2003/10/27 1. 2003/10/27 2 mobilization for upper extremity (i) 1.basic concept: pp 119~p127...

林燕慧操作治療

2003/10/27 1

學期報告

以臨床見習骨科病人為對象報告操作治療的介入


2003/10/27 2

Mobilization for upper extremity (I)

1. Basic concept: pp 119~p127

2. Shoulder: 1. Pp 165~168

2. pp 194~214


2003/10/27 3

Joint mobilizationJoint mobilization

Joint StretchingJoint Stretching

Joint Range of MotionJoint Range of Motion


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General Rules of Mobilization Techniques

1. The patient must be relaxed

2. The operator must be relaxed• Body mechanics

3. Do not move into or through the point of pain

4. The mobilizing force should be 1. as close to the operator’s center of gravity as possi

ble

2. Directed with gravity assistance, especially when treating larger joint


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• Each technique is both an evaluative technique and a treatment technique.

• Assessment mobilization– The resting position (Table 5-3*)

• maximal joint traction and joint play

– Actual resting • Neutral• Loose-packed position• Least painful

• Reassessment– Before, during, and after treatment


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Peripheral jointThe direction of movement during treatment

• Perpendicular or parallel to the treatment plane– Fig. 5-3

– Perpendicular: traction

• To separate the joint surface

– Parallel: gliding

treatment plane:A plane perpendicular to a line running from the axis of rotation to the middle of the concave articular surface


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Gliding mobilization

• Direct:

in the direction in which the mobility test has shown that gliding is actually restricted

• Indirect: – If the mobility test in the desired direction produced

pain

– Hypomobile joint

– Little movement


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General Rules of Mobilization Techniques • Treatment force close to the joint surface• The contact surface

– Large

– Firm

– Finger tips to palpate

• stabilization– Hand– External

• Plinth• The patient’s body weight• Belt

– Close to joint space without pain


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• Velocity of movement– slow stretching for large capsular restriction

– faster oscillation for minor degree of restriction• Amplitude of movement:

– graded according to pain, guarding and degree of restriction

• Compare accessory joint movement to opposite side ( extremity)

• One movement is performed at a time, at one joint at a time


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In spinal joints

• In balance:The occiput is in line with the coccyx

• The direction of mobilization– Determined by provocation test

– Initially: direction in which the pain and nociceptive reaction are diminished

• Traction (level I-II)– to improved pain

– prior to applying the specific mobilization


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Each technique can be used as • Examination procedure:

slack only to see accessory movement and pain

• Therapeutic procedure: High-velocity, small-amplitude thrust or graded

oscillation


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Indications:

• Joint dysfunction

• Restriction of accessory joint motion

• Capsuloligamentous tightening

• Internal derangement

• Reflex muscle guarding

• bony blockage


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Contraindication• Absolute:

– bacterial infection,

– neoplasm,

– recent fracture

• Relative– Joint effusion or inflammatio

n

– Arthrosis ( e.g. degenerative joint disease) if acute, or if causing a bony block to movement to be restored)

– Rheumatoid arthritis

– Osteoporosis

– internal derangement

– General debilitation ( e.g. influenza, pregnancy, chronic disease)


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Grading of movement

• Rate• Rhythm• Intensity• Acute• Chronic• According to the

response of the patient to the technique

• The type of movement performed ultimately depends on the immediate effect desired– Relief of pain

– Muscle guarding

– Stretching a tight joint capsule or ligament


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Manual traction• Grade I, II

– Pain reduction

• Grade III– Reduce pain– Increase periarticular extensibi

lity

• Other forms– Oscillatory– Inhibitory– Progressive– Adjustive: high-velocity thrust– Position

• Fig. 17-32, 20-45


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Three-dimensional traction (Kaltenborn)

• spine, positioned relative to all three cardinal planes (with relative position such as flexion, lateral flexion, and rotation)

• Ex:A painful joint may be positioned in a pin-free position


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Systems of Gliding mobilization

• Sustained joint-play (stretch) techniques

• Graded oscillation techniques


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Sustained joint-play (stretch) techniques

• Grade (stage) 1~3

• Loss of joint play and decreased functional range

• Direct technique

• Move the bony partner– First : available range of

motion (resistance is felt)

– Then: Stretch force against the resistance

• For restricted joints

1. A minimum of a 6-second stretch force

2. Partial release to grade 1 or 2

3. Repeat at 3- to 4-second intervals


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Graded oscillation techniques• Grade 1~5• Recommended for pain or hi

gh tone• Gr 1~3:

– Irregular rhythm to trick muscle

• Usual methods1. Small-or large-amplitude mo

vement at a rate of 2~3 seconds within the range

2. Combined with sustained stretch as small-amplitude oscillations applied at the limit of the joint range


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Tips

• To inhibit pain– Low-amplitude, high speed

• To relax muscle guarding– Slow speed

• Depends on the patient response• Grade 1of 2 systems: no tension placed on the

joint capsule or surrounding tissue• Traction is always the first procedure


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2003/10/27 22

Glenohumeral joint

Peripheral mobilization


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General techniques for elevation and relaxation (fig. 9-28)

• Distraction – in flexion (A)– With lateral glide (B)– With Inferior glide (C) : in flexion

• Inferior glide – At side (D)

• With halter (E)

• Progressive long-axis extension moving abduction


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Inferior glide techniques for elevation fig. 9-29

• Resting position (A)• Moving toward flexion (B)• In abduction (C)

– About 90º – Guided by the ease with a relaxed movement– To increase abduction– Avoiding impingement

• In more than 90º elevation (D)– Stretching– A few degree of elevation are restricted


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Internal rotation (fig. 9-30)

• Posterior glide– Arm in various degrees of abduction (10 º -55 º) (A)– Arm close to the limits of internal rotation (B)– Arm close to 90º abduction (C)


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External rotation (fig. 9-31)

• Anterior glide– Arm at side (A)– Prone (B)– Near the limits of external rotation (C)– Arm close to 90º abduction (D)


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General capsular stretch and techniques for horizontal adduction (Fig. 9-

32)• Posterior glide or shear (A)

• Lateral glide – at side (distraction) (B)– In flexion (C) – And backward in flexion (D)

• With belt (E)


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Anteroposterior glide for the last few degrees of elevation (Fig. 9-33)

• Anterior glide – in supine (A)– In sitting (B)


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Sternoclavicular joint

• Distraction (fig. 9-34A)

• Superior glide (fig. 9-34B)

• Inferior glide (fig. 9-34C)

• Posterior glide (fig. 9-34D)


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Acromioclavicular joint

• Distraction (fig 9-35A)

• Anteroposterior glide (fig 9-35B)

• Posteroanterior glide (fig 9-35C)

• Clavicle– Inferior glide


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Scapulothoracic joint

• Distraction of the medial border of the scapula (fig 9-37A)

• Distraction or inferior glide of the scapula (fig 9-37B)

• Scapulothoracic articulations (fig 9-38)– Medial-lateral glide– Superior-inferior glide– rotational and diagonal patt

ern

• The soft tissue is stretched to obtain normal shoulder-girdle motion

• Prone Side-lying


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Self-mobilization


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Inferior glide• Long-axis extension (fig. 9-39)• Shoulder adduction with distraction (fig. 9-40)• Glenohuumeral abduction when patient has been les

s than 90º abduction(fig. 9-41A)• Glenohuumeral abduction when patient has been les

s than 90º abduction (fig. 9-41B)• Glenohuumeral abduction when patient has been les

s than 90º flexion (fig. 9-42A)• Glenohuumeral abduction when patient has been les

s than 90º flexion (fig. 9-42B)


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• Anterior glide (fig. 9-43)– Shoulder extension

• Shoulder internal rotation (fig. 9-44)

• Shoulder external rotation (fig. 9-45)


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Self capsular stretches

• Anterior capsular stretch (fig. 9-46A)

• Inferior capsular stretch (fig. 9-46C)

• Posterior capsular stretch (fig 9-46D)


2003/10/27 36

Self range of motion - shoulder• flexion

– Sitting (fig. 9-47)– Standing (fig. 9-48)

• extension (fig. 9-49)• abduction


• Internal rotation (fig. 9-52)• External rotation


2003/10/27 1. 2003/10/27 2 mobilization for upper extremity (i) 1.basic concept: pp 119~p127...

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