Peripheral HVTs

Question 1

Radial head

Answer 1

• Hold distal end of radius/ulnar/wrist with pinky in hand (like wrist accessory)
• Other hand, using thumb, fix radial head
• Stand side on facing Pt
• Allow bicep and brachioradialis to relax (don’t thrush straight away)
• Pronate, extend and add traction
• Use hip as barrier (slap against)

Question 2

AC

Answer 2

• Supine
• Pt hand behind neck
• Practitioner places hand medial to scapula, other hand into Pts axilla (thumb in armpit)
• Pts elbow into practitioners axilla
• Adduction from practitioner  Pt through elbow, lateral movement from hand contact in axilla
• Thrust= in line with humerus

Question 3

GH

Answer 3

• Seated
• Fix scapula with chest
• Pt holds around their neck, or across body
• Hand closest to their bent arm fixes in axilla, produce a lateral force
• Other hand over their elbow
• Thrust towards their chest in line with humerus (same time as lateral shear)

Question 4

Anteriorising fib head

Answer 4

• Stuck posterior
• Weakness in eversion- due to peroneals- Pt may come in with rolled ankle
• Bicep femoris tendinopathy
• Contact behind proximal posterior fib head (2nd MCP)- pick up slack
• Be mindful of peroneal nerve (slightly inferior)
• Other hand around malleoli
• Flex knee, ER
• Build up tension, push further for HVT- don’t lose bind
• Anteriorises fib head

Question 5

Posteriorising fib head

Answer 5

• IR, PF, slight flexion
• Pisiform contact on fib head
• Thrust down and towards the Pt

Question 6

Posteriorising fib head straight leg

Answer 6

• 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

Question 7

Anteriorising talus

Answer 7

• Alien hand under calcaneus (only to stop it moving)
• Other hand over distal tibia
• Pressure straight down (turn body so facing away from Pt)
• Alien hand resist

Question 8

Anteriorising talus contact on dome of talus

Answer 8

• Interlock fingers over dome of talus (middle finger in particular)
• DF, evert= locking talus
• Traction
• Thrust= inferiorly, posteriorly (squeeze hands)

Question 9

Navicular

Answer 9

• Interlock fingers over navicular (middle finger in particular)
• DF, evert= locking talus
• Traction
• Thrust= inferiorly, posteriorly (squeeze hands)

Question 10

Cuboid

Answer 10

• Prone
• Hand leg off couch, knee flexed
• Cross thumbs over posterior aspect of cuboid
• Perform repetitive oscillatory movement with downward, lateral movement

Question 11

Cuneiforms

Answer 11

• Knee bent, foot flat
• Evert foot (maintain- opens cuneiforms)
• Pisiform contact over lateral cuneiform
• Thrust straight towards same hip
• Move contact medial to intermedial cuneiform
• Thrust towards knee
• Move contact again to medial cuneiform
• Thrust towards them