Joint Mobility Assessment PT 142: Assessment in Physical Therapy Joint Mobility Assessment Kristofferson G. Mendoza, PTRP Department of Physical Therapy College of Allied Medical Professions University of the Philippines Manila All Rights Reserved 2009

Learning Objectives 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 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

Review of Relevant Concepts Joint Mobility Assessment Review of Relevant Concepts

Amount of Available ROM joint motion integrity of joint surfaces amount of scarring present Amount of Available ROM age and gender mobility and pliability of the soft tissues around the joint degree of soft tissue approximation that occurs

Amount of Joint Motion shape of articulating surfaces health of the surrounding tissues 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 the anatomic barrier cannot be exceeded without disrupting the joints integrity accessory motion can be observed when resistance to active motion is applied when the patient’s muscles are completely relaxed

= Normal Range of Motion Physiologic Motion (Osteokinematic) controlled by contractile tissues + Accessory Motion (Arthrokinematic) controlled by inert tissues = Normal Range of Motion

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

Joint Mobility Assessment Assessment Procedure

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 Mobility Test tests the accessory joint motion determines if joint accessory motion is hypomobile, normal or hypermobile

Passive Accessory Mobility 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)

Positioning 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 Glides Base direction of glide on the direction of the limited physiologic motion and the convex-concave rule

Use 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 Compression Provides additional information as to the structure causing the problem Perform 2 to 3 distractions / compressions (ideally 1 only)

Use of Distraction and Compression Test the unaffected extremity (or spinal segments) first to provide baseline information to avoid traumatizing the patient

Precautions same as the precautions and contraindications of PJM and spinal mobilization

Interpretation of Results Joint Mobility Assessment Interpretation of Results

Hypomobility vs. Hypermobility hypomobile joint lesser movement compared to what is normal or compared to the same joint on the opposite extremity hypermobile joint more movement compared to what is normal or compared to the same joint on the opposite extremity

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

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

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

Joint Instability vs. Hypermobility an unstable joint is different from a hypermobile joint a hypermobile joint has insufficient stability to prevent damage from occurring but its stability is preserved under normal conditions and remains functional in weight bearing and within certain limits of motion

Joint Instability vs. Hypermobility an unstable joint is different from a hypermobile joint an unstable joint involves disruption of the osseous and ligamentous structures of that joint resulting to loss of function

Interpreting 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 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 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 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 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

Documentation

Sources 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.

Kristofferson G. Mendoza, PTRP kmendoza.ptrp@yahoo.com PT 142: Assessment in Physical Therapy Joint Mobility Assessment Thank You Kristofferson G. Mendoza, PTRP kmendoza.ptrp@yahoo.com All Rights Reserved 2009