Lecture 3 - Shoulder

Question 1

GH Joint:

Loose packed

Closed packed

Capsular Pattern of Restriction

Answer 1

Loose packed position or Resting Position:
40 - 55 degrees abduction
30 degrees of horizontal adduction (in the scapular plane)

Closed packed position:
Full abduction with lateral (external) rotation

Capsular Pattern of Restriction:

First: lateral (external) rotation
Second: abduction
Third: medial (internal) rotation

Question 2

GH joint - Mobilizations

Answer 2

Anterior glide
Long axis traction
Posterior glide
Inferior glide at 90 degrees of abduction
Inferior glide at 90 degrees of flexion
Lateral distraction

Question 3

Anterior glide

Answer 3

Anterior glide

Therapeutic Effect:
Increase extension, decrease pain, reduce posterior positional fault
Precautions: the anterior joint capsule is looser and more lax so don’t over mobilize in this direction
Hand Placements/Procedures:
Stabilizing Hand: scapula (coraco process)and clavicle are resting on a firmly rolled towel for support, stabilize distal arm under distal humerus (use small pillow instead)
Mobilizing Hand: the head of the humerus in the anterior direction.

Helpful Suggestions: keep patient’s elbow flexed and relaxed to not pull on the biceps tendon

Question 4

Long Axis Traction (axial distraction or inferior glide)

Answer 4

Long Axis Traction (axial distraction or inferior glide)

Therapeutic Effect:
Decompress the joint, increase overall range of motion and specifically to increase inferior glide, decrease pain.
Precautions: do not allow the shoulder girdle to move inferiorly as it may compress the brachial plexus between the clavicle and the first rib.
Hand Placements/Procedures:
Stabilizing Hand: start with the shoulder girdle in an inferior position, place proximal hand on coracoid process and on the AC joint
Mobilizing Hand: grasp the distal humerus proximal to the epicondyles and distract inferiorly through the long axis of the humerus.
Helpful Suggestions: keep patient’s elbow flexed, therapist rotates body to facilitate pulling humerus

Question 5

Posterior Glide

Answer 5

Posterior Glide

Therapeutic Effect:
To increase internal rotation, flexion and to reduce an anteriorly positioned humeral head.(and pain management)
Precautions: do not allow the humerus to externally rotate
Hand Placements/Procedures:
Stabilizing Hand: spine of scapula on scapula and block arm with hip to prevent external rotation of the humerus
Mobilizing Hand: head of the humerus is moved posteriorly and slightly lateral.
Helpful Suggestions: therapists thumbs are parallel to the joint line and help guide mobilization

Question 6

Inferior Glide at 90 Degrees of abduction

Answer 6

Inferior Glide at 90 Degrees of abduction

Therapeutic Effect:
Increase abduction and flexion, to decompress the joint and to decrease pain.
Precautions: with inferior joint instability use caution, may provoke pain.
Hand Placements/Procedures:
Stabilizing Hand: proximal to medial epicondyle of humerus, gentle grasp
Mobilizing Hand: gently pull the humerus first then mobilize the head of the humerus inferiorly.
Helpful Suggestions: depress the shoulder girdle first as this stabilizes the scapulothoracic joint.

Question 7

Inferior Glide at 90 degrees of Flexion

Answer 7

Inferior Glide at 90 degrees of Flexion

Therapeutic Effect:
Increase flexion and abduction
Precautions: Do not lever the joint as this may damage the capsule. Take caution for inferior joint instability. Try to minimize pain at the humeral head while mobilizing.
Hand Placements/Procedures:
Stabilizing Hand: distal humerus on therapists shoulder
Mobilizing Hand: head of the humerus in the inferior direction
Helpful Suggestions: make sure mobilizing hand is distal to the acromion

Question 8

Lateral Distraction

Answer 8

Lateral Distraction

Therapeutic Effect:
Decompress the joint, increase overall range of motion and to decrease pain.
Precautions: do not apply pressure to patient’s chest with forearms, may compress the ribs, your forearm should be just below the breast tissue.
Hand Placements/Procedures:
Stabilizing Hand: distal humerus at lateral supracondylar crest
Mobilizing Hand: grasp proximal humerus near the axilla and mobilize laterally
Helpful Suggestions: therapist uses body weight to create a lateral glide force by leaning inwards. Elbows should be perpendicular to the patient’s body. Form a soft C shape with your mobilizing hand to avoid compressing nerves in the medial arm.

Question 9

Apley’s Scratch Test

Specifically measures internal and
External rotation at the GH joint.

Answer 9

Question 10

GH joint - Special Tests

Impingement test

Answer 10