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2003/10/27 1. 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.

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Presentation on theme: "2003/10/27 1. 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."— Presentation transcript:

1 2003/10/27 1

2 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

3 2003/10/27 3 Joint mobilization Joint Stretching Joint Range of Motion

4 2003/10/27 4 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 close to the operators center of gravity as possible 2.Directed with gravity assistance, especially when treating larger joint

5 2003/10/27 5 General Rules of Mobilization Techniques 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

6 2003/10/27 6 Peripheral joint The 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

7 2003/10/27 7 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

8 2003/10/27 8 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 patients body weight Belt –Close to joint space without pain

9 2003/10/27 9 General Rules of Mobilization Techniques 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

10 2003/10/27 10 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

11 2003/10/27 11 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

12 2003/10/27 12 Indications: Joint dysfunction Restriction of accessory joint motion Capsuloligamentous tightening Internal derangement Reflex muscle guarding bony blockage

13 2003/10/27 13 Contraindication Absolute: –bacterial infection, –neoplasm, –recent fracture Relative –Joint effusion or inflammation –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)

14 2003/10/27 14 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

15 2003/10/27 15 Manual traction Grade I, II –Pain reduction Grade III –Reduce pain –Increase periarticular extensibility Other forms –Oscillatory –Inhibitory –Progressive –Adjustive: high-velocity thrust –Position Fig , 20-45

16 2003/10/27 16 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

17 2003/10/27 17 Systems of Gliding mobilization Sustained joint-play (stretch) techniques Graded oscillation techniques

18 2003/10/27 18 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

19 2003/10/27 19 Graded oscillation techniques Grade 1~5 Recommended for pain or high tone Gr 1~3: –Irregular rhythm to trick muscle Usual methods 1.Small-or large-amplitude movement 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

20 2003/10/27 20 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

21 2003/10/27 21

22 2003/10/27 22 Glenohumeral joint Peripheral mobilization

23 2003/10/27 23 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

24 2003/10/27 24 Inferior glide techniques for elevation fig 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

25 2003/10/27 25 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)

26 2003/10/27 26 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)

27 2003/10/27 27 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)

28 2003/10/27 28 Anteroposterior glide for the last few degrees of elevation (Fig. 9-33) Anterior glide –in supine (A) –In sitting (B)

29 2003/10/27 29 Sternoclavicular joint Distraction (fig. 9-34A) Superior glide (fig. 9-34B) Inferior glide (fig. 9-34C) Posterior glide (fig. 9-34D)

30 2003/10/27 30 Acromioclavicular joint Distraction (fig 9-35A) Anteroposterior glide (fig 9-35B) Posteroanterior glide (fig 9-35C) Clavicle –Inferior glide

31 2003/10/27 31 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 pattern The soft tissue is stretched to obtain normal shoulder-girdle motion Prone Side-lying

32 2003/10/27 32 Self-mobilization

33 2003/10/27 33 Inferior glide Long-axis extension (fig. 9-39) Shoulder adduction with distraction (fig. 9-40) Glenohuumeral abduction when patient has been less than 90º abduction(fig. 9-41A) Glenohuumeral abduction when patient has been less than 90º abduction (fig. 9-41B) Glenohuumeral abduction when patient has been less than 90º flexion (fig. 9-42A) Glenohuumeral abduction when patient has been less than 90º flexion (fig. 9-42B)

34 2003/10/27 34 Anterior glide (fig. 9-43) –Shoulder extension Shoulder internal rotation (fig. 9-44) Shoulder external rotation (fig. 9-45)

35 2003/10/27 35 Self capsular stretches Anterior capsular stretch (fig. 9-46A) Inferior capsular stretch (fig. 9-46C) Posterior capsular stretch (fig 9-46D)

36 2003/10/27 36 Self range of motion - shoulder flexion –Sitting (fig. 9-47) –Standing (fig. 9-48) extension (fig. 9-49) abduction –Sitting (fig. 9-50) –Standing (fig. 9-51) Internal rotation (fig. 9-52) External rotation –Sitting (fig. 9-53) –Standing (fig. 9-54)

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