以臨床見習骨科病人為對象 報告操作治療的介入 學期報告 以臨床見習骨科病人為對象 報告操作治療的介入 林燕慧 操作治療

Mobilization for upper extremity (I) Basic concept: pp 119~p127 Shoulder: Pp 165~168 pp 194~214 林燕慧 操作治療

Joint mobilization Joint Stretching Joint Range of Motion 林燕慧 操作治療

General Rules of Mobilization Techniques The patient must be relaxed The operator must be relaxed Body mechanics Do not move into or through the point of pain The mobilizing force should be as close to the operator’s center of gravity as possible Directed with gravity assistance, especially when treating larger joint 林燕慧 操作治療

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 林燕慧 操作治療

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 林燕慧 操作治療

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 林燕慧 操作治療

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 patient’s body weight Belt Close to joint space without pain 林燕慧 操作治療

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 林燕慧 操作治療

In spinal joints In balance: The direction of mobilization 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 林燕慧 操作治療

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 林燕慧 操作治療

Indications: Joint dysfunction Restriction of accessory joint motion Capsuloligamentous tightening Internal derangement Reflex muscle guarding bony blockage 林燕慧 操作治療

Contraindication Absolute: Relative bacterial infection, neoplasm, 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) Absolute: bacterial infection, neoplasm, recent fracture 林燕慧 操作治療

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 林燕慧 操作治療

Manual traction Grade I, II Grade III Other forms Pain reduction Reduce pain Increase periarticular extensibility Other forms Oscillatory Inhibitory Progressive Adjustive: high-velocity thrust Position Fig. 17-32, 20-45 林燕慧 操作治療

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 林燕慧 操作治療

Systems of Gliding mobilization Sustained joint-play (stretch) techniques Graded oscillation techniques 林燕慧 操作治療

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 A minimum of a 6-second stretch force Partial release to grade 1 or 2 Repeat at 3- to 4-second intervals 林燕慧 操作治療

Graded oscillation techniques Recommended for pain or high tone Gr 1~3: Irregular rhythm to trick muscle Usual methods Small-or large-amplitude movement at a rate of 2~3 seconds within the range Combined with sustained stretch as small-amplitude oscillations applied at the limit of the joint range 林燕慧 操作治療

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 林燕慧 操作治療

林燕慧 操作治療

Peripheral mobilization Glenohumeral joint Peripheral mobilization 林燕慧 操作治療

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 林燕慧 操作治療

Inferior glide techniques for elevation fig. 9-29 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 林燕慧 操作治療

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) 林燕慧 操作治療

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) 林燕慧 操作治療

General capsular stretch and techniques for horizontal adduction (Fig Posterior glide or shear (A) Lateral glide at side (distraction) (B) In flexion (C) And backward in flexion (D) With belt (E) 林燕慧 操作治療

Anteroposterior glide for the last few degrees of elevation (Fig. 9-33) Anterior glide in supine (A) In sitting (B) 林燕慧 操作治療

Sternoclavicular joint Distraction (fig. 9-34A) Superior glide (fig. 9-34B) Inferior glide (fig. 9-34C) Posterior glide (fig. 9-34D) 林燕慧 操作治療

Acromioclavicular joint Distraction (fig 9-35A) Anteroposterior glide (fig 9-35B) Posteroanterior glide (fig 9-35C) Clavicle Inferior glide 林燕慧 操作治療

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 林燕慧 操作治療

Self-mobilization 林燕慧 操作治療

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) 林燕慧 操作治療

Shoulder internal rotation (fig. 9-44) Anterior glide (fig. 9-43) Shoulder extension Shoulder internal rotation (fig. 9-44) Shoulder external rotation (fig. 9-45) 林燕慧 操作治療

Self capsular stretches Anterior capsular stretch (fig. 9-46A) Inferior capsular stretch (fig. 9-46C) Posterior capsular stretch (fig 9-46D) 林燕慧 操作治療

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) 林燕慧 操作治療