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Upper Extremity Joint Mobilization Carolyn Brown University of North Dakota

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Upper Extremity Joint Mobilization Carolyn Brown University of North Dakota University of North Dakota UND Scholarly Commons Physical Therapy Scholarly Projects Department of Physical Therapy 1997 Upper Extremity Joint Mobilization Carolyn Brown University of North Dakota Follow this and additional works at: https://commons.und.edu/pt-grad Part of the Physical Therapy Commons Recommended Citation Brown, Carolyn, "Upper Extremity Joint Mobilization" (1997). Physical Therapy Scholarly Projects. 76. https://commons.und.edu/pt-grad/76 This Scholarly Project is brought to you for free and open access by the Department of Physical Therapy at UND Scholarly Commons. It has been accepted for inclusion in Physical Therapy Scholarly Projects by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. UPPER EXTREMITY JOINT MOBILIZATION by Carolyn Brown Bachelor of Science in Physical Therapy University of North Dakota, 1996 An Independent Study Submitted to the Graduate Faculty of the Department of Physical Therapy School of Medicine University of North Dakota in partial fulfillment of the requirements for the degree of Master of Physical Therapy " Grand Forks, North Dakota May 1997 This Independent Study, submitted by Carolyn A. Brown in partial fulfillment of the requirements for the Degree of Master of Physical Therapy from the University of North Dakota, has been read by the Faculty Preceptor, Advisor, and Chairperson of Physical Therapy under whom the work has been done and is hereby approved. (Faculty Preceptor) - \~i\nM (Graduate School Advisor) \~~~'A- (Chairperson, Physical Therapy) 11 PERMISSION Title Upper Extremity Joint Mobilization Department Physical Therapy Degree Master of Physical Therapy In presenting this Independent Study Report in partial fulfillment of the requirements for a graduate degree from the University of North Dakota, I agree that the Department of Physical Therapy shaH make it freely available for inspection. I further agree that permission for extensive copying for scholarly purposes may be granted by the professor who supervised my work or, in her absence, by the Chairperson of the department. It is understood that any copying or publication or other use of this Independent Study Report or part thereof for financial gain shall not be allowed without my written permission. It is also understood that due recognition shaH be given to me and the University of North Dakota in any scholarly use which may be made of any material in my Independent Study Report. Signature ~t a ~ ) Date /(2 ~ III TABLE OF CONTENTS LIST OF FIGURES .......................... ............ .. ............................................. ...... ............. Vl ACKNOWLEDGEMENTS .................. ... ... ......... ... .......................................... ......... .. ... Vll ABSTRACT .......................... .. ............ ... ... .. ... ............................................ ..... ...... .......... viii CHAPTER I INTRODUCTION ................................................. .. ........... .. ....................... ........... II PRINCIPLES OF JOINT MOBILIZATION ........................................ .......... ... .... 5 Biomechanics .............................. ... .... .. .... .. ................... ... ....................... ......... 5 Joint Play .. ...................................................................... ... ................................ 6 Convex/Concave Rule............ .... .. ..... .................................... ..... ......... ....... ....... 8 Treatment Plane .. ...................... .... ...................................................... .... ... ..... .. 10 Grades of Mobilization............. ......................... .. ... .......................................... 12 III INDICATIONS AND CONTRAINCATIONS FOR TREATMENT .. .... .. .... ...... .. .... ................. .................................... ... .. ............ 16 Indications ........................................ ................. ........ ........ .... ..... ..... ... .............. 16 Improve Tissue Extensibility... .. .. .... ... ......... ... ........ ................. .... .. ......... .... ...... 16 Nutrition .. ............................... .. .. ..... ... .... .. .. .... ......... .. ......... ....... ................. .... .. 17 Pain Reduction......................... ... ............... .. .. ........................... .... ........ .. ... .. ..... 19 Contraindications and Precautions............................................... .................... 19 IV MOBILIZATION TECHNIQUES ..... ................................................................... 21 Assessment ... ......................... ......................... .. .......................... ..... .............. ... 21 Joints of the Hand............... .. ............. .. .............. .. ..... ... ..................................... 22 Metacarpophalangeal (MCP Joints 1-5 .. ... ................... ........ .... ...... ... ... ........ 22 Interphalangeal (IP) Joints 1-5 .. ... ............................... ... ...... ... ... ...... .. .......... 23 Joints of the Wrist.............. ...... ................... ... .......................... .... .... .... .. ........... 23 Carpometacarpal (CMC) Joints 2-5 ......... .................. ..... ....... ... ... ..... ........... 23 Trapeziometacarpal Joint..... .. .................................. .. ......... .... ... ... .... ..... ... ... 24 lV Radiocarpal Joint .. ........................ .. .............................. .............................. 24 Midcarpal Joint ............................. ..... .... ..................... ..... ............................ 25 Ulna-Meniscal-Triquetral Joint..... .. .. ............................................. .............. 26 Distal Radioulnar Joint ................................... .... .. ................. .. .... .. .... ....... ... 26 Joints of the Elbow and Forearm..... ........................................ .. ....................... 26 Humeroulnar Joint .. ....... ..... .. ......... ... .. ....... .. .... ... ........... ... ... ... .... .......... .. ..... 26 Humeroradioal Joint ... .......... ......... ..................... ................. ..... ... .. .............. 27 Proximal Radioulnar Joint ......... ............. ... .................................................. 27 Joints of the Shoulder .............. ............................................................ ...... ....... 28 Glenohumeral Joint......................... ..... ............... .................................. ....... 28 Sternoclavicular Joint ......................................... ..... .. ............. .. .. ....... ....... ... 28 Acromioclavicular Joint...................................... ........ .. .... ... ..... ............ ....... 29 V CONCLUSION ................... ................................ .. ................................. ... ... ......... 30 APPENDIX A ... .......................... ............................................ .... .. ............ .... ... .. .... ......... 31 APPENDIX B ...... ... ... .......... ... ...... .... ... .. ... ....... ... ... ......... ..... ............................. ............ .. 33 REFERENCES ..... .. ...... ............................ .... .................................................. ................ 35 v LIST OF FIGURES FIGURES 1. Accessory motion................................................................................ .................. 7 2. Joint play assessment ........................................... ... .................................. .......... .. 9 3. Treatment plane during distraction and gliding mobilizations ............... .. ........... 11 4. Grades of oscillation in a normal joint........................... ........................... ........... 13 5. Grades of oscillation in ajoint with pathology .... .. ........ ...................................... 14 6. The stress-strain curve .. ..................................................... ................ ..... .. .. ......... 18 VI Acknowledgments Thank you to all of my "cheerleaders"; my parents, my sister Kathleen and Jason. They have provided the all important ingredient of encouragement that was necessary to make the past three years a success. Vll ABSTRACT Musculoskeletal injuries are one of the most costly nonfatal pathologies in the United States. Eighty to 90% of persons afflicted with musculoskeletal dysfunctions will require a treatment other than surgery. Manual therapy is a system of techniques which may be used to ease the pain and dysfunction with which these patients present. The purpose of this paper and the accompanying video tape, is to provide the physical therapy student with a source to aid their study of upper extremity joint mobilization. The paper presents a brief history of manual therapy, beginning in ancient Thailand and Egypt and ending with the current joint mobilization education offered to physical therapy students. The basic principles of joint mobilization are explained, followed by a description of the indications for mobilization and the physiologic explanations for these indications. The specific mobilization techniques for selected joints of the upper extremity are explained in detail including a brief description of the anatomy of each joint, the purpose of the mobilization, the patient's position, mobilizing and stabilizing forces and specific instructions for direction of mobilizing force. VIII Chapter I Introduction As many as twenty million people in the
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