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Picture

What is a 'Joint Dysfunction?'

9/5/2015

1 Comment

 
I rarely give patients pathoanatomical diagnosis anymore, but rather I give them a Physical Therapy diagnosis. For example, I do not tell my patients they have a rotator cuff tear. Instead I choose to say they have scapular downward rotation syndrome. This diagnostic approach focuses on a movement based problem and not a single tissue. When looking at movement dysfunction, I choose to focus my attention on the joint level first. Many times I tell my patients they have a joint dysfunction that is limiting their movement. However, unless the patient has had some advanced anatomy course, I have to explain to the patient what joint dysfunction means. More importantly I need to teach them why the joint is affecting their movement dysfunction. In this post I am going to breakdown the definition of a joint dysfunction and the different causes of a joint dysfunction.
Picture
The Basics
All synovial joints have involuntary movement known as joint play. Generally, the amount of joint play is minimal (<1/8 inch). While this movement is minimal, the joint cannot move normally unless the joint play is normal. If joint play is lost, a joint dysfunction is the result. Since the muscles cannot correct a joint dysfunction, restoring the joint play through mobility based interventions is essential.   

Why do joint dysfunctions occur?
The 4 common causes of joint dysfunction are trauma, immobilization, sustained postures, and following a serious pathology. These 4 causes should seem reasonable. If a patient has a traumatic injury, swelling occurs in the joint altering the normal arthrokinematics. If a patient is immobilized after an injury OR performs sustained postures for several hours at a time, synovial fluid exchange is altered and the joint becomes stiff. Finally if the patient has a more serious pathology, such as a heart attack, their body becomes deconditioned and less mobile.

Treatment
When one finds a hypomobile joint dysfunction, perform joint mobilizations or manipulation. One's manual therapy skills can drastically assist in returning normal joint play. Following manual techniques, perform a corrective exercise to sustain the changes of the manual techniques. For the patient's home program, give them a similar mobility based exercise so the changes are not lost within session. For example, if a patient presents with scapular downward rotation syndrome. I would assess the thoracic spine and CT junction joint play. Assuming it is hypomobile, I would manipulate these regions. Next, I would perform a thoracic mobility exercise (such as cat/camel or quadruped thoracic extension rotation). Finally, I would give the patient this same exercise at home to sustain the changes gained in the clinic. 

Let me know if you have other questions regarding joint dysfunctions.

Jim


1 Comment
Ned
9/9/2015 06:36:31 am

Hi Jim,

Thank you for the post. I have a couple questions. In this scenario where you don't talk about a RTC tear, what do you say to them if they come in with MD opinion or MRI revealing RTC tear?

I have not heard of scapular downward rotation syndrome. Is it a part of SFMA or the movement system impairment syndrome? Would you recommend any resources to learn more about this?

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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test