Shoulder complex Flashcards
Axial Distraction/ inferior glide
Purpose: to decompress the joint and to increase overall range of motion and/or increase inferior glide. To decrease pain
Precautions: do not let the shoulder girdle move inferiorly as it may impinge the brachial plexus between the clavicle & the first rib. This may cause a “stinger” (temporary neurological symptoms)
Stabilize: first move the shoulder girdle inferior. Place your proximal hand on the coracoid process and the AC joint. With your index finger you can palpate the head of the humerus as it glides/moves during mobilization
Mobilize: grasp the distal humerus just proximal to the epicondyles and mobilize inferiorly through the long axis of the humerus
Lateral Distraction
Purpose: to decompress the joint and to increase overall range of motion & to decrease pain
Precautions: do not apply pressure to the patient/client’s thorax with therapist forearms as this might compress the ribs. Your forearm should be just below the breast tissue
Stabilize: distal humerus at the lateral supracondylar crest. You can use your hip to stabilize the distal femur
Mobilize: Grasp proximal humerus near/in the axilla and mobilize laterally
Posterior Glide of the humerus
Purpose: to increase internal rotation, flexion & reduce an anteriorly positioned humeral head
Precautions: do not let the humerus externally rotate. Make sure mobilizing hand is positioned lateral to the acromion
Stabilize: Scapula at the spine of the scapula, and block the patient/client’s forearm with your hip to prevent external rotation of the humerus
Mobilize: Head of the humerus is mobilized posteriorly and slightly laterally with the lateral/outside hand
Lateral Distraction @ 90 degrees of flexion
Purpose: To increase overall range of motion of the GH joint and/or to increase horizontal adduction. To decompress the joint and decrease pain
Precautions: Do not let the elbow move medially as this will cause a levering effect and permit the rolling instead of the glide!
Stabilize: Distal humerus with superior hand
Mobilize: Grasp the proximal humerus and mobilize directly laterally.
Axial Posterior glide
Purpose: to increase flexion, abduction, horizontal adduction and internal rotation. To reduce an anterior positional fault.
Precautions: Do not let the scapula move posteriorly moving off the thorax.
Stabilize: Place your lateral hand under the scapula. Make a cup with your hand to accommodate the spine of the scapulae.
Mobilize: Grasp the distal humerus with your medial hand and mobilize directly posteriorly through the axis of the humerus.
Inferior glide at 90 degrees of abduction
Purpose: to increase abduction and flexion, to decompress the joint, and reduce pain. To reduce the arch of pain during abduction
Precautions: inferior joint instability. While applying pressure over the head of the humerus this may generate some discomfort.
Stabilize: Place hand just proximal to the medial epicondyles of the humerus. Gentle grasp over distal humerus.
Mobilize: gently pull the humerus first and then mobilize the head of the humerus inferiorly. The therapist extends the wrist of the mobilizing hand to move the head inferiorly.
Inferior Glide @90 degrees of flexion #1
Purpose: To increase flexion & abduction
Precautions: Do not lever the joint as this may cause articular and capsular damage. Watch for inferior joint instability. Try to minimize pain due to the applied pressure over the humeral head.
Stabilize: distal humerus with therapist’s shoulder
Mobilize: Head of the humerus in the inferior direction
Helpful Suggestions:
Make sure the mobilizing hand is distal to the acromion
Inferior glide @ 90 degrees flexion #2
Purpose: to increase flexion & abduction
Precautions: do not lever the joint as this may cause articular and capsular damage
Stabilize: Distal humerus under the elbow. Your sternum may help to stabilize
Mobilize: head of the humerus in the inferior direction by leaning superiorly & mobilizing inferiorly
Inferior-lateral-anterior glide
Purpose: to restore FULL elevation (abduction & flexion combination)
Precautions: Do not let the arm go into full ER as this will put the GH joint into the close packed position; DO not apply pressure through the therapists thumbs, as this will compress the neurovascular bundle
Stabilize: distal arm & forearm are held against your body
Mobilize: head of the humerus into the inferior capsule by moving the head in an inferior-lateral-anterior direction (down, out & forward)
anterior glide @90 degrees of abduction
Purpose: To increase external rotation and extension, to reduce a posterior positional fault of the GH joint
Precautions: the anterior joint capsule is structurally lax. Watch that you don’t’ hyperextend your wrist with your mobilization
Stabilize: (lateral hand) Scapula and clavicle with foam block just under the coracoid process. Stabilize the distal arm with the hand under anterior surface of the distal humerus.
Mobilize: (medial hand) the head of the humerus in the anterior direction
Anterior Glide
Purpose: to increase extension, to decrease pain, to reduce a posterior positional fault
Precautions: the anterior joint capsule is structurally lax; avoid over-mobilizing
Stabilize: Scapula & clavicle with a firmly rolled up towel just under the coracoid process as shown. Stabilize the distal arm with hand under anterior surface of the distal humerus.
Mobilize: the head of the humerus in the anterior direction.
Anterior-lateral glide
Purpose: to increase extension & internal rotation
Precautions: the anterior joint capsule is structurally lax; avoid over-mobilizing
Stabilize: Place scapula into retraction and stabilize with palm. Stabilize distal humerus with your forearm.
Mobilize: Head of the humerus in the anterior & lateral direction as shown.
Inferior glide/shoulder depression
Purpose: to increase shoulder depression & mobility
Precautions: if the brachial plexus is stretched/compressed or in any way compromised with this mobilization, causing neurological symptoms discontinue the technique! This may occur between the first rib and the clavicle or at the nerve roots. Perform with care.
Pt PRONE
Place your superior hand over the acromion and upper trapezius while your other hand is placed with the inferior angle between your thumb and index finger
Mobilize the scapula inferiorly between your hands while controlling the glide inferiorly with the hand around the inferior angle of the scapula
superior glide/ shoulder elevation
Purpose: to increase shoulder elevation & shoulder mobility
Precautions: use a soft touch and light pressure on the scapulae so you do not cause muscle guarding or apprehension.
Place your superior hand over the acromion and the upper trapezius while your other hand is placed with the inferior angle between your thumb & index finger
Mobilize the scapula superiorly between your hands while controlling the glide superiorly with your upper hand
lateral rotations/ superior glide
Purpose: to increase lateral rotation & elevation
Precautions: use a broad & soft hand approach so that you do not apply too much pressure on the bony prominences and the scapulae.
Place your mobilizing hand on the inferior angle of the scapula while the other hand is placed over the acromion process and the supraspinous fossa
Perform a superior-lateral (rotational) directed force on the inferior angle while the opposing hand directs the mobilization superiorly and medially.
