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CAFMT > Functional Mobilization Upper Extremity > Flashcards

Functional Mobilization Upper Extremity Flashcards

1
Q

Upper extremities Evaluation

A
  1. Cervical Rotation
  2. Upper T-spine Rotation
  3. First and second rib mobility
  4. Shoulder Abduction
  5. Shoulder Horizontal Adduction
  6. Shoulder Internal Rotation
  7. Testing of Automatic setting of humeral head
  8. Postural Evaluation/Vertical Compression Test
  9. Elbow Flexion test
  10. Upper Limb Neural Tension
  11. Disinhibition series
  12. Impact test
  13. Arm pull at side
  14. T1-2 flexion extension
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2
Q

Cervical Rotation

A

Lateral border of hand at A/C joint and fingertips on the posterior neck
- 1st point of contact (to 1st knuckle) = 70%
- Middle knuckle/2nd knuckle = 80%
- Proximal knuckle/3rd knuckle = 90%
- Chin touching hand 100%

70% from cs 30% from ts

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3
Q

Upper T-Spine Rotation

A

Palpate the spinous processes to access rotation (move opposite direction of the head)
a. Same level- noting the decree of motion that occurs during cervical rotation
b. Level above or below - note the amount of rotation occurring between thoracic levels

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4
Q

First and Second Rib mobility

A
  1. evaluate end feel of 1st ribs
  2. asses mobility with cervical motions (diagonal and side bending motions)
    Efficient state, the rib drops inferiorly as the head moves towards it.
    Repeat with 2nd rib
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5
Q

Shoulder Abduction

A

Efficient shoulder= close to 180 degrees AAROM abd with shoulder fixed in PD.
palm facing downward
evaluate range and quality of motion
Limitation indicates dysfunction of capsule, AC joint or neural tension
Arm heavier on dysfunctional side

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6
Q

Hypermobility end range

A

when feels like will move (excessive joint i.e. pt reports joint drop)
Stop prior to “hyper”

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7
Q

Hypermobility and stabilization

A

Apprehension with hypermobility is normal. Cue to relax apprehension before stabilizing.

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8
Q

Shoulder Horizontal Adduction

A

stabilize shoulder
note ROM in the arc of flexion add down to extension adduction

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9
Q

Shoulder Internal Rotation

A

Evaluate HBB reaching upwards to head
Note range where humeral head translates anteriorly (hand on humeral head)

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10
Q

Testing of automatic setting of humeral head/VCT

A

ability of shoulder to have stabilizing contraction while resisting flexion/approximation at 90 degrees
Straight arm/elbow
Stagger stance (see what stagger is weaker each side and retest using same stance)
Hand on inferior prox. humerus vs scapula

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11
Q

Elbow Flexion test

A

Stability of GH and scapula
Efficiency of connection to core

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12
Q

Postural evaluation

A

lateral view for overall postural alignment

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13
Q

Stabilizing shoulder girdle options for Upper Limb Neural Tension Test

A

Therapist positioned
- SUPERIORLY depressing shoulder girdle assessing for tension subjectively and objectively (initial take up of nerve and check for immediate NT)
- INFERIORLY with hand under posterior shoulder and depress the shoulder girdle
-Can utilize strapping belt to stabilize the shoulder
- Can add cervical side bending and rotation to further challenge the neurovascular structures

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14
Q

Most common nerve tension

A

Median

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15
Q

If tension with initial shoulder depression

A

Treat above the clavicle

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16
Q

Areas of nerve tension

A

Carpal tunnel
Aponeurosis
Neck
Elbow
Pronator Teres

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17
Q

Localization with ULTT

A

Drop head to same side: Increase in ROM = treat Soft tissue and fascia
No change with head to same side: Think joint

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18
Q

Upper Limb Neural tension for brachial plexus and median nerve

A

Arm at side, extend the elbow with forearm in supination and progress to slowly extending the wrist testing for tension. Further progress to shoulder abduction up to 90 degrees
Add increased demand on neural mobility by side bending head away from side being tested
Evaluate if tension felt in any cervical vertebrae
*Note ROM of wrist and shoulder ABD at first sign of tension or symptom provocation

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19
Q

Upper Limb Neural tension for Radial nerve

A

Position like Median nerve with forearm in pronation and wrist flexion (palm down)

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20
Q

Upper Limb Neural tension for Ulnar nerve

A

Flex arm and place hand next to face (circle between thumb and first finger). Slowly horizontally abduct arm testing for tension

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21
Q

Neural tension caution

A

Avoid stretching neural tissues (exacerbation of symptoms). Only test tissues to initiation of tension - therapist or patient perception

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22
Q

Disinhibition series identifies

A

-Evaluate initiation (ACE), strength, ability to hold (not push), ability to produce irradiation, and endurance
-Means of identifying if there is a cervical component to peripheral weakness
-Identify what type of cervical position or upper quadrant stress will inhibit
-Develop home program and body mechanics strategies

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23
Q

Disinhibition series

A
  1. Evaluation of CPM
  2. Pivot Prone (shoulder girdle and upper extremity response)
  3. Peripheral Strength (supine and sitting. compare bilaterally)
    4.Segmental Eval
  4. Treatment in supine/sitting
  5. Retest weak muscles
  6. Impact test
  7. Treatment strategies
  8. HEP training
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24
Q

Peripheral muscle weakness connected too

A

Disinhibition of FFM/ACE
Check Impact test/ core

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25
Q

CPM

A

Evaluate diagonal direction for flexion/extension for ACE, Initiation, Strength, Endurance, And irradiation

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26
Q

Pivot prone

A

Identifies inhibition of muscular response
Caution with manual contact To front/lateral surface with testing
Feel scapula
ER not hand facing forward
Ask self: where is breaking point? GH, Scapula, Serratus posterior, neck?

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27
Q

Peripheral Strength tests

A
  1. Thumb add & opposition (C8-T1)
    -arm at side elbow at 90 mid range supination and pronation
  2. Wrist flexors (C7)
    -Same as Thumb add
  3. Wrist extension (C6)
    -Same as Thumb add
  4. ER/IR (C5-6)
    -Same as Thumb add
  5. Elbow flexion (C5-6) and Extension (C7)
    -at side forearm in supination
  6. Forearm pronation
    -Pronator teres (C6) and Quadratus Teres (C8-T1)
    -Palm down at side, PT hand in hand thumbs interlocked
  7. Shoulder flexion (C5-6)
    -PNF upper extremity patterns (optional)
  8. Problematic function motion or pattern

*Break test score not MMT

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28
Q

Disinhibition Segmental eval

A
  1. Evaluated in supine or sitting
  2. perform axial elongation (lengthening and posterior motion of cervical spine and tucking of the chin)
  3. Pressure on transverse processes, assess ability to hold each level
  4. Deep neck flexors: resist under chin with chin tucked
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29
Q

What muscle is the primary deep cervical stabilizer?

A

Longus coli

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30
Q

Disinhibition Treatment (inhibited segments)

A
  1. into axial extension
  2. General resistance PA resistance
  3. Specific segmental faciliatory treatment
    a. Prolonged hold to specific transverse process of identified inhibited segments
    b. Unilateral enhanced facilitation: add cranial rotation towards weak side
    c. Irradiation- Discover what will assist using 1) resisted chin tucking 2) LE or UE resistance to facilitate inhibited segments
    d. Resistance to cranial elongation through pressure on top of head or behind occipital ridge
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31
Q

Axial extension should

A

Lengthen not buckle

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32
Q

Disinhibition HEP

A
  1. Train patient: perform self-resisted axial elongation one hand behind neck to resist posterior motion one hand under chin to resist short neck flexors. Tip of tongue on rugae of hard palate. Maintain contraction until an enhanced contraction is achieved.
  2. Resisted home program- resistance to specific weak segments with TheraBand or belt. Progressively increase length of hold time. Perform on regular basis up to 10x daily; finding target muscle weakness and whenever inadvertently utilize agg. activities.
  3. Progression: to sitting and prolong axial extension in functional postures
  4. Elongation: TheraBand resist
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33
Q

Primary thoracic girdle structures

A

1st and 2nd Thoracic vertebra
1st and 2nd ribs
Manubrium
Sternoclavicular joints

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34
Q

Upper T/S manipulations can improve

A

Cervical, shoulder, and elbow functions

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35
Q

Disinhibition retesting muscles

A

No change: prognosis is guarded
Strength and initiation improved: central involvement or inhibited state and mechanism to facilitate improvement

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36
Q

Thoracic girdle Evaluation

A
  1. VCT and EFT
  2. Thoracic girdle
  3. Mobility
    1st and 2nd rib
  4. Extension hypomobilities of upper T/S
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37
Q

EFT assesses what in the shoulder?

A

Watch for GH stabilization
Meet contraction
Shoulder winging
ACE/CFS

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38
Q

Impact test

A

In supine or sitting
*teach patients to test themselves
1. Prolonged cervical flexion -most often inhibitory motion
2. Other cervical motions- Extension (looking up), Side bending (phone), forward head posture, rotation (backing up car)
3. Axial compression-compression on top of head (wearing a hat)
4. Arm pull- carrying objects (Thoracic outlet)
5. Any motion or activity pt reports aggravates symptoms

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39
Q

Shoulder girdle VCT Assessment

A

Test both foot position strategies and find which weakest vs strongest
Test flexion vs approximation stabilization
Can shoulder girdle push to engage?

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40
Q

Sources of prolonged C/S flexion

A

Watching TV, Cell phones, Sleeping with multiple pillows under head

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41
Q

Therapist mechanics for 2nd rib

A

Weight shift through hips

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42
Q

Disinhibition treatment strategies

A
  1. identify positive activities (inhibitory)
  2. Train to avoid those activities or motions. Most reintroduce within several weeks.
  3. Retest patient in more demanding ways as they improve
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43
Q

Thoracic girdle mobility

A

Breathing
Folding and lengthening of ribs and manubrium with flexion / extension
T1-2 with flexion / extension / rotation hands interlocked behind neck (lift elbows to create T/S extension)

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44
Q

1st and 2nd rib

A
  1. First rib
    a. Side bending
    b. Rotation
  2. Soft tissue
    a. Deep fascia, levator, upper traps
    b. Posterior superior Serratus
  3. 2nd/3rd ribs side lying
  4. First rib A/P-P/A
  5. First rib depression
  6. Anterior and medial scalenus mobility
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45
Q

1st rib movement with Right Cervical movement

A

Right Rib posterior superior
Left Rib anterior inferior

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46
Q

1st rib to assessment

A

Glide Inferior/anterior vs posterior

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47
Q

1st rib mobility aspects

A

AP/PA
Depression

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48
Q

1st rib mobilization ideas

A

Snowman with a hat
Knuckle

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49
Q

FMP for 1st rib ideas

A

LTR
Breathing
Head rotation

50
Q

FMP for 2nd rib idea

A

Breathing
Basking seal
Press feet into the table

51
Q

Deep C/S fascia mobilization ideas

A

Fist
Round side of Fascia freer

52
Q

Accessory muscle of breathing that gets Confused with trap tightness

A

Posterior superior serratus

53
Q

Extension hypomobilities of upper T/S

A
  1. POE
    a. STM grove of spine
    b. joint mobilization
  2. Upper Thoracic backward bending
    a. Evaluation- hip hinge 20 degrees lift elbows superiorly. Note end-feel.
    b. Treatment sitting on supporting surface or PT knees
  3. Localize restriction flex/ext then R/L. Increase hip flexion with lower T/S
54
Q

Mobilization options for Thoracic extension

A
  1. Cervical rotation or side bending (active, passive, assisted)
  2. Cover Position
  3. Active or resisted shrugging
  4. Lower trunk rotation
  5. BOS - opposite leg into underlying surface
55
Q

Scaleni

A

Anterior: c3-6
Medial: 2-7
Posterior: 5-7

56
Q

Extension Hypomobilities Upper T/S

A

Prone on elbows
Upper Thoracic backward bending
- elbows on supporting surface
- elbows on therapist’s knee
*Spring test
*Try and drop T/S forwards
*Assess how moves to R vs L, side bend, C/S rotation
*If painful at end range, then back side bend to loose pack
*Hand behind head: beware of shoulder issues but good for fusion

57
Q

Extension Hypomobilities Upper T/S mobilization strategies

A

Snowman with a hat
Dycem
Breathing
weight shifts
oscillations
Feet into the floor
Pull arms down
Push hands together
Lift arms-NMRE
- hold vertebra into range then resist rotation
- vertebra resist and arm irradiation

58
Q

Form Closure

A

Form (structures) allow it to have stability

59
Q

Form closure of shoulder girdle

A

Clavicle forwards
scapula down and back

60
Q

Example of limited Shoulder girdle form closure

A

Pull from neck preventing colure on rib cage

61
Q

Force closure

A

Muscle contraction creates stability

62
Q

Shoulder Girdle Evaluation

A
  1. Shoulder position
    a. Anterior/Posterior Superior/Inferior
    b. Humeral Head position
    c. Shoulder girdle Vertical Compression
    d. Pull on UE
    e. UE ROM
    -does the weight go to the foot?
63
Q

Shoulder positioning manual evaluation

A

Hand on scapula and clavicle

64
Q

Clavicle mobility with ROM

A

moves posteriorly on acromion with Horiz add
moves Anteriorly with Horiz abd
Downward glide with flexion
Upward glide with extension/shoulder girdle depression

65
Q

Big ben

A

Shoulder Clock

66
Q

Shoulder clocks (Big Ben)

A

Evaluate passive and active movement of scapula looking for mechanical and motor control problems
Asses range, end-feel, quality of motion in AE/PD/AD/PE
assess soft tissues, AC and SC movements
Trace and isolate then retrain in new range

67
Q

AC joint PA mobility in sidelying

A

anterior fingers on posterior clavicle
posterior hand gripping anterior humerus

68
Q

AC joint AP mobility sidelying

A

Anterior hand on posterior humerus
Posterior fingers fingers acromion

69
Q

AC joint percussion

A

Kong while resisted shrugging

70
Q

SC movements with posterior scapula patterns

A

Proximal end of clavicle distracts away from manubrium

71
Q

SC movements with anterior scapula patterns

A

Proximal end of clavicle Compresses against the manubrium

72
Q

SC movements with elevation scapula patterns

A

Proximal end of clavicle moves inferiorly (Caudally)

73
Q

SC movements with depression scapula patterns

A

Proximal end of clavicle moves superiorly (cranially)

74
Q

Clavicle distraction

A

Patient move from anterior position posteriorly to mobilize
*Dycem can assist in grip and reducing tenderness

75
Q

Scapula thoracic articulation mobilization

A

Side lying
Roll pt toward you
use zyphoid/sternum on shoulder to compress scapula into fingers
Can use dycem for better grip

76
Q

Latissimus pocket

A

Assess if accessing latissimus pocket with unilateral EFT
Train stability through prolonged holds to shoulder girdle and UE

77
Q

Sitting AC mobilization

A

Elbow resting on table at restricted motion in scaption
Access AC and SC

78
Q

FMUE functional tests

A

Impact test
Pivot prone
VCT
EFT or arm pull

79
Q

UE force couples

A

BAD: Pec Minor and Subscap (Internal rotators)
GOOD: Serratus anterior, Rhomboids, and RC

80
Q

CoreFirst application to shoulder

A

Establish BOS
Align over effective BOS
PNF to engage core/deep stabilizers of joint
Weight shift within BOS
WS out of BOS and WA into new BOS
Vary BOS
Speed and automatic engagement

81
Q

Shoulder Girdle Mobilization

A

A/C joint
S/C joint
Scapular thoracic pocket
Latissimus pocket

82
Q

GHJ Evaluation

A

VCT
CS ROM
Shoulder girdle position
First rib mobility
Shoulder ROM
Approximation

83
Q

GHJ mobilization

A

-Posterior translation
-Gapping distraction of GH articulation
-Caudal translation of head of humerus
-Downward (caudal) glide of humerus
-Humeral Posterior shear
-Internal Rotation in Abduction

84
Q

Primary shoulder off axis

A

Shoulder sitting anteriorly

85
Q

Purpose of Posterior translation

A

Getting humeral head on axis in glenoid fossa

86
Q

Purpose of distraction of GH articulation

A

Improving space between the humeral head and glenoid fossa
*essential intrinsic accessory motion

87
Q

Purpose of Caudal translation of humeral head

A

Decompression of subacromial space

88
Q

Purpose of downward (caudal) glide of humerus

A

Improving ability for humeral head to glide caudally

89
Q

Shoulder capsule can be treated with

A

Caudal glide

90
Q

Caudal glide in sitting

A

Arm placed in scaption
mobilize with down ward force through shoulder
Retrain with hands in axilla

91
Q

Capsule is

A

60% tendon type tissue
Remainder is capsule type tissue

92
Q

Posterior capsule is made of which tendon

A

Infraspinatus

93
Q

90% of dislocations occur

A

anteriorly

94
Q

Posterior shear mobilizes

A

posterior capsule

95
Q

Muscles to assess with soft tissue mobilizations Flex Abd ER/Ext ADD IR (PE/AD)

A

Superficial fascia
Pectoralis major tendon and muscle
pectoralis minor
inferior capsule
subscapularis
neurovascular structures
teres major and minor
infraspinatus
latissimus
serratus
deltoids
triceps
head of triceps
bicipital groove
supraspinatus body
supraspinatus tendon
upper trapezius
levator
deep cervical fascia
posterior superior serratus

96
Q

Muscles to assess with soft tissue mobilizations Flex Add ER/Ext ABD IR (PD/AE)

A

Superficial fascia
pectoralis
pectoralis tendon folding
pectoralis minor
coracoid process
anterior deltoid
biceps
biceps tendon
inferior capsule
subscapularis
teres major and minor
infraspinatus
latissimus
serratus
posterior deltoids
triceps
upper trapezius
levators
deep cervical fascia
supraspinatus
supraspinatus tendon

97
Q

Roll on it mobilization with sidelying restroom request (flexion horiz add)

A

Mobilizing humerus for IR, flexion, Horiz add
evaluate humeral motion

98
Q

Roll on it Internal rotation (Jackie Gleason)

A

good home exercise for internal rotation

99
Q

Round about

A

Arm circles

100
Q

Prayer pose palm down

A

emphasis on lower traps

101
Q

Prayer pose Thumb up

A

Lateral muscles like latissimus

102
Q

Prayer pose Thumb down

A

Medial muscles of Rhomboids

103
Q

Increased UE nerve tension that does not maintain associated with

A

Previous Concussion (especially loss of consciousness)
Hyper sympathetic

104
Q

Thrust nerve mobilization

A

Isolate
deep breath and holds
muscle contraction
Trust (not a big motion, just quick)

105
Q

Nerve treatment motions

A

Wrist
Elbow
Cervical side bending
Shoulder Horiz. add and abd

106
Q

Areas of nerve mobility
*primary restrictions

A

Cervical foramen
Anterior scalene
First rib
Superior and inferior clavicle*
Coracoid process
Pectoralis minor*
Axilla region
Course of arm, forearm (Pronator teres)*
Wrist retinaculum*
Aponurosis of palm

107
Q

Passive arm circles

A

Big spin

108
Q

Elbow Mobilization

A

Extension of Olecranon process and radial head
Olecranon and radial distraction
Olecranon mobility
Radial head mobility
Radial head gapping
Anterior glide of humerus
Weight bearing
Flexion supination and pronation

109
Q

Olecranon efficient positioning

A

Should “Disappear” with supinated extension and maintain with pronation without shifting

110
Q

Lateral Tendonitis?

A

Think radial head distraction and on axis

111
Q

Forearm elbow resistance

A

Straight flexion/extension in supination or pronation
flexion with supination
flexion with pronation
Extension with supination
Extension with pronation

112
Q

Supported flexion is…

A

Pivot of elbow in PNF pattern

113
Q

Wrist and Forearm mobilization

A

Circumduction
Distal radius and ulnar mobility
Superior (Proximal) metacarpals
Inferior (Distal) metacarpals
Lateral Shear wrist
proximal to distal rows of carpals and metacarpals
Medial to lateral columns of carpals and metacarpals
Wrist flexion
Weight bearing wrist extension

114
Q

Fingers Mobilization

A

Palm fold and lenthen ability
Weight bearing hand spreading
Circumduction of MCP
Articulation Diagonals and rotation
MP flexion and extension

115
Q

Thumb Mobilization

A

Opposition
Radial extension
Palmar abduction
Adduction
Resisted Mass grasp and release

116
Q

PNF hand placement

A

inside hand always on the hand
outside on the forearm
Radial pattern: inside hand fingers pointing towards thumb
outside on radius
Ulnar pattern” inside hand fingers toward pinky side
outside hand on ulna

117
Q

PNF body mechanics

A

Table midthigh height
use WS and hinging for resistance rather than arms
Switch pelvis direction to other diagonal @ 90 degrees shoulder flexion
* make use you get full rotation at head of table

118
Q

Flexion Abduction External Rotation Irradiation (PE)

A

Scapular PE or PD
Bilaterals
Elbow flexion
Radial extension
lifting pattern hold at end range
Resist extremity through full flexion abduction pattern
dowel resist bilateral flexion abduction

119
Q

Extension Adduction Internal rotation Irradiation (AD)

A

Scapula AD
Elbow extended or flexion
Wrist ulnar flexion
Bilateral UE
Chopping
Resist extremity through full extension adduction pattern
Dowel

120
Q

Extension abduction Internal Rotation Irradiation (PD)

A

Scapular PD
Wrist Ulnar extension
Bilateral UE
Resist extremity through full extension abduction pattern
Chopping
Dowel

121
Q

Flexion Adduction External Rotation Irradiation (AE)

A

Scapula AE
Elbow flexion
Wrist radial flexion
bilateral UE
Lifting
Resist extremity through full flexion adduction pattern
Dowel

122
Q

Dowel PNF

A

Different hand positions change what hand is doing more work
Great for shoulder patients and helping get core to engage

CAFMT (8 decks)

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