Joint Play

TMJ Joint Play

*use gloves, place thumb on inside of mandible Distraction, Anterior Glide, Lateral Glide (Medial and Posterior Glide not often seen in clinic)

Finger Joint Play

A/P glide, Long-axis extension, Rotation, Side Glide

Elbow: Distraction of Radius

pt- PT

Cervical (Segmental): Unilateral PA's

pt- prone PT- move thumbs 2-3 cm lateral to SP (C2-T1), apply pressure in order to rotate vertebra

Cervical (Segmental): Central PA's

pt- prone PT- thumbs placed directly over SP (C2-T1), apply pressure downwards

Scapulothoracic

pt- sidelying PT- grasp scapula and move in different directions (medial/lateral; superior/inferior)

Intermetacarpal Joints and Isolated Carpals

pt- sitting PT- stabilize MC bone and move adjacent MC bone anteriorly and posteriorly

Wrist: Long Axis Extension

pt- sitting PT- stabilize distal forearm, apply longitudinal distraction force at wrist

Wrist: A/P Glide

pt- sitting PT- stabilize distal forearm, apply longitudinal distraction force, move hand anteriorly and posteriorly

Wrist: Side Glide

pt- sitting PT- stabilize distal forearm, apply longitudinal distraction force, move hand ulnarly and radially

AC: A/P Glide

pt- sitting or supine PT-

AC: Inferior Glide

pt- sitting or supine PT- stabilize clavicle, press down on acromion (shelf of bone)

Glenohumeral: A/P Glides

pt- supine PT- (posterior) one hand over anterior HH, one hand around distal humerus, pt arm supported against PT's thorax, apply posterior pressure at anterior HH keeping arm parallel w/ body (anterior) same as above except one hand under posterior HH, apply anterior force keeping arm parallel w/ body

Cervical: Rotation A/A

pt- supine PT- flex pt head, passively rotate head in both directions *>40 deg rotation in either direction = sprained alar ligament *<40 deg rotation in either direction = tightness in alar ligament

Cervical: Side Glide

pt- supine PT- hold pt's head, move from side to side keeping head parallel w/ shoulders

Elbow: A/P Glide of Radius

pt- supine PT- locate radial head and neck, apply pressure downwards at radial neck

Glenohumeral: Inferior (Caudual) Glide

pt- supine PT- one hand inside distal humerus, one hand supporting shoulder, apply distraction force w/ lower hand

Glenohumeral: Lateral Distraction

pt- supine PT- one hand on outside of distal humerus, one hand on inside of proximal humerus near axilla, apply lateral force w/ upper hand while stabilizing w/ lower hand

Cervical: A/P Glide

pt- supine PT- one hand supporting occiput, one hand around jaw, move head anteriorly and posteriorly (avoid flexion/extension)

Cervical: Traction Glide

pt- supine PT- one hand supporting occiput, one hand around jaw, pull longitudinally through occiput

SC: A/P Glide

pt- supine PT- palpate SC joint w/ one hand, (anterior) place lateral side of index finger under clavicle and lift, (posterior) place pulp of thumb over clavicle and press posteriorly

SC: Inferior/Superior Glide

pt- supine PT- palpate SC joint w/ one hand, (inferior) place lateral side of index finger under clavicle and press inferiorly, (superior) press pulp of thumb on inferior aspect of clavicle superiorly

SC: Distraction

pt- supine PT- palpate SC joint w/ one hand, grip clavicle and apply distractive force

Cervical (Segmental): Side Glide

pt- supine PT- use "soft" area at 2nd MCP and glide vertebra w/ force from shoulder and arm

Elbow: Radial/Ulnar Deviations

pt- supine or sitting, elbow extended PT- (radial) one hand on distal humerus, one hand distal forearm, stabilize w/ upper hand and pull forearm towards yourself w/ lower hand (ulnar) same as above except lower forearm applies force towards pt's body

Elbow: Distraction of Olecranon

pt- supine, arm at side, slight elbow flexion PT- "scoop ulna out of joint"

First Rib Mobility

test 1 pt- supine PT- locate rib posterior to clavicle, instruct pt to take a deep breath in and out (feel for movement of rib) test2 pt-prone or supine PT- use dummy thumb over rib and apply pressure caudually