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AH 321

Joint Play Laboratory

Assess the joint play and end feel for each of the following joints in the loose packed and closed packed position. Record the end feel for your partner for each joint in the appropriate boxes.

Joint

Closed packed

Loose packed #1

Loose packed #2
1st Interphalangeal joint of foot      
1st Metatarsophalangeal      
3rd PIP      
4th DIP      
5th MP      
Calcaneocuboid      
5th metatarsocuboid      
Talonavicular      
Subtalar      
Talocrural      
Inferior tibiofibular      
Proximal tibiofibular      
Tibiofemoral      
Patellofemoral      
Acetabular femoral      
Posterior intervertebral joints C2-S1      
Sternoclavicular      
Acromioclavicular      
Glenohumeral      
Humeroulnar      
Radiocapitellar      
Proximal Radioulnar      
Scaphoradial      
Scapholunate      
Distal Radioulnar      
1st carpometacarpal      
1st metacarpophalangeal      
3rd metacarpophalangeal      
5th metacarpophalangeal      
1st PIP      
2nd PIP      
1st DIP      
4th PIP      
3rd DIP      
Temporomandibular      

 

Mennell’s Rules for Joint Play Testing
  • The patient should be relaxed and fully supported
  • The examiner should be relaxed and should use a firm but comfortable grasp
    •
  • One joint should be examined at a time
    •
  • One movement should be examined at a time
    •
  • The unaffected side should be tested first
    •
  • One articular surface is stabilized while the other surface is moved
    •
  • Movements must be normal and not forced
    •
  • Movements should not cause undue discomfort

    • Joint

    Resting (Loose Packed) Position of Joints

    Close Packed Position of Joints
    Facet (spine) Midway between flexion and extension Extension
    Temporomandibular Mouth slightly open (freeway space) Clenched teeth
    Glenohumeral 550 abduction, 300 horizontal adduction Abduction and lateral rotation
    Acromioclavicular Arm resting by side in normal physiological position Arm abducted to 900
    Sternoclavicular Arm resting by side in normal physiological position Maximum shoulder elevation
    Ulnohumeral (elbow) 700 flexion, 100 supination Extension
    Radiohumeral Full extension, full supination Elbow flexed 900, forearm supinated 50
    Proximal radioulnar 700 flexion, 350 supination 50 supination
    Distal radioulnar 100 supination 50 supination
    Radiocarpal (wrist) Neutral with slight ulnar deviation Extension with radial deviation
    Carpometacarpal Midway between abduction-adduction and flexion-extension  
    Metacarpophalangeal (thumb)   Full flexion
    Metacarpophalangeal (fingers)   Full opposition
    Metacarpophalangeal Slight flexion  
    Interphalangeal Slight flexion Full extension
    Hip 300 flexion, 300abduction, slight lateral rotation Full extension, medial rotation*
    Knee 250 flexion Full extension, lateral rotation of tibia
    Talocrural (ankle) 100 plantar flexion, midway between maximum inversion and eversion Maximum dorsiflexion
    Subtalar Midway between extremes of range of movement Supination
    Midtarsal Midway between extremes of range of movement Supination
    Tarsometatarsal Midway between extremes of range of movement Supination
    Metatarsophalangeal Neutral Full extension
    Interphalangeal Slight flexion Full extension

    End Feels

    Normal

    Examples

    Abnormal

    Examples
    Bone to bone Elbow extension Early muscle spasm Protective spasm after injury
    Soft tissue approximation Knee flexion Late muscle spasm Spasm caused by instability
    Tissue stretch G-H external rotatrion Hard capsular Frozen shoulder
        Soft capsular Synovitis, soft tissue edema
        Bone to bone Osteophyte formation
        Empty Acute subacromial bursitis
        Springy block Meniscus tear