Joint+mobility+assessment

Joint MobilityJoint Mobility
AssessmentAssessment
Kristofferson G. Mendoza, PTRP
Department of Physical Therapy
College of Allied Medical Professions
University 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
situation, demonstrate joint mobility
assessment techniques with correct
procedure and patient care skills
situation, communicate the
assessment rationale, procedure, and
results clearly and concisely

Review of RelevantReview of Relevant
ConceptsConcepts
Joint Mobility AssessmentJoint Mobility Assessment

Amount of Available ROMAmount of Available ROM
integrity of
joint surfaces
amount of
joint 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 MotionAmount of Joint Motion
shape of
articulating surfaces
health of
surrounding tissues
health of the
joint
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 Motion= Normal Range of Motion
Physiologic MotionPhysiologic Motion
(Osteokinematic)(Osteokinematic)
controlled by contractile
tissues Accessory MotionAccessory Motion
(Arthrokinematic)(Arthrokinematic)
controlled by inert
tissues
++

Limitation of MotionLimitation of Motion
Physiologic MotionPhysiologic Motion
(Osteokinematic)(Osteokinematic)
controlled by contractile
tissues
Accessory MotionAccessory Motion
(Arthrokinematic)(Arthrokinematic)
controlled by inert
tissues
++

AssessmentAssessment
ProcedureProcedure

Assessment ProceduresAssessment Procedures
 Pain Assessment
 Active Motion Test
 Passive Motion Test (Endfeel)
 Passive Accessory Mobility Test (PAM
Test)
 Passive Accessory Intervertebral
Mobility Test (PAIVM Test)

Passive AccessoryPassive Accessory
Mobility TestMobility Test
 tests the accessory joint motion
 determines if joint accessory motion is
hypomobile, normal or hypermobile

Passive AccessoryPassive 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 andUse 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 andUse 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 ofInterpretation of
ResultsResults

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 joint
more movement compared to what is
normal or compared to the same joint
on the opposite extremity

Hypomobility vs.Hypomobility vs.
hypomobile jointhypomobile joint
has insufficient motion for it to be
functional
hypermobile jointhypermobile joint
has insufficient stability to prevent
damage from occurring

generalized hypermobilitygeneralized hypermobility
multiple joint laxity; greater mobility in
all joints
e.g. acrobats, gymnasts, genetic
diseases
localized hypermobilitylocalized hypermobility
single joint involvement
reaction/compensation to neighboring
joint stiffness or injury

generalized hypermobilitygeneralized hypermobility
no intervention warranted
localized hypermobilitylocalized hypermobility
need to address the neighboring
hypomobility

Joint Instability vs.Joint Instability vs.
anan unstable jointunstable joint isis
different from adifferent from a hypermobile jointhypermobile joint
aa hypermobile jointhypermobile joint
 hashas insufficient stabilityinsufficient stability to preventto prevent
damage from occurringdamage from occurring
 but itsbut its stability is preservedstability is preserved under normalunder normal
conditionsconditions
 andand remains functionalremains functional in weight bearingin weight bearing
and within certain limits of motionand within certain limits of motion

Joint Instability vs.Joint Instability vs.
anan unstable jointunstable joint isis
different from adifferent from a hypermobile jointhypermobile joint
anan unstable jointunstable joint
 involvesinvolves disruptiondisruption of theof the osseousosseous andand
ligamentous structuresligamentous structures of that jointof that joint
 resulting toresulting 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

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

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 CompressionInterpreting Compression
 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

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.

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