Articulatory techniques UE

Question 1

Elevated/adducted clavicle

Answer 1

• pt lying supine, doc at head
• pts neck full flexed, resting against doc’s chest
• doc places thumb over sternal end exerting a downward/caudal pressure on the clavicle
• pt instructed to inhale and exhale fully
• during exhalation the physician springs the clavicle to release restriction
• reassess

Question 2

Position for Spencer’s techniques

Answer 2

• Pt in lateral recumbent position with affected shoulder up
• pt’s knees and ips flexed, back str8 and perpendicular to the table
• head supported by a pillow
• doc at side of table facing the pt
• doc grabs pt’s forearm w/ one hand, flexing pts elbow
• other hand is place on top of pt’s shoulder to lock the shoulder girdle, limiting scapular movement

Question 3

Spencer step 1-

Answer 3

extension
-move pts arm in sagittal plane, extending shoulder and returning it to a neutral position, increasing excursion with each motion

Question 4

Spencer Step 2

Answer 4

flexion

• flex pt’s shoulder, straightening the elbow until the arm is over the pt’s ear
• repeat in rhythmic fashion with the shoulder returned close to neutral with each motion

Question 5

Spencer step 3

Answer 5

Circumduction

• flex pts elbow sharply and abduct the shoulder to 90
• then lock the pt’s shoulder in position using the pts elbow as a pivot
• gently rotate the shoulder in a circular fashion increasing the diameter with each motion
• start clockwise then go counterclockwise

Question 6

Spencer step 4

Answer 6

Circumduction with traction

• extend pts elbow and abduct arm to 90
• lock the pts scapula in position and rotate the humerus in increasingly larger circles
• star clockwise and then counterclockwise
• maintain TRACTION during motions at the pt’s wrist

Question 7

spencer step 5

Answer 7

Abduction/adduction

• ABD: start by placing upper hand on pts shoulder, flex pt’s elbow in flexed postion with their hand resting on docs forearm below the elbow joint
• docs lower arm gently exerts an upward pressure on pt’s flexed elbo, bring pt’s shoulder into abduction repeat 6-8 times
• ADD: maintaining above position, gently exert a downward pressure on pt’s flexed elbow bring pts upper arm into adduction

Question 8

Spencer step 6

Answer 8

internal rotation

• place pts hand behind their lower ribs with the elbow flexed
• doc uses upper hand to lock scapula and lower hand to draw pt’s elbow forward and down (int rotation)
• pt’s elbow released and maneuver repeated

Question 9

Spencer step 7

Answer 9

traction stretch

• pts hand placed on doc’s shoulder with elbow straight
• doc clasps hands around pt’s upper arm
• then provide a gentle pull, lifting the humeral head away from the fossa
• doc may consider leaning back to use body weight vs muscular force