Joint Mobilization of the Upper Extremity

Description

*University & multi-center Licensure available upon request; all courses single user only
*FL Live Interactive approved 20-171353 for 4 hours

*Watch on your idevices, smart phones, tablets and MORE
Domain of OT, Occupational Therapy Process

This interactive course is in movie format. This course is excellent for occupational and physical therapists, COTA’s, and PTA’s that want to learn the art of joint mobilization. You will learn mobilizations techniques up close and learn how to make stiff joints move. Watch, rewind and re-watch. This feature allows you to “take the instructor home with you”. This is a mixed learning level course.

Note: This mixed learning level online movie course provides conceptual preparation to seek additional training, and does not provide you a mentored hands-on skills session. Please seek additional experience, with a mentor, to perform hands-on skills. Upon Successful completion of the examination (80%) your certificate will be sent via email.

Objectives

• • Review precautions and contraindications for joint mobilization
  • Review joint mobilization techniques that promote good body mechanics and mechanical advantages
  • Introduce joint mobilization skills that will insure accuracy and consistency
  • Understand the type of joint you are mobilizing
  • Introduce joint mobilization skills that will insure effective and efficient treatment

Outline

1. Introduction
   1. Definition-skilled passive movement of a joint
   2. Overview
      1. One “tool” in the therapists “tool box”
      2. Used only after determined by a thorough evaluation that joint mobilization is needed
      3. More effective if combined with an active rehabilitation program
   3. Indications
      1. Joint hypomobility
   4. Contraindications
      1. Unstable joint
      2. Hemiarthrosis-bleeding in the joint
      3. Healing fracture-involved or adjacent joint
      4. Acute inflammation
      5. Bony disease
      6. Cancer
      7. Infection
   5. Precautions
      1. Muscle guarding
      2. Osteoporosis
      3. OA
      4. RA
      5. Hypermobile joint
      6. Swelling and inflammation
      7. Fracture not fully healed or undiagnosed
   6. Anatomy & physiology-know what you are mobilizing so you have an expectation (patient also) as to what is going to happen
      1. Joints
         1. Type
            1. Saddle (i.e. carpometacarpal jt. of the thumb)
            2. Gliding (i.e. intercarpal jts.)
            3. Ball and socket (i.e. glenohumeral jt.)
            4. Pivotal (i.e. radiohumeral jt.)
            5.  Hinge (i.e. humeroulnar jt.)
            6.  Ellipsoid (i.e. metacarpal phalangeal jts.
            7. Bicondylar (i.e. interphalangeal jts.)
         2. Cartilage
            1.  Concave surface cartilage is more dense around the periphery
            2.  Convex surface cartilage is more dense in the center
            3. Cartilage is bloodless
         3. Concave-Convex principle
            1.  Concave on Convex
            2. Convex on Concave
            3. Instances where concave-convex principle does not apply
      2. Ligaments and Capsule
         1. Ligaments contain kinesthetic receptors
            1.  Ruffini endings
            2. Golgi tendon receptors
            3.   Pacinian corpuscles
         2. Capsule tissue is fibrous and is interlaced with ligaments and tendons
         3. Ligaments have great tensile strength
   7. Osteokinematics
      1. Classical motions (i.e. flexion, extension, pronation, supination, etc.)
   8. Athrokinematics
      1.  Movement relationships within the joint (i.e. glide, spin, roll, etc.)
2. Examination-General Principles
   1. Avoid assumptions; start from scratch and do not assume anything
      1. Avoid the “I give you a hammer you look for a nail-syndrome.”
   2. Thorough
      1. Examination format should include
         1. Subjective-interview and intake information (see syllabus)
   3. Motion
      1. Active/Passive
      2. End feel
      3. Quality
   4. Absolutes
      1. Evaluate involved and uninvolved sides
      2. Evaluate before and after treatment
3. Treatment General Principles
   1. Prepare the patient
      1. Relaxed
      2. Supported
      3. Clear instructions on what to do, what not to do, and what to expect (i.e. pressure, pulling)
   2. Prepare yourself
      1. Wide base of support
      2. Set up in gravity assist position whenever possible
      3. Firm relaxed hold, not tense
   3. Accuracy
      1. Forearm alignment to help guide therapists� direction of force
      2. Palpate during the mobilization with stabilizing hand
      3. Observe proximal- when movement begins, you are moving something else and therefore becoming less accurate
   4. Technique
      1. Slack skin
      2. Use pads of fingers, not tips
      3. Energy conservation/joint protection methods
      4. Distractions
      5. Glides
      6. Tilts
      7. Rotations
   5. Mobilization grades
      1. Grade I
      2. Grade II
      3. Grade III
      4. Grade IV
      5. Tip on how to determine range and grade
         1. Stabilization hand compared to mobilization hand
4. Joint Mobilization
   1. Shoulder Complex
      1. Sternoclavicular joint
         1. Evaluation
         2. Treatment
            1. Posterior glides
            2.  Inferior glides
         3. Acromioclavicular joint
            1. Evaluation
            2. Treatment
               1.  Anterior glides
               2.  Posterior glides
            3. Scapulothoracic joint
               1. Evaluation
               2. Treatment
                  1.  Superior glides
                  2.  Inferior glides
                  3.   Medial glides
                  4. Lateral glides
                  5.  Distraction
            4. Glenohumeral joint
               1. Evaluation
               2. Treatment
                  1.  Lateral distraction
                  2.  Posterior glides
                  3. Anterior glides
                  4. Inferior glides
            5. Elbow
               1. Radiohumeral joint
                  1. Evaluation
                  2. Treatment
                     1.    Distraction
                     2.  Approximation
               2. Humeroulnar joint
                  1. Evaluation
                  2. Treatment
                     1.  Distraction
                     2. Valgus tilt
                     3.   Varus tilt
            6. Forearm
               1. Proximal radioulnar joint
                  1. Evaluation
                  2. Treatment
                     1.   Anterior glides (radius on ulna)
                     2. Posterior glides (radius on ulna)
               2. Distal radioulnar joint
                  1. Evaluation
                  2. Treatment
                     1.    Distractions
                     2.  Approximations
                     3.   Anterior glides
                     4.  Posterior glides
                     5.  Outward roll
            7. Wrist
               1. Intercarpal joint
                  1. Evaluation
                  2. Treatment
                     1. Anterior glides
                     2.  Posterior glides
                  3. Radiocarpal joint
                     1. Evaluation
                     2. Treatment
                        1. Medial glides
                        2. Lateral glides
                        3. Anterior glides
                        4.   Posterior glides
                     3. Ulnocarpal
                        1. Evaluation
                        2. Treatment
                           1.  Ulnomeniscotriquetrial glide
                     4. Midcarpal joint
                        1. Evaluation
                        2. Treatment
                           1.   Medial glides
                           2.  Lateral glides
                           3. Anterior glides
                           4.   Posterior glides
                     5. Carpal metacarpal joints (2-5)
                        1. Evaluation
            8. Thumb
               1. CMC
                  1. Evaluation
                  2. Treatment
                     1.  Medial glides
                     2.   Lateral glides
                     3. Anterior glides
                     4.  Posterior glides
                     5.  Distraction
                     6.  Rotations (supination/pronation)
               2. Metacarpal phalangeal joint
                  1. Evaluation
                  2. Treatment
                     1.  Medial glides
                     2.  Lateral glides
                     3. Anterior glides
                     4. Posterior glides
                     5. Medial tilts
                     6.  Lateral tilts
                     7.   Rotations (supination/pronation)
            9. Fingers
               1. Metacarpal phalangeal joints
                  1. Evaluation
                  2. Treatment
                     1.  Medial glides
                     2. Lateral glides
                     3.   Anterior glides
                     4.   Posterior glides
                     5.  Medial tilts
                     6. Lateral tilts
                     7. Rotations (supination/pronation)
            10. Fingers and thumb
                1. Interphalangeal joints
                   1. Evaluation
                   2. Treatment
                      1.  Anterior glides
                      2.  Posterior glides
                      3. Medial tilts
                      4.   Lateral tilts
                      5. Anterior-posterior unicondilar glides