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.
GH Joint Play / Adjustment – AP and PA
- Patient is seated.
- Dr. in bunny hop position.
- Dr. inside thumb on the anterior surface with finger wrapping around to posterior surface. IH same as CH.
- Dr. lifts the humeral head P-A until resistance is felt then distracts with their knees. After distraction more P-A motions is applied feeling for spring.
- Same procedure is done for A-P
- If no spring is felt the Dr. adds an impulse into the direction of resistance while adding LAD with their knees.
What are some additional tests to be considered when evaluating the shoulder?
Adson’s
Wright’s
Costoclavicular
