NMS3 Shoulder Flashcards
Procedure for SC Joint Play – SI
- Patient seated
- Dr. stands behind patient (mostly on the side of contact)
- Dr. takes his contact hand and reaches around to the opposite side of the patient to their superior surface of the proximal clavicle with an index, thumb contact.
- Dr. takes indifferent hand (side of contact), grasps the patients wrist and abducts the shoulder to 90.
- Dr. takes his contact hand and springs S-I for endfeel.
Procedure for SC Joint Play – AP
After testing S-I
- Dr. moves their contact hand to the anterior surface of the proximal clavicle.
- Dr. moves the patient’s arm from abduction into horizontal flexion.
- Dr. then presses A-P for endfeel.
Procedure for SC Joint Play – PA
After testing A-P
- Dr. moves their contact to the posterior surface of the proximal clavicle and uses a thumb contact.
- Dr. moves the patients arm into horizontal extension.
- Dr. then presses P-A for endfeel.
Procedure for SC Joint Play – IS
After testing P-A
- Dr. moves their contact to the inferior surface of the proximal clavicle.
- Dr. move the patient’s arm back to the open packed position at 90 abduction.
- Dr. lowers the patients arm but before it gets to 0 abduction, presses I-S for endfeel.
SC Adjustment – Supine Superior Subluxated Proximal Clavicle
- Patient is supine w/ head piece lowered.
- Dr. is at the head of the table using a thumb contact (CH= same side hand as the malposition). on the superior surface of the proximal clavicle.
- Indifferent hand reinforces thumb contact. (pisiform on thumb)
- Dr. asks patient to look at the side of contact.
- Dr. positions themselves so their arms are parallel to the floor.
VECTOR: S-I
SC Adjustment – Supine Anterior Subluxated Proximal Clavicle
- Patient is supine
- Dr. on opposite side from contact.
- Dr. takes caudal hand, thumb contact over the anterior clavicle, closest to the joint.
- Dr. IH reinforces with pisiform contact.
- Dr. leans over the patient (face over face)
VECTOR: A-P
SC Adjustment – Supine Inferior Subluxated Proximal Clavicle
- Same position as Anterior Subluxated Proximal Clavicle except doctor drops their forearm along the line of the patient’s chest.
VECTOR: I-S
SC Adjustments – Seated Anterior Subluxated Proximal Clavicle
- Patient is seated.
- Dr. uses their opposite side from patient malposition hip to support the patients back.
- Dr. uses the opposite hand from patient malposition pisiform contact to reach around and contact the anterior proximal clavicle.
VECTOR: A-P
SC Adjustment – Seated Inferior Subluxated Proximal Clavicle
- Patient is seated.
- Dr. uses their opposite side hip from patients malposition to support the patients back.
- Dr. takes a knife edge contact with their opposite hand from malposition to contact the inferior aspect of the clavicle.
- Dr. reinforces with IH and leans back approx 30-60 degrees.
VESTOR: (Pull) I-S
AC Adjustments – Supine Superior Subluxated Distal Clavicle
- Patient is supine.
- Dr. abducts the shoulder 90, flexes the elbow 90 and rests it on their outside thigh.
- Dr. stabilizes the patients arm to their thigh with their outside hand in the crease of the elbow.
- Dr. uses an index contact on the distal clavicle with their forearm parallel to the floor.
VECTOR: S-I
AC Adjustment – Seated Inferior Subluxated Distal Clavicle
- Patient is seated
- Dr. uses hip opposite of malposition to stabilize the patients back.
- Dr. uses opposite MP thumb contact from malposition to reach around and slide under the clavicle/coracoid process.
- Dr. reinforces with other hand and leans the patient back 30-60
VECTOR: I-S
AC Adjustment – Seated Anterior Subluxated Distal Clavicle
- Patient is seated.
- Dr. uses opposite side hip from malposition to stabilize the patients back.
- Dr. uses opposite side CH hand from malposition to reach around with a thenar contact over anterior surface of distal clavicle.
- Dr. asks patient to turn their head to the side of contact.
- Dr. reinforced with IH.
VECTOR: A-P
AC Adjustment – Seated Superior Subluxated Distal Clavicle
- Patient is seated.
- Dr. uses an index contact over the distal clavicle, elbow facing the ceiling.
- Dr. uses IH to passively externally rotate the patients arm.
- Dr. slowly abducts the patiens arm to 90 but before it reaches that thrust (arm is moving when thrust is givin).
VECTOR: S-I
GH Joint Play / Adjustment – LAD
- Patient is supine.
- Dr. in bunny hop position.
- Dr. inside hand uses a web contact over the anterior part of the shoulder, with their thumb going into the armpit, planting the shoulder to the table.
- Dr. outside hand, thumb and index finger contact slide off the acromion process into GH joint space.
- Dr. distracts the arm by pulling with their knees feeling for tension and extra spring.
- If there is no extra spring Dr. adds an impulse in LAD, then re-evaluates.
GH Joint Play / Adjustment – Ext&Int Rotation
- Patient is supine.
- Dr. in bunny hop position double gripping the humerus at the insertion of the deltoid muscle.
- Dr. externally rotates the humerus until end of motion then applies LAD. Once distracted applies a little more external rotation feeling for endfeel.
- Dr. repeats procedure for internal rotation.
- If no endfeel is felt the Dr. adds a rotational impulse of whatever rotation he is feeling for while pulling LAD.
