1、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
2、 B mediolateral中侧轴 C longitudinal纵轴,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 joint cavity关节腔 articular cartilage关节软骨 joint capsule关节囊 synovial fluid关节液,“Dia
3、rthroses”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. Ne
4、umann (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,maximum congruency最大的接触 increased tissue tensio
5、n组织张力增加 no distraction没有分离,From Levangie and Norkin (2001). FA Davis,Loose Packed Position resting松散的位置（休息位）,minimum congruency最小的接触 minimum tissue tension最小的组织张力 maximum distraction最大分离,From Levangie and Norkin (2001). FA Davis,Osteokinematics骨运动学,movement of bones骨之间的运动physiological motion生理运动AROM
6、主动关节活动度,Arthrokinematics关节运动学,movement of joint surfaces关节面运动 accessory 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,A
7、rthrokinematics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-distal,Distal-on-proximal,Fig 1-6. Neumann (2002). Mosby.,PERIPHERAL JOINTS (Appendicular Skeleton) 周围关节（四肢骨骼）,Joint Play Assessment Joint Mobilizatio
8、n 关节松动,SHOULDER COMPLEX 肩关节复合体,Joint Play Assessment Joint Mobilization,SHOULDER GH joint盂肱关节,LOOSE PACK 休息位55 abduction30 hor. adduction 肩外展55 水平内收30,SHOULDER GH Joint JPAs 盂肱关节,Anterior (ventral) Glide ( external rotation)向前方（腹部）滑动，改善外旋 Posterior Glide ( internal rotation)向后方滑动，改善内旋 Inferior Glide
9、 ( abduction/arm elevation)向足侧滑动，改善外展 Distraction ( to joint surface) ( “everything”)关节牵引（分离），垂直治疗面，改善各方向ROM Long-axis distraction ( abduction/arm elevation) 长轴牵引，改善外展,SHOULDER SC joint胸锁关节,Osteokinematic Motions 运动特点,SHOULDER SC Joint JPA 胸锁关节,Anterior Glide ( protraction) 向前滑动改善前伸 Posterior Glide
10、( retraction) 向后滑动改善回缩,SHOULDER SC Joint JPA 胸锁关节,Superior Glide ( depression) 向头侧滑动下压活动度 Inferior Glide ( elevation) 向足侧上举,SHOULDER AC Joint JPA 肩锁关节,SHOULDER AC Joint JPA 肩锁关节,LPP = 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
11、壁关节,LPP = arm resting at side休息位 Inferior Glide ( arm posterior reach) 向下滑动，改善后伸 Lateral Glide ( arm elevation) 横向滑动，改善上举 Upward 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,LPP = 70 flexion and 10
12、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,LLP = 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) Co
13、mpression (90) 挤压和分离,ELBOW Proximal RU Joint 近端桡尺关节,LPP = 75 flexion and 35 supination 休息位=肘屈曲75前臂旋前351. 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,LPP = Neutral with slight ulnar deviation
14、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 Ulnar (medial) glide of the
15、 metacarpal on the capitulum ( flexion) 掌骨在头状骨上尺侧滑动屈曲 Radial (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
16、 ( 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,Ventral (anterior) glide of the phalanx on the metacarpal ( flexion)指骨相对掌骨的腹侧滑动屈曲 Dorsal (posterior) glide of the phalanx on the metacarpal ( extension)背侧滑动伸展,MC
17、P 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 Distraction 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
18、节,LLP of the PIP and DIP joints = Slight flexion 休息位=轻度屈曲 ROLL & 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,Connection between SPINE and LEG 连接脊柱和腿 Power generator 产生动力,HIP Osteokinematics髋关节运动学,HIP JPA髋关节松动术,LLP = 30 flexion, 30 ABd
19、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 Lateral Glide ( hip aDd & other movement） 侧方滑动内收及其他 Anterior (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 Assessme
20、nt Joint Mobilization,KNEE Osteo- & Arthrokinematics 膝骨和关节运动学,LPP = 25 flexion 休息位=屈曲25,KNEE JPA膝关节,TIBIO-FEMORAL JOINT胫股关节 Anterior glide前方 Posterior glide后方 Medial glide内侧 Lateral glide外侧 PATELLO-FEMORAL JOINT 髌股关节 Multi-directional glides 多个方向滑动,KNEE JPA膝关节,TIBIO-FEMORAL JOINT 胫股关节 Anterior glide
21、 Posterior glide Medial glide Lateral 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,In LPP, moving tibia on femur 休息位，胫骨相对股骨的运动 In sitting, moving tibia on femur (non-LPP)
22、坐位，活动胫骨,Knee Joint Mobe for Flexion 膝屈曲的松动,3. Combining Osteo- and Arthokinematics at the barrierPosterior 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. L
23、ateral 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,PF 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
24、is associated with knee flexion向下滑动和屈膝有关,PATELLO-FEMORAL JOINT 髌股关节,Superior glide 向上滑动 Inferior glide 向下滑动 Medial glide 内侧滑动 Lateral 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,ANKLE LPP = 1
25、0 PF 踝关节 休息位=踝关节跖屈10,ANKLE JPA 踝关节,Distal-on-proximal Posterior glide of talus on fixed tib-fib ( dorsiflexion) 距骨的后向滑动，固定胫腓骨背屈 Anterior glide of talus on fixed tib-fib (plantar flexion) 距骨的前向滑动，固定胫腓骨跖屈 3. Traction of the talocrural joint (influences all movements)踝关节（距小腿关节）的牵引分离 Proximal on distal
26、Anterior glide of tibia on fixed talus ( dorsiflexion) 胫骨的前向滑动，固定距骨背屈,STJ Osteokinematics 距下关节,Transverse Tarsal Joint 跗横关节,Transverse Tarsal Joint 跗横关节,AXIAL SKELETON (Spine) 中轴骨骼（脊柱）,Joint Play Assessment Joint Mobilization/Manipulation 关节评定和关节松动,VERTEBRAL COLUMN 脊柱,LOOSE PACK松散位置 Neutral position中立位CLOSE PACK紧密位置 Full extension充分伸展CAPSULAR PATTERN Coupled loss of SB and Rotation,LUMBAR SPINE AROM 腰椎主动运动,LUMBAR SPINE JPA 腰椎松动,Central Pressures Unilateral Pressures _Transverse Pressures ,THORACIC VERTEBRAE胸椎,THORACIC SPINE / RIBS 胸椎/肋骨,Central PressuresUnilateral PressuresRib Springing,
