742 Accessory Motion

physiologic motion

movements of the bones, termed osteokinematics, are movements that can be performed voluntarily

accessory motion

involuntary motions. These mobility tests involve the clinician assessing arthrokinematic motions using joint glides and determining whether glide is hypomobile, normal, or hypermobile

factors that limit joint motion and/or improve joint stability

• muscle structure, muscle contraction, bony contours, cartilage, ligaments, nerve sensitivity, and pain

• resistance of the joint capsule

• patient experience of pain

indications for assessing accessory motion/joint play

• limited active or passive physiologic motion

• excessive physiologic motion

• normal physiologic motion with abnormal end feel

• pain with motion

• patient perceived stiffness in a joint

• poor joint mechanics are observed

contraindications/precautions to joint accessory motion

• vascular compromise/insufficiency

• patients on blood thinners, including aspirin

• evidence of instability (fracture or dislocation)

• acute nerve issues (worsening numbness/tingling)

• decreased bone density

• caution with children

• any condition that is worsening

region specific contraindications to assessing accessory joint motion

• RA

• cervical arterial dysfunction

• vertebrobasilar insufficiency

• after radiation (for cancer)

• structural instability

• post trauma

what to document for accessory motion

• the joint

• the side (R or L)

• the direction (type of glide)

• the finding (hypo, hypermobile, normal)

lose packed position

the position where the capsule/ligament is most lax and the capsule has the greatest capacity for motion. The type of position you want the joint to be in when assessing accessory motion

close packed position

the position where the capsule/ligaments are most taut and the joint surfaces are maximally congruent and compressed

hip open/loose packed positon

30° flexion, 30° abduction, slight lateral/external rotation

hip closed pack position

full extension, medial.internal rotation, abduction

tibiofemoral open/loose packed position

25° flexion

tibiofemoral closed packed position

full extension

patellofemoral open/loose packed position

full extension - 5° of knee flexion

patellofemoral closed-packed position

60-90° flexion

talocrural open/loose packed position

10° plantarflexion

talocrural closed packed position

full dorsiflexion

subtalar joint open/loose packed position

neutral (midway between ranges)

subtalar joint closed packed position

supination

all midfoot joints open/loose packed postion

neutral (midway between ranges)

all midfoot joints closed position

supination

MTP 1 open/loose packed position

5-10° extension

MTP 1 closed packed position

full extension

glenohumeral joint open/loose packed position

55° abduction, 30° horizontal adduction

glenohumeral joint closed packed position

abduction with full lateral rotation

sternoclavicular open/loose packed position

anatomical position

sternoclavicular closed pack position

maximum shoulder elevation

acromioclavicular open/loose packed position

anatomical position

acromioclavicular closed packed position

abduction 90°

humeroulnar open/loose packed position

70° flexion, 10° supination

humeroulnar closed packed position

extension

huermoradial open/loose packed position

full extension, full supination

humeroradial closed packed position

90° flexion, 5° supination

proximal radioulnar open/loose packed position

70° flexion, 35° supination

proximal radioulnar closed packed position

5° supination

distal radioulnar open/loose packed position

10° supination

distal radioulnar closed packed position

5° supination

radiocarpal open/loose packed position

neutral (or 10° of flexion) with slight ulnar deviation

radiocarpal closed packed position

full extension with radial deviation

spine apophyseal/facet joint open/loose packed position

neutral (midway between flexion and extension)

spine apophyseal/facet joint closed packed position

slight extension

TMJ open/loose packed position

mouth slightly open

TMJ closed packed position

teeth clenched

when a convex surface moves on a concave surface…

the roll and slide moves in the opposite directions

when a concave surface moves on a convex surface…

the roll and slide occur in the same direction

no detectable motion

possibly ankylosed or fused

hypomobile

restriction in joint play accessory motion and physiologic motion

normal

that which is expected for the specific joint per individual

hypermobile

increase in joint play motion which may or may not be associated with increased physiologic motion

unstable

excessive range without restraint

R1

the position where the first resistance is felt by hands

R2

the position where resistance that ultimately restricts further motion is felt

P1

the position where the first pain is felt/reported

P2

the position where pain that restricts further movement is felt/reported by patient