Lab 2: UE HVLA/BLT

Question 1

What is the BLT for a GH SD?

Answer 1

• Pt is LR w/ dysf. side UP. Doc stands behind patient
• Grasp olecranon of dysf arm and flex elbow. Use other hand to stabilize the shoulder, monitoring w/ the thumb and index finger
• Using the elbow as a lever, put the GH joint in its indirect position (aB/ADduction, flexion/ext., compression/traction, IR/ER)
• Hold until a release is felt and then reassess

Question 2

What is the BLT for SC SD?

Answer 2

• Pt is seated. Place thumb on tip of inferomedial clavicle at SC joint
• Place other thumb on the dysf. lateral clavicle at the inferomedial AC joint
• Move both thumbs laterally, superiorly, and slightly posteriorly while the patient retracts unaffected shoulder posteriorly.
• Maintain pressure and apply prinicples of BLT

Question 3

What is the HVLA for an Adducted and Extension SD of the SC joint?

Answer 3

• Pt is supine w/ physician at head of table.
• Place thenar eminence of monitoring hand over restricted SC joint
• Apply a cephalad traction on arm on side of dysf.
• Apply a thrust on SC joint while simultaneously inducing a rapid traction force thru the pt’s arm
• Adduction SD (Elevated SC): inferior thrust
• Extension SD (Anterior SC): posterior thrust

Question 4

What is the BLT for a Superior Glide SD of the AC joint?

Answer 4

• Doc places both thumbs under the dysf. side clavicle, fingers above clavicle
• Pt rests ipsilateral forearm over doc’s forearms
• Pt leans towards and rotates away from doc. Doc carries dysf. shoulder posteriorly, gapping SC and AC joints
• Clavicle is carried to point of BLT.

Question 5

What is the MET for Ulnar Abduction/Adduction dysfunctions?

Answer 5

• Pt is seated with forearm supinated
• Place ulnar into RB
• Instruct pt to push into the ease for 3-5 secs, relax, repeat 3-5x
• Reassess

Question 6

What is the HVLA for an Ulnar Abduction SD?

Answer 6

• Pt is seated w/ elbow fully extended and supinated. Grasp elbow w/ fingers of monitoring hand on either side of olecranon, other hand grasps distal radius/ulna
• Move elbow into ulnar adduction. Apply a medial to lateral thurst over the medial olecranon

Question 7

Ulnar adduction is what type of test and coupled with what wrist motion?

Answer 7

• Varus testing
• Coupled w/ wrist abduction (radial deviation)

* Ulnar motion is named for the distal portion

Question 8

Ulnar abduction is what type of test and coupled with what wrist motion?

Answer 8

• Valgus test
• Coupled with wrist adduction (ulnar deviation)

Question 9

What is the HVLA for an Ulnar Adduction SD?

Answer 9

• Pt is seat w/ fully extended and supinated elbow. Grasp elbow w/ fingers of monitoring hand on either side of olecranon, other hand grasps distal radius/ulnar
• Move elbow into ulnar abduction. Apply a lateral to medial thrust over the lateral olecranon

Question 10

What is the BLT for the Interosseous Membrane?

Answer 10

• Doc holds the pt’s hand, with the other hand place index finger on the pt’s radius for monitoring. Use thumbs to monitor interosseous membrane
• Perform indirect positioning of the wrist and elbow to attain point of BLT at the interosseous membrane
• Add respiratory phases and make minor adjustments to maintain BLT

Question 11

What is the HVLA for an Anterior Radial Head SD?

Answer 11

• Pt seated w/ doc standing facing the pt.
• Place thumb of one hand into the crease of the pt’s elbow contacting directly over the anterior radial head. Other hand flexes elbow and pronates forearm.
• Exert a rapid hyperflexion force while simultaneously thrusting the radial head posteriorly

Question 12

What is the HVLA for a Posterior Radial Head SD?

Answer 12

• Pt seated w/ doc standing facing the pt.
• Extend and supinate the elbow. Place thumb over posterior aspect of radial head
• Exert a rapid hyperextension force while simultaneously thrusting the radial head anteriorly

Question 13

How do we perform the articulatory with traction for a Radiocarpal joint SD?

Answer 13

• Doc cups hands by approximating thenar and hypothenar eminences to form a groove in each hand
• Doc’s hands are placed over the dysfunction w/ the grooves parallel to the joint line
• Doc squeezes between his/her hands, producing traction as the eminences separate
• Doc maintains the squeeze and traction while articulating the pt’s wrist in a clockwise, then counter-clockwise motion (circles or figure-8), carrying the dysf. through the RB

Question 14

What is the HVLA for wrist extension/ventral carpal SD?

Answer 14

• Pt seated w/ doc facing the pt
• Pronate elbow and grasp pt’s hand, thumbs contacting dorsally at the proximal carpal bones (radiocarpal joint)
• Deliver a whip-like thurst moving from extension to flexion through the carpal dysf.

Question 15

What is the HVLA for wrist flexion/dorsal carpal SD?

Answer 15

• Pt seated w/ doc facing the pt
• Pronate elbow and grasp pt’s hand, thumbs contacting dorsally at the proximal carpal bones (radiocarpal joint)
• Deliver a whip-like thurst moving from flexion to extension through the carpal dysf.

Question 16

How do we perform the finger articulatory treatment?

Answer 16

• Lock the dysf. metacarpal between the thumb and index finger of one hanf. With other hand, place thumb and index finger on the dorsal and volar aspext of the dysf. phalance.
• Apply long-axis extension (straight-line traction) or rotation or anteroposterior glide

Question 17

What is the HVLA for Phalangeal Dysfunction?

Answer 17

• Pt seated w/ doc standing facing the pt
• Isolate dysfunctional joint. While stabilizing the wrist, exert traction and a hyperflexion thrust through the SD