you are investigating an intervention on infants) D) All of the above are considered your "best evidence."
b
Your patient has a loss of radiocarpal flexion. Which of the following statements is incorrect? A)A distraction force can be applied if it is perpendicular to the articular surface of the radius B) A radial glide will improve radial deviation C) An ulnar glide will improve radial deviation D) A posterior glide will improve flexion ROM
b
What is the closed packed position for the glenohumeral joint?
full shoulder abduction with external rotation
GH concave/convex rule
humerus is convex glenoid is concave it is opposite
Which of the following is an indication for performing joint mobilization? A) Joint hypomobility B) Tight and short hamstrings C) Reversible joint hypomobility D) Ankylosing spondylitis
c
Which of the following statements is incorrect regarding traction: A) A pull along the long axis of a bone B) A separating force C) Will always result in a symmetrical separation of joint surfaces D) All of the above statements are correct
c
Your patient who sustained a trimalleolar fracture of her right ankle 8 weeks ago has just had her cast removed. The gait section of the PT evaluation notes that the patient is having difficulty with the push off phase of stance due to stiffness. Which of the following interventions will most likely correct the gait deviation noted in the PT evaluation? A) Ice to reduce swelling B) Eccentric anterior tibialis strengthening C) Joint mobilization to restore ankle ROM in dorsiflexion/plantarflexion D) Functional ESTIM to restore plantarflexion strength
c
Radiocarpal what is concave/convex open packed/loose packed position capsular pattern
convex: carpals concave: radius [opposite direction] Closed packed position: wrist extension with radial deviation. Loose packed position: neutral wrist flexion/extension with slight ulnar deviation . Capsular pattern: flexion and extension are equally limited. Treatment plane. The treatment plane is in the articulating surface of the radius perpendicular to the long axis of the radius
Distal tibiofibular
convex: fibula concave: tibia [opposite direction]
Interphalangeal (IP)
convex heads of the more proximal phalanx with the concave base of the more distal phalanx (same) Resting position. The resting position is in light flexion for all joints. Volar glide to increase flexion (Fig. 5.43). Dorsal glide to increase extension. Radial or ulnar glide (depending on finger) to increase abduction or adduction.
sternocalvicular joint what is concave/convex open packed/loose packed position capsular pattern
convex superiorly/inferiorly and concave anteriorly/posteriorly with an articular disk between it and the manubrium of the sternum. Posterior glide to increase retraction; superior glide to increase depression of the clavicle. Close-packed position: full shoulder elevation and protraction Loose-packed position: arm at side
hip abduction glide
inferior
An evaluative finding reads radiocarpal radial deviation = 0-25 degrees. Which of the following applies? A) Perform a radial glide to increase radial deviation B) Perform an ulnar glide to increase radial deviation C) Perform a radial glide to improve ulnar deviation D) Joint mobilization is not indicated
d
Which joint mobilization technique will result in a general capsular stretch (entire capsule)? A) Grade 3 anterior glide B) Grade 4 posterior glide C) Grade 3 or 4 inferior glide D) None of the above will stretch the entire capsule
d
Which of the following best describes an annotation (according to the MWCC PTA Program): A) Copy the author's abstract verbatim B) A 20-30 sentence synopsis of a journal article C) a brief summary of an article (6-7 sentences) D)A brief summary of an article (6-7 of your own sentences including a sentence on how the article will help answer your research question)
d
Which of the following glides will improve glenohumeral internal rotation? A) Distraction B) Inferior glide C) Anterior glide D) Posterior glide
d
Joint motion stimulates biological activity by
moving synovial fluid, which brings nutrients to the avascular articular cartilage of the joint surfaces and intra-articular fibrocartilage of the menisci.
Metacarpophalangeal (MP) concave/convex
distal end of the proximal articulating surface is convex and the proximal end of the distal articulating surface is concave (same) Resting position. The resting position is in light flexion for all joints. Volar glide to increase flexion (Fig. 5.43). Dorsal glide to increase extension. Radial or ulnar glide (depending on finger) to increase abduction or adduc
Ankle closed packed position
dorsiflexion
hip IR glide
posterior
Intermetatarsal, Metatarsophalangeal, and Interphalangeal Joints
the articulating surface of the proximal bone is convex, and the articulating surface of the distal bone is concave. It is easiest to stabilize the proximal bone and glide the surface of the distal bone either plantarward for flexion, dorsalward for extension, and medially or laterally for adduction and abduction.
Ankle open packed position
the open packed position of the ankle joint is plantar flexion
What are the indications for joint mobilization?
•Pain, muscle guarding and spasm - gentle joint play •Reversible joint hypomobility - progressive vigorous joint stretching (stiff but will get better) •Progressive limitation - maintain available motion (wont get better) •Functional immobility - prevent effects of immobility