关节松动术PPT.pptx
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关节松动术PPT.pptx
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,JointStructure-FunctionandMechanics关节结构功能和力学,SPECIALTHANKSTO:
BryanHeiderscheit,PhD,PTPhysicalTherapyProgramDepartmentofOrthopedicsandRehabilitationUWSchoolofMedicineandPublicHealth,PlanesandAxes面和轴,AxesAanteroposterior前后轴Bmediolateral中侧轴Clongitudinal纵轴,C,A,B,3,Planestransverse横断面sagittal矢状面frontal额状面1,2,material:
dense,irregularconnectivetissuemotion:
negligiblefunction:
bindsbonesasfunctionalunit;forcedispersionamphiarthroses(nonsynovial-cartilagenous)material:
hyalinecartilageorfibrocartilagemotion:
minimaltomoderatefunction:
providecombinationofrelativelyrestrainedmovementandshockabsorption,JointClassifications关节分类,NON-SYNOVIAL非滑液关节,Synarthroses不动关节,Amphiarthroses微动关节,Sutures颅缝,Gomphoses嵌合,Syndesmoses韧带联合,Synchondroses软骨结合,Symphyses联合,motion:
extensivefunction:
primarypivotpointsformovement,JointClassifications,FEATURES:
特点jointcavity关节腔articularcartilage关节软骨jointcapsule关节囊synovialfluid关节液,Uniaxial单轴关节,Biaxial双轴关节,Triaxial三轴关节,SYNOVIAL滑液关节“Diarthroses”可以动,Diarthrosis可动关节synovialuniaxial/uniplanar滑液-单轴/单平面,Fig2-2and2-3.Neumann(2002).Mosby.,Hinge屈戌关节,Pivot车轴关节,Diarthrosis,Fig2-8and2-9.Neumann(2002).Mosby.,synovialbiaxial/biplanar滑液-双轴/双平面Condyloid髁状关节,Saddle鞍状关节,Fig2-4.Neumann(2002).Mosby.,Ellipsoid椭圆关节,Diarthrosissynovialtriaxial/triplanar三轴/三平面,ball-and-socket球窝关节,Fig2-5.Neumann(2002).Mosby.,Diarthrosis,synovialtranslatory/multiplanar移动/多维的Planar平面,Fig2-6.Neumann(2002).Mosby.,ClosedPackedPosition紧密的位置,maximumcongruency最大的接触increasedtissuetension组织张力增加nodistraction没有分离,FromLevangieandNorkin(2001).FADavis,LoosePackedPositionresting松散的位置(休息位),minimumcongruency最小的接触minimumtissuetension最小的组织张力maximumdistraction最大分离,FromLevangieandNorkin(2001).FADavis,Osteokinematics骨运动学,movementofbones骨之间的运动physiologicalmotion生理运动AROM主动关节活动度,Arthrokinematics关节运动学,movementofjointsurfaces关节面运动accessorymotion附属运动,Roll滚动,Glide滑动,Spin旋转,Arthrokinematics关节运动学,Fig1-8.Neumann(2002).Mosby.,Arthrokinematics关节运动学,Fig1-8.Neumann(2002).Mosby.,Arthrokinematics关节运动学,FromLevangieandNorkin(2001).FADavis,Flexion屈曲,Extension伸展,Arthrokinematics关节运动学,Fig1-10.Neumann(2002).Mosby.,Spin旋转,Arthrokinematics关节运动学,Fig1-11.Neumann(2002).Mosby.,Arthrokinematics关节运动学,Distal-on-proximalProximal-on-distal,Fig1-6.Neumann(2002).Mosby.,PERIPHERALJOINTS(AppendicularSkeleton),周围关节(四肢骨骼)JointPlayAssessmentJointMobilization关节松动,SHOULDERCOMPLEX肩关节复合体,JointPlayAssessmentJointMobilization,SHOULDERGHjoint盂肱关节,LOOSEPACK休息位55abduction30hor.adduction肩外展55水平内收30,SHOULDERGHJointJPAs盂肱关节,Anterior(ventral)Glide(externalrotation)向前方(腹部)滑动,改善外旋PosteriorGlide(internalrotation)向后方滑动,改善内旋InferiorGlide(abduction/armelevation)向足侧滑动,改善外展Distraction(tojointsurface)(“everything”)关节牵引(分离),垂直治疗面,改善各方向ROMLong-axisdistraction(abduction/armelevation)长轴牵引,改善外展,SHOULDERSCjoint胸锁关节,OsteokinematicMotions运动特点,SHOULDERSCJointJPA胸锁关节,protraction),AnteriorGlide(向前滑动改善前伸PosteriorGlide(retraction)向后滑动改善回缩,SHOULDERSCJointJPA胸锁关节,SuperiorGlide(depression)向头侧滑动下压活动度InferiorGlide(elevation)向足侧上举,SHOULDERACJointJPA肩锁关节,SHOULDERACJointJPA肩锁关节,LPP=Armrestingbysideinnormalposition休息位AnteriorGlide向前滑动PosteriorGlide向后滑动,SHOULDERSTJoint(thorax)肩胛胸壁关节,LPP=armrestingatside休息位InferiorGlide(armposteriorreach)向下滑动,改善后伸LateralGlide(armelevation)横向滑动,改善上举UpwardRotation(armelevation)上旋,上举,ELBOW-FOREARMCOMPLEX肘-前臂复合体,JointPlayAssessmentJointMobilization,ELBOWMOTIONS肘运动,ELBOWHUJoint(hinge)肱尺关节,LPP=70flexionand10supination休息位=肘屈曲70前臂旋后10Distraction分离牵引Glide滑动,hinge),ELBOWHRJoint(2肱桡关节,LLP=Fullextensionandfullsupination休息位,flexion)extension),Anteriorglideoftheradialhead(Posteriorglideoftheradialhead(桡骨头的前后滑动(掌侧背侧)Distractionofradialhead(influencesallmotions)Compression(90挤压和分离,ELBOWProximalRUJoint近端桡尺关节,LPP=75flexionand35supination休息位=肘屈曲75前臂旋前35Anteriorglide向前滑动(supination)改善旋后Posteriorglide向后滑动(pronation)改善旋前,WRIST-HANDCOMPLEX腕-手复合体,JointPlayAssessmentJointMobilization,WRIST腕关节,LPP=Neutralwithslightulnardeviation休息位=中立位稍尺偏VentralglideforExtension腹侧滑动伸展DorsalglideforFlexion背侧滑动屈曲,WRIST腕关节,Radialglideforulnardeviation桡侧滑动尺偏Ulnarglideforradialdeviation尺侧滑动桡偏Distraction分离,CARPOMETACARPALJOINTS腕掌关节,CARPOMETACARPALJOINTS腕掌关节,LPP=midwayposition中立位Ulnar(medial)glideofthemetacarpalonthecapitulum(flexion)掌骨在头状骨上尺侧滑动屈曲Radiallateralglideofthemetacarpalonthecapitulumextension)掌骨的桡侧滑动伸展,CARPOMETACARPALJOINTS腕掌关节,Dorsal(posterior)glideofthemetacarpalonthecapitulum(aBd)背侧滑动外展Ventral(anterior)glideofthemetacarpalonthecapitulum(aDd)腹侧滑动内收Distractionofthemetacarpalonthecapitulum(influencesallmotions分离所有,MCPJoints掌指关节,LPP=Slightflexion休息位=轻度屈曲,Ventral(anterior)glideofthephalanxonthemetacarpal(flexion)指骨相对掌骨的腹侧滑动屈曲Dorsal(posterior)glideofthephalanxonthemetacarpal(extension)背侧滑动伸展,LPP=Slightflexion,MCPJoints掌指关节,Ulnar(medial)glideofthephalanxonthemetacarpal(AB/Duction)指骨相对掌骨尺侧滑动外展Radial(lateral)glideofthephalanxonthemetacarpal(AB/Duction)桡侧滑动内收Distractionofthephalanxonthemetacarpal(influencesallmotions)分离影响所有运动,PIPsandDIPs近端、远端指间关节,LLPofthePIPandDIPjoints=Slightflexion休息位=轻度屈曲ROLL&GLIDE滚动和滑动intheSAMEDIRECTION方向相同,HIPCOMPLEX髋关节复合体,JointPlayAssessmentJointMobilization,HIPCOMPLEX,ConnectionbetweenSPINEandLEG连接脊柱和腿Powergenerator产生动力,HIPOsteokinematics髋关节运动学,HIPJPA髋关节松动术,LLP=30flexion,30ABdandslightER休息位=屈曲、外展30,轻度外旋Traction(tojoint)(“everything”)分离InferiorGlide(influencesallmotions)足侧滑动LateralGlide(hipaDd&othermovement)侧方滑动内收及其他Anterior(ventral)Glide(extension)向前方滑动伸展,Followmobilizationwithmovement遵循在运动中松动,KNEECOMPLEX膝关节复合体,JointPlayAssessmentJointMobilization,KNEEOsteo-&Arthrokinematics膝骨和关节运动学,LPP=25flexion休息位=屈曲25,KNEEJPA膝关节,TIBIO-FEMORALJOINT胫股关节Anteriorglide前方Posteriorglide后方Medialglide内侧Lateralglide外侧PATELLO-FEMORALJOINT髌股关节Multi-directionalglides多个方向滑动,KNEEJPA膝关节,TIBIO-FEMORALJOINT胫股关节AnteriorglidePosteriorglideMedialglideLateralglide,KNEEJointMobeforExtension膝伸展的松动,VentralglideofTibiaonFemur胫骨在股骨上向腹侧滑动PosteriorglideofFemurontibia股骨在胫骨上向后面滑动,KneeJointMobeforFlexion膝屈曲的松动,InLPP,movingtibiaonfemur休息位,胫骨相对股骨的运动Insitting,movingtibiaonfemur(non-LPP)坐位,活动胫骨,KneeJointMobeforFlexion膝屈曲的松动,3.CombiningOsteo-andArthokinematicsatthebarrierPosteriorglideofthetibiacombinedwithmedialrotationonfixedfemur固定股骨,胫骨后向滑动结合内旋,OTHERKNEEMOBILIZATION膝关节其他松动技术,ents)外侧滑动,MedialGlideofthetibiaonfemur(influencesallmovements)胫骨相对股骨的内侧滑动LateralGlideofthetibiaonfemur(influencesallmovemTraction牵引Self-mobilization自我松动,PATELLO-FEMORALJOINT髌股关节,PATELLO-FEMORALJOINT髌股关节,PFJointisaplanejointwithmultidirectionalgliding平面关节可多方向滑动Superiorglideisassociatedwithkneeextension向上滑动和伸膝有关Inferiorglideisassociatedwithkneeflexion向下滑动和屈膝有关,PATELLO-FEMORALJOINT髌股关节,Superiorglide向上滑动Inferiorglide向下滑动Medialglide内侧滑动Lateralglide外侧滑动,Openvs.closedkineticchaintraining开链和闭链动态训练,FOOT-ANKLECOMPLEX足-踝复合体,JointPlayAssessmentJointMobilization,FOOT&ANKLEBONES足和踝的骨骼,ANKLE踝关节,LPP=10PF休息位=踝关节跖屈10,ANKLEJPA踝关节,dorsiflexion),Distal-on-proximalPosteriorglideoftalusonfixedtib-fib(距骨的后向滑动,固定胫腓骨背屈,Anteriorglideoftalusonfixedtib-fib(plantarflexion)距骨的前向滑动,固定胫腓骨跖屈3.Tractionofthetalocruraljoint(influencesallmovements)踝关节(距小腿关节)的牵引分离,dorsiflexion),ProximalondistalAnteriorglideoftibiaonfixedtalus(胫骨的前向滑动,固定距骨背屈,STJOsteokinematics距下关节,TransverseTarsalJoint跗横关节,TransverseTarsalJoint跗横关节,AXIALSKELETON(Spine),JointPlayAssessmentJointMobilization/Manipulation关节评定和关节松动,VERTEBRALCOLUMN脊柱,LOOSEPACK松散位置Neutralposition中立位CLOSEPACK紧密位置Fullextension充分伸展CAPSULARPATTERNCoupledlossofSBandRotation,腰椎,CentralPressuresUnilateralPressuresTransversePressures,THORACIC,胸椎,CentralPressuresUnilateralPressuresRibSpringing,JPA:
P-AT-spine,JPAUnilateralPA:
T-spine,PARibSpringing,JPA:
JPA:
Costo-sternalAPspringing,CERVICAL,CentralPressuresC1-T8UnilateralPressuresC1-T8Side-glideManeuverOcciputtoCTJ,JPA:
P-AC2,JPA:
ContinueC-spinecentralJPAtotheallthewaydowntoT8,ContinueC-spineunilateralJPAtotheallthewaydowntoT8,
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