Joint Mobility Assessment Kristofferson G. Mendoza, PTRP Department of Physical Therapy College of Allied Medical Professions University of the Philippines.

Joint Mobility Joint Mobility AssessmentAssessment

Kristofferson G. Mendoza, PTRPDepartment of Physical TherapyCollege of Allied Medical ProfessionsUniversity of the Philippines Manila

PT 142: Assessment in Physical TherapyPT 142: Assessment in Physical Therapy

All Rights Reserved 2009

Learning ObjectivesLearning Objectives

By the end of the learning session, the student should be able to:

Explain relevant concepts in joint mobility assessment

State principles and guidelines related to the proper use of joint mobility assessment techniques

Identify indications and precautions as to the use of joint mobility assessment

Given a simulated patient care situation, interpret the results of the joint mobility assessment

Record in an acceptable format the findings gathered from the joint mobility assessment

Given a simulated patient care situation, demonstrate joint mobility assessment techniques with correct procedure and patient care skills

Given a simulated patient care situation, communicate the assessment rationale, procedure, and results clearly and concisely

Review of Review of Relevant Relevant ConceptsConcepts

Joint Mobility AssessmentJoint Mobility Assessment

Amount of Available Amount of Available ROMROM

integrity of joint surfaces

amount ofjoint motion

mobility and pliability of the soft tissues around the joint degree of soft tissue

approximation that occurs

amount of scarring present

age and gender

Amount of Joint Amount of Joint MotionMotion

shape of articulating surfaces

health of surrounding tissues

health of thejoint

load-deformation history of the joint

physiologic motion is limited by a physiologic barrier

tension develops within the surrounding tissues (joint capsule, ligaments and connective tissue)

additional amount of passive range of motion can be performed

accessory motion can be observed • when resistance to active motion is applied• when the patient’s muscles are completely relaxed

the anatomic barrier cannot be exceeded without disrupting the joints integrity

= Normal Range of = Normal Range of MotionMotion

Physiologic Physiologic MotionMotion

(Osteokinematic)(Osteokinematic)controlled by contractile

tissues

Accessory Accessory MotionMotion

(Arthrokinematic)(Arthrokinematic)controlled by inert

tissues

++

Limitation of MotionLimitation of Motion

Physiologic Physiologic MotionMotion

(Osteokinematic)(Osteokinematic)controlled by contractile

tissues

Accessory Accessory MotionMotion

(Arthrokinematic)(Arthrokinematic)controlled by inert

tissues

++

Assessment Assessment ProcedureProcedure

Joint Mobility AssessmentJoint Mobility Assessment

Assessment Procedures Assessment Procedures

Pain Assessment Active Motion Test Passive Motion Test (Endfeel) Passive Accessory Mobility Test (PAM

Test) Passive Accessory Intervertebral

Mobility Test (PAIVM Test)

Passive Accessory Passive Accessory Mobility TestMobility Test

tests the accessory joint motion

determines if joint accessory motion is hypomobile, normal or hypermobile

Passive Accessory Passive Accessory Mobility TestMobility Test

gives information about the integrity of the inert structures

accessory motion are involuntary

muscles cannot restrict the glides of a joint (with just a few exceptions)

PositioningPositioning

avoid closed-packed positions

use open-packed positions (resting position)

or place the joint at the end of available motion (especially the spine)

Use of GlidesUse of Glides

Base direction of glide on

the direction of the limited physiologic motion and

the convex-concave rule

Use of GlidesUse of Glides

Perform 2 to 3 glides (ideally 1 only)

Test the unaffected extremity (or spinal segments) first

to provide baseline information

to avoid traumatizing the patient

Use of Distraction and Use of Distraction and CompressionCompression

Provides additional information as to the structure causing the problem

Perform 2 to 3 distractions / compressions (ideally 1 only)

Use of Distraction and Use of Distraction and CompressionCompression

Test the unaffected extremity (or spinal segments) first

to provide baseline information

to avoid traumatizing the patient

PrecautionsPrecautions

same as the precautions and contraindications of PJM and spinal mobilization

Interpretation of Interpretation of ResultsResults

Joint Mobility AssessmentJoint Mobility Assessment

Hypomobility vs. Hypomobility vs. HypermobilityHypermobility

hypomobile jointhypomobile joint lesser movement compared to what is normal or compared to the same joint on the opposite extremity

hypermobile jointhypermobile jointmore movement compared to what is normal or compared to the same joint on the opposite extremity

Hypomobility vs.Hypomobility vs.HypermobilityHypermobility

hypomobile jointhypomobile joint has insufficient motion for it to be functional

hypermobile jointhypermobile jointhas insufficient stability to prevent damage from occurring

HypermobilityHypermobility

generalized hypermobilitygeneralized hypermobilitymultiple joint laxity; greater mobility in all joints e.g. acrobats, gymnasts, genetic

diseases

localized hypermobilitylocalized hypermobilitysingle joint involvementreaction/compensation to neighboring joint stiffness or injury

HypermobilityHypermobility

generalized hypermobilitygeneralized hypermobilityno intervention warranted

localized hypermobilitylocalized hypermobilityneed to address the neighboring hypomobility

Joint Instability vs.Joint Instability vs.HypermobilityHypermobility

an an unstable jointunstable joint is is

different from a different from a hypermobile jointhypermobile joint

aa hypermobile joint hypermobile joint has has insufficient stabilityinsufficient stability to prevent to prevent

damage from occurring damage from occurring but its but its stability is preservedstability is preserved under normal under normal

conditionsconditions and and remains functionalremains functional in weight bearing in weight bearing

and within certain limits of motionand within certain limits of motion

Joint Instability vs.Joint Instability vs.HypermobilityHypermobility

an an unstable jointunstable joint is is

different from a different from a hypermobile jointhypermobile joint

anan unstable joint unstable joint involves involves disruptiondisruption of the of the osseous osseous andand

ligamentous structuresligamentous structures of that joint of that joint resulting to resulting to loss of functionloss of function

Interpreting GlidesInterpreting Glides

If the joint glide is unrestricted

integrity of both the joint surface and the periarticular tissue is good

the patient’s loss of motion must be the result of contractile tissue

intervention: soft-tissue mobilization

Interpreting GlidesInterpreting Glides

If the joint glide is unrestricted and excessive

excessive motion may indicate: pathological hypermobility instability may be normal for the individual

intervention: stabilizing techniques to support the joint

through muscle action and mobilization of hypomobile neighboring joint

Interpreting GlidesInterpreting Glides

If joint glide is restricted

LOM is caused by the joint surface and periarticular tissues (but contractile tissue may still be affected)

intervention: joint mobilization

once intervention is done, osteokinematic motions are assessed again. if movement is still limited then the muscles are at fault

Interpreting DistractionInterpreting Distraction

if distraction is limited, it may indicate a contracture of connective tissue

if distraction increases pain, it may indicate a tear of connective tissue and may be associated with increased range

if the distraction decreases pain, it may indicate an involvement of the joint surface

Interpreting Interpreting CompressionCompression

if the compression increases pain, a loose body or internal derangement of the joint is present

if compression decreases pain, the joint capsule may be affected

DocumentationDocumentation

SourcesSources

Kisner C, & Colby LA (2002). Therapeutic exercise: Foundations and techniques (4th ed.). PA: FA Davis.

Dutton (2004). Orthopaedic examination, evaluation, & intervention. NY: McGraw-Hilll

Magee (2002). Orthopedic physical Assessment (4th ed.). Phil: Saunders.

Uy, J. (2002). Cervical Mobilization Seminar Handout.

Thank You Thank You

PT 142: Assessment in Physical TherapyPT 142: Assessment in Physical Therapy Joint Mobility AssessmentJoint Mobility Assessment

Kristofferson G. Mendoza, PTRP

[email protected]

All Rights Reserved 2009