HVLA UE

Question 1

SC adduction df

Answer 1

• pt supine, doc at head of table
• inf force with thumb over SC joint
• grab arm on side of df and exert cephalad force
• push downward through SC joint

Question 2

Elbow Abduction/adduction ulnar df’s

Answer 2

• supinate and fully extend elbow
• grab elbow
• other hand grab distal radius/ulna
• Assess df barrier and apply a corrective thrust into barrier either for adduction (varus) or abduction (valgus)

Question 3

Elbow ant radial head df

Answer 3

• place 2nd and 3rd fingers of one hand into the crease of pts elbow contacting directly over the radial head
• other hand flexes elbow and pronates forearm
• take elbow into hyperflexion while simultaneously thrusting the radial head dorsally

Question 4

posterior radial head df.. more common

Answer 4

• engage restrictive barrier with one hand’s thumb over posterior radial head
• other hand grabs pts distal raidus/ulna bringing elbow into extension and supination
• HVLA thrust is a simultaneous ventral force on radial head and elbow hyperextension

Question 5

Wrist Extension/Ventral carpal dysfunction

Answer 5

• Grab pt’s hand, thumbs contacting dorsaly at the proximal carpal bones
• Ext df: doctor delivers a whip like thrust moving from extension to flexion and dorsal glide force through the carpal dysfunction
• REASSESS!!
• for flexion df, just whip from flexion to extension

Question 6

Radial deviation/abduction wrist df

Ulnar deviation/adduction wrist df

Answer 6

• 20-30 abduction expected
• 30-40 adduction expected as normal
• pt seated, elbow flexed 90
• contact hand with one hand and pt’s distal radius/ulna with the other
• engage restrictive barrier then provide HVLA thrust
• reassess!!

Question 7

Phalangeal df

Answer 7

• Assess ROM of flexion/extension, abd/add int/ext rotation
• isolate df joint while exerting traction
• simultaneously deliver a corrective hyperflexion thrust