PERIPHERAL HVT Flashcards
PERIPHERAL HVT - ANTERIORISATION OF THE RADIAL HEAD
Pt seated
Stand to the side of the pt
Have their arm out to their side
Hold distal end of radius/ulnar/wrist with pinky in hand (like wrist accessory)
Other hand with finger contact on the medial side of the elbow with thumb on the posterior aspect of the radial head
Allow bicep and brachioradialis to relax (don’t thrush straight away)
Pronate, extend and add traction
Use hip as barrier (slap against)
PERIPHERAL HVT - AC SUPINE
Supine
Pt hand behind neck
Practitioner places hand medial to scapula, other hand into Pts axilla (thumb in armpit)
Pts elbow into practitioners axilla
Adduct pt arm by using elbow and produce a lateral movement from hand contact in axilla
Thrust is in line with humerus
PERIPHERAL HVT - AC SEATED
Pt seated
Pt hand on hip
One hand comes through pt arm and body and other hand comes over the top and interlocks over the GH
Bring pt arm forward and ask pt to push shoulder back into you if it doesnt go, bring pt arm further forward and try again2
PERIPHERAL HVT - GH
Seated
Fix scapula with chest
Pt holds around their neck, or across body
Interlock fingers over pt elbow and bring the elbow down with your pressure
Move the shoulder girdle through a few ranges of movement to accumulate bind
Thrust = upwards through the humerus
PERIPHERAL HVT - ANTERIORISING FIB HEAD
Stuck posterior (you are anteriorising the fib head)
Weakness in eversion- due to peroneals - Pt may come in with rolled ankle, Bicep femoris tendinopathy
Pt supine
Place hand on the back of pt knee
Curl hand into a C then pronate - contact is 2nd MCP on the fibula head (Be mindful of peroneal nerve (slightly inferior))
Bend pt leg and hold round the base of the heel/malleolus
Extrenally rotate the tibia
Keep leg in line with the femur
Accumulate bind by bringing foot to bum
Build up tension, push further for HVT- don’t lose bind
Anteriorises fib head
PERIPHERAL HVT - POSTERIORISING FIB HEAD
Graded mobilisation with impulse
Pt supine
Internally rotate pt leg
Contact on pt malleolus
Slightly plantarflex their foot
Pisiform contact in the head of the fibula
Thrust down and towards the Pt
PERIPHERAL HVT - POSTERIORISING FIB HEAD WITH STRAIGHT LEG
Supine, leg straight
Hypothenar eminence on fib head
Initially spring, spare patella/ other knee structures as uncomfortable
Thrust is down towards couch
Avoid hyperextending knee
PERIPHERAL HVT - ANTERIORISING TALUS
Good to help with plantarflexion
Pt foot needs to be on couch (if too tall they can sit up)
Hold heel like you would during a talar tilt with other hand on the bottom of the tibia
Thrust like your doing a posterior sheer (push tibia back) - turn shoulders to face away from the pt and thrust straught down
PERIPHERAL HVT - ANTERIORISING TALUS WITH KNEE BENT
Pt supine
Knee bent almost to 90 with foot flat on the couch
Thrust tibia towards pt bum
PERIPHERAL HVT - ANTERIORISING TALUS CONTACT ON DOME OF TALUS
Interlock fingers over dome of talus (middle finger in particular)
DF, evert= locking talus
Traction
Thrust= inferiorly, posteriorly (squeeze hands)
PERIPHERAL HVT - NAVICULAR
Pt supine
Interlock ring and middle fingers over navicular (middle finger in particular)
Other hand bracing over and thumbs come round and contact around the ball of the foot and under the metatarsals
Dorsiflex and evert the foot to lock the talus
Lift leg off the couch and traction
Thrust = inferiorly, posteriorly (diagonally down)
Can also do it with the leg still on the couch and pull straight backwards by stepping back
PERIPHERAL HVT - CUBOID
Can be done for a localised tenderness
Pt prone
Hang leg off side of couch with knee flexed
Cross thumbs over posterior aspect of cuboid
Perform repetitive oscillatory movement with downward, lateral movement
PERIPHERAL HVT - CUNEIFORMS
Pt supine
Knee bent
Foot flat on couch
Evert foot (maintain as it opens cuneiforms)
Medial contact is underneath the metatarsals (under the arch) you can use the finger pads or the border of the index finger
Pisiform contact over lateral cuneiform, Thrust straight towards shin
Move contact medial to intermedial cuneiform, Thrust towards hip
Move contact again to medial cuneiform, Thrust towards knee
