关节松动术课件_5

Joint Structure-Function and Mechanics 关节结构功能和力学 SPECIAL THANKS TO: Bryan Heiderscheit, PhD, PT Physical Therapy Program Department of Orthopedics and Rehabilitation UW School of Medicine and Public Health Planes and Axes面和轴 Planes 1 transverse横断面 2 sagittal矢状面 3 frontal额状面 Axes A anteroposterior前后轴 B mediolateral中侧轴 C longitudinal纵轴 C A B 3 1 2 Joint Classifications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 Joint Classifications FEATURES:特点 ojoint cavity关节腔 oarticular cartilage关节软骨 ojoint capsule关节囊 osynovial fluid关节液 “Diarthroses”可以动 Uniaxial单 轴关节 Biaxial双轴 关节 Triaxial三轴 关节 SYNOVIAL滑液关节 Diarthrosis可动关节 synovialuniaxial/uniplanar滑液-单轴/单 平面 Fig 2-2 and 2-3. Neumann (2002). Mosby. Hinge屈戌关节Pivot车轴关节 Diarthrosis synovial biaxial/biplanar 滑液-双轴/双平面 Fig 2-8 and 2-9. Neumann (2002). Mosby. Condyloid髁状关节 Saddle鞍状关节 Fig 2-4. Neumann (2002). Mosby. Ellipsoid椭圆关节 Diarthrosis synovial triaxial/triplanar三轴/三平面 ball-and-socket球窝关节 Fig 2-5. Neumann (2002). Mosby. Diarthrosis synovial translatory/multiplanar移动/ 多维的 Planar平面 Fig 2-6. Neumann (2002). Mosby. Closed Packed Position紧密的位置 omaximum congruency最大 的接触 oincreased tissue tension组 织张力增加 ono distraction没有分离 From Levangie and Norkin (2001). FA Davis Loose Packed Position resting松散的位置（休息位） ominimum congruency最小的接 触 ominimum tissue tension最小的 组织张力 omaximum distraction最大分离 From Levangie and Norkin (2001). FA Davis Osteokinematics骨运动学 omovement of bones骨之间的运动 ophysiological motion生理运动 oAROM主动关节活动 度 Arthrokinematics关节运动学 omovement of joint surfaces关节 面运动 oaccessory motion附属运动 Roll 滚动 Glide滑动 Spin 旋转 Arthrokinematics关节运动学 Fig 1-8. Neumann (2002). Mosby. Arthrokinematics关节运动学 Fig 1-8. Neumann (2002). Mosby. Arthrokinematics关节运动学 From Levangie and Norkin (2001). FA Davis Flexion屈曲Extension伸展 Arthrokinematics关节运动学 Fig 1-10. Neumann (2002). Mosby. Spin旋转 Arthrokinematics关节运动学 Fig 1-11. Neumann (2002). Mosby. Arthrokinematics关节运动学 Proximal-on-distalDistal-on-proximal Fig 1-6. Neumann (2002). Mosby. PERIPHERAL JOINTS (Appendicular Skeleton) 周围关节（四肢骨骼） Joint Play Assessment Joint Mobilization 关节松动 SHOULDER COMPLEX 肩关节复合体 Joint Play Assessment Joint Mobilization SHOULDER GH joint盂肱关节 lLOOSE PACK 休息位 55 abduction 30 hor. adduction 肩外展55 水平内收30 SHOULDER GH Joint JPAs 盂肱关节 lAnterior (ventral) Glide ( external rotation) 向前方（腹部）滑动，改善外旋 lPosterior Glide ( internal rotation) 向后方滑动，改善内旋 lInferior Glide ( abduction/arm elevation) 向足侧滑动，改善外展 lDistraction ( to joint surface) ( “everything”) 关节牵引（分离），垂直治疗面，改善各方向 ROM lLong-axis distraction ( abduction/arm elevation) 长轴牵引，改善外展 SHOULDER SC joint胸锁关节 lOsteokinematic Motions 运动特点 SHOULDER SC Joint JPA 胸锁关节 lAnterior Glide ( protraction) 向前滑动改善前伸 lPosterior Glide ( retraction) 向后滑动改善回缩 SHOULDER SC Joint JPA 胸锁关节 lSuperior Glide ( depression) 向头侧滑动下压活动度 lInferior Glide ( elevation) 向足侧上举 SHOULDER AC Joint JPA 肩锁关节 SHOULDER AC Joint JPA 肩锁关节 lLPP = Arm resting by side in normal position休息位 1.Anterior Glide向前滑动 2.Posterior Glide向后滑动 SHOULDER ST Joint (thorax) 肩胛胸壁关节 lLPP = arm resting at side休息位 lInferior Glide ( arm posterior reach) 向下滑动，改善后伸 lLateral Glide ( arm elevation) 横向滑动，改善上举 lUpward Rotation ( arm elevation)上旋，上举 ELBOW-FOREARM COMPLEX 肘-前臂复合体 Joint Play Assessment Joint Mobilization ELBOW MOTIONS肘运动 ELBOW HU Joint (hinge) 肱尺关节 lLPP = 70 flexion and 10 supination 休息位=肘屈曲70前臂旋后10 1.Distraction分离牵引 2. Glide滑动 ELBOW HR Joint (2 hinge) 肱桡关节 lLLP = Full extension and full supination 休息位 1. Anterior glide of the radial head ( flexion) 2. Posterior glide of the radial head ( extension) 桡骨头的前后滑动（掌侧背侧） 3. Distraction of radial head (influences all motions) lCompression (90) 挤压和分离 ELBOW Proximal RU Joint 近端桡尺关节 lLPP = 75 flexion and 35 supination 休息位=肘屈曲75前臂旋前35 1. Anterior glide 向前滑动 ( supination)改善旋后 2. Posterior glide 向后滑动 ( pronation)改善旋前 WRIST-HAND COMPLEX 腕-手复合体 Joint Play Assessment Joint Mobilization WRIST腕关节 lLPP = Neutral with slight ulnar deviation 休息位=中立位稍尺偏 1.Ventral glide for Extension腹侧滑动伸展 2. Dorsal glide for Flexion 背侧滑动屈曲 WRIST腕关节 3. Radial glide for ulnar deviation 桡侧滑动尺偏 4. Ulnar glide for radial deviation 尺侧滑动桡偏 5. Distraction分离 CARPOMETACARPAL JOINTS 腕掌关节 CARPOMETACARPAL JOINTS腕掌关节 LPP = midway position 中立位 lUlnar (medial) glide of the metacarpal on the capitulum ( flexion) 掌骨在头状骨上尺侧滑动屈 曲 lRadial (lateral) glide of the metacarpal on the capitulum ( extension) 掌骨的桡侧滑动伸展 CARPOMETACARPAL JOINTS腕掌关节 3. Dorsal (posterior) glide of the metacarpal on the capitulum ( aBd)背侧滑动外展 4. Ventral (anterior) glide of the metacarpal on the capitulum ( aDd)腹侧滑动内收 5. Distraction of the metacarpal on the capitulum (influences all motions 分离所有 MCP Joints LPP = Slight flexion 掌指关节 休息位=轻度屈曲 lVentral (anterior) glide of the phalanx on the metacarpal ( flexion)指骨 相对掌骨的腹侧滑动屈曲 lDorsal (posterior) glide of the phalanx on the metacarpal ( extension)背 侧滑动伸展 MCP Joints LPP = Slight flexion 掌指关节 3. Ulnar (medial) glide of the phalanx on the metacarpal ( AB/Duction) 指骨相对掌骨尺侧滑动外展 4. Radial (lateral) glide of the phalanx on the metacarpal ( AB/Duction) 桡侧滑动内收 lDistraction of the phalanx on the metacarpal (influences all motions) 分离影响所有运动 PIPs and DIPs 近端、远端指间关节 lLLP of the PIP and DIP joints = Slight flexion 休息位=轻度屈曲 lROLL & GLIDE 滚动和滑动 in the SAME DIRECTION 方向相同 HIP COMPLEX 髋关节复合体 Joint Play Assessment Joint Mobilization HIP COMPLEX lConnection between SPINE and LEG 连接脊柱和腿 lPower generator 产生动力 HIP Osteokinematics髋关节运动学 HIP JPA髋关节松动术 lLLP = 30 flexion, 30 ABd and slight ER 休息位=屈曲、外展30，轻度外旋 1. Traction ( to joint) ( “everything”) 分离 2. Inferior Glide (influences all motions)足侧滑动 lLateral Glide ( hip aDd & other movement） 侧方滑动内收及其他 lAnterior (ventral) Glide (extension) 向前方滑动伸展 Follow mobilization with movement 遵循在运动中松动 KNEE COMPLEX 膝关节复合体 Joint Play Assessment Joint Mobilization KNEE Osteo- & Arthrokinematics 膝骨和关节运动学 lLPP = 25 flexion 休息位=屈曲25 KNEE JPA膝关节 TIBIO-FEMORAL JOINT胫股关节 lAnterior glide前方 lPosterior glide后方 lMedial glide内侧 lLateral glide外侧 PATELLO-FEMORAL JOINT 髌股关节 lMulti-directional glides 多个方向滑动 KNEE JPA膝关节 TIBIO-FEMORAL JOINT 胫股关节 lAnterior glide lPosterior glide lMedial glide lLateral glide KNEE Joint Mobe for Extension 膝伸展的松动 1. Ventral glide of Tibia on Femur 胫骨在股骨上向腹侧滑动 2. Posterior glide of Femur on tibia 股骨在胫骨上向后面滑动 Knee Joint Mobe for Flexion 膝屈曲的松动 lIn LPP, moving tibia on femur 休息位，胫骨相对股骨的运动 lIn sitting, moving tibia on femur (non-LPP) 坐位，活动胫骨 Knee Joint Mobe for Flexion 膝屈曲的松动 3. Combining Osteo- and Arthokinematics at the barrier Posterior glide of the tibia combined with medial rotation on fixed femur固定股骨，胫骨后 向滑动结合内旋 OTHER KNEE MOBILIZATION 膝关节其他松动技术 1. Medial Glide of the tibia on femur (influences all movements)胫骨相对股骨的 内侧滑动 2.Lateral Glide of the tibia on femur (influences all movements)外侧滑动 3. Traction牵引 4. Self-mobilization 自我松动 PATELLO-FEMORAL JOINT 髌股关节 PATELLO-FEMORAL JOINT 髌股关节 lPF Joint is a plane joint with multidirectional gliding平面关节可多方向 滑动 Superior glide is associated with knee extension 向上滑 动和伸膝有关 Inferior glide is associated with knee flexion向下滑动和 屈膝有关 PATELLO-FEMORAL JOINT 髌股关节 lSuperior glide 向上滑动 lInferior glide 向下滑动 lMedial glide 内侧滑动 lLateral glide 外侧滑动 Open vs. closed kinetic chain training 开链和闭链动态训练 FOOT-ANKLE COMPLEX 足-踝复合体 Joint Play Assessment Joint Mobilization FOOT & ANKLE BONES 足和踝的骨骼 ANKLELPP = 10 PF 踝关节 休息位=踝关节跖屈10 ANKLE JPA 踝关节 Distal-on-proximal lPosterior glide of talus on fixed t