1. 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
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操作治療

2. Mobilization for upper extremity (I)
Basic concept: pp 119~p127
Shoulder:
Pp 165~168
pp 194~214
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3. Joint mobilization Joint Stretching Joint Range of Motion
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4. 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
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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
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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
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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
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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 patient’s body weight
Belt
Close to joint space without pain
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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
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10. 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
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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
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12. Indications: Joint dysfunction Restriction of accessory joint motion
Capsuloligamentous tightening
Internal derangement
Reflex muscle guarding
bony blockage
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13. 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
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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
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15. 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 , 20-45
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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
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17. Systems of Gliding mobilization
Sustained joint-play (stretch) techniques
Graded oscillation techniques
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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
A minimum of a 6-second stretch force
Partial release to grade 1 or 2
Repeat at 3- to 4-second intervals
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19. 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
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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
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21. 林燕慧
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22. Peripheral mobilization
Glenohumeral joint
Peripheral mobilization
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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
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24. 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
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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)
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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)
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27. 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)
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28. Anteroposterior glide for the last few degrees of elevation (Fig. 9-33)
Anterior glide
in supine (A)
In sitting (B)
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29. Sternoclavicular joint
Distraction (fig. 9-34A)
Superior glide (fig. 9-34B)
Inferior glide (fig. 9-34C)
Posterior glide (fig. 9-34D)
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30. Acromioclavicular joint
Distraction (fig 9-35A)
Anteroposterior glide (fig 9-35B)
Posteroanterior glide (fig 9-35C)
Clavicle
Inferior glide
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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
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32. Self-mobilization
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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)
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34. 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)
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35. Self capsular stretches
Anterior capsular stretch (fig. 9-46A)
Inferior capsular stretch (fig. 9-46C)
Posterior capsular stretch (fig 9-46D)
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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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