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A HANDY JOINT MOBILISATION GUIDE


  • Joint Mobilization

    THE UPPER EXTREMITY
    Glenohumeral Joint
    -Convex head of humerus on a proximal concave glenoid fossa of scapula.
    A. Loose-packed position: 55 degs abduction, 30 degs horizontal adduction
    B. Close-packed position: Full abduction and external rotation
    C. Capsular pattern: External rotation, abduction, internal rotation
    D. Glides:

  • Inferior glide to increase abduction
  • Anterior glide to improve extension and external rotation
  • Posterior glide to improve flexion and internal rotation

    Acromioclavicular Joint
    -Concave clavicle on convex acromion process.
    A. Loose-packed position: Arm resting at side
    B. Close-packed position: 90 degs of shoulder abduction
    C. Capsular pattern: Maximal elevation

  • Anterior glide to improve overall joint mobility

    Sternoclavicular Joint
    -Convex clavicle on concave sternum superior and inferiorly; Concave clavicle on a convex sternum anterior and posteriorly.
    A. Loose-packed position: Arm resting at side
    B. Close-packed position: Shoulder maximally elevated
    C. Capsular pattern: Maximal elevationSuperior glide to increase depression

  • Inferior glide to increase elevation
  • Anterior glide to increase protraction
  • Posterior glide to increase retraction

    Scapulothoracic Joint
    -Not a true joint but permits scapular motions of retraction, protraction, elevation, depression, tipping, and winging.

  • Postion patient in side-lying and perform scapular movements to increase scapular mobility.

    Humeroulnar Joint
    -Concave olecranon fossa of humerus on a convex humerus.
    A. Loose-packed position: 70 degs elbow flexion, 10 degs supination
    B. Close-packed position: Full elbow extension and supination
    C. Capsular pattern: Elbow flexion then extension

  • Distal glide to increase elbow flexion

    Humeroradial Joint
    -Concave radial head on a convex humerus
    A. Loose-packed position: Full elbow extension and supination
    B. Close-packed position: 90 degs flexion, 5 degs supination
    C. Capsular pattern: Flexion then extension

  • Dorsal glide to increase extension
  • Ventral glide to increase flexion

    Proximal radioulnar joint
    -Convex radial head on a concave ulna.
    A. Loose-packed position: 70 degs flexion, 35 degs supination
    B. Close-packed position: Full extension, 5 degs supination
    C. Capsular pattern: Elbow supination and pronation equally limited

  • Dorsal glide to increase pronation
  • Ventral glide to increase supination

    Distal Radioulnar Joint
    -Concave radius on a convex ulna.
    A. Loose-packed position: 10 degs supination
    B. Close-packed position: 5 degs supination
    C. Capsular pattern: Supination and pronation equally limited

  • Dorsal glide to increase supination
  • Ventral glide to increase pronation

    Radiocarpal Joint
    -Convex proximal carpal row on concave radius and ulna
    -Proximal carpal row is made up of the scaphoid, lunate, triquetrum
    -Distal carpal row is made up of the trapezium, trapezoid, capitate, and hamate.
    A. Loose-packed position: Slight ulnar deviation
    B. Close-packed position: Full wrist extension and radial deviation
    C. Capsular pattern: Wrist flexion and extension equally limited

  • Ventral glise to increase wrist extension
  • Dorsal glide to increase wrist flexion
  • Radial glide to increase ulnar deviation
  • Ulnar deviation to increase radial deviation
    -Scaphoid convex on a concave radius
  • Glide radius on fixed scaphoid ventrally to increase flexion
  • Glide scaphoid on a fixed radius ventrally to increase extension
    -Lunate convex on a concave radius
  • Glide radius on a fixed lunate ventrally to increase flexion
    -Scaphoid convex on concave trapezii
    -Capitate convex on concave lunate

    Carpometacarpal, Metacarpophalangeal, and Interphalangeal Joints of fingers 2-5
    -All are concave on a convex proxiaml surface
    A. Loose-packed position: CMC=midway between all ranges; MCP=slight flexion with ulnar deviation; PIP=10 degs flexion; DIP=30 degs flexion
    B. Close-packed position: CMC=full opposition; MCP=full flexion; PIP & DIP=full extension
    C. Capsular pattern: CMC=equally in all directions; PIP & DIP=flexion then extension

  • All glides are ventral to increase flexion
  • All glides are dorsal to increase extension

    Carpometacarpal Joint of Thumb
    -Concave trapezium on a convex MCP for abduction and adduction; convex trapezium on a concave MCP for flexion and extension.
    A. Loose-packed position: Midway in all positions
    B. Close-packed position: Full opposition
    C. Capsular pattern: Abduction greater than extension

  • Ulnar glide to increase flexion
  • Radial glide to increase extension
  • Ventral glide to increase adduction
  • Dorsal glide to increase abduction

    THE LOWER EXTREMITY

    The Hip Joint
    -Convex head of femur on concave acetabulum of pelvis.
    A. Loose-packed position: 30 degs flexion, 30 degs abduction, slight external rotation
    B. Close-packed position: Full extension, abduction, and internal rotation
    C. Capsular pattern: Flexion then internal rotation, abduction

  • Posterior glide to increase flexion and internal rotation
  • Anterior glide to increase extension and external rotation

    The Knee Joint (Tibiofemoral)
    -Concave tibia on a convex femur
    A. Loose-packed position: 25 degs flexion
    B. Close-packed position: Maximal extension and external rotation
    C. Capsular pattern: Flexion then extension

    Tibiofibular Joint
    -Concave fibular head on convex tibia
    A. Capsular pattern: Pain when stressed

    Talocrural Joint
    -Convex talus on concave tibia and fibula mortice
    A. Loose-packed position: 10 degs plantarflexion
    B. Close-packed position: Full dorsiflexion
    C. Capsular pattern: Loss of plantarflexion then dorsiflexion

    Subtalar Joint (Talocalcaneal joint)
    -Convex calcaneus and cuboid on a concave talus
    A. Loose-packed position: 10 degs plantarflexion
    B. Close-packed position: Full inversion
    C. Capsular pattern: Varus then valgus (inversion then eversion)

    Midtarsal Joint
    -Concave on convex (cuboid on calcaneus, navicular on talus)
    A. Open-packed position: 10 degs plantarflexion
    B. Close-packed position: Full supination
    C. Capsular pattern: Supination then pronation

    Tarsometatarsal Joints
    -Concave on convex
    A. Open-packed position: Midway between supination and pronation
    B. Close-packed position: Full supination
    C. Capsular pattern: Supination then pronation

    Metatarsophalangeal Joints
    -Concave proximal phalanx on convex surface
    A. Open-packed position: Neutral (10 degs extension)
    B. Close-packed position: Full extension
    C. Capsular pattern: (I is extension then flexion); (II-IV is flexion)

    Interphalangeal Joints
    -Concave IP on convex MTP
    A. Open-packed positon: Slight flexion
    B. Close-packed position: Full extension
    C. Capsular pattern: Extension

    Vertebral Joints
    A. Open-packed positon: Midway between flexion and extension
    B. Close-packed position: Full extension
    C. Capsular pattern: 1)Occipitoatlantal is forward bend then backward bend; 2)Atlantoaxial is rotation; 3)C3-T2 is sidebending and rotation, then backward bending; 4)Thoracic spine is Sidebending and rotation, then extension, then flexion; 5)Lumbar spine is sidebending and rotation, then extension, then flexion; 6)SI joint and below are painful when stressed.

    Temperomandibular
    -Convex mandible on concave occiput
    A. Open-packed positon: Jaw open slightly
    B. Close-packed position: Mouth maximally closed with teeth clenched (retrusion) or mouth maximally open
    C. Capsular pattern: Mouth opening


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