Term 2 Lab Maneuvers Flashcards
Cx spine hypermobility biomechanical Ax - test 1
Pt:
- Supine, crook-lying position
- Cx spine in neutral/towel under head as needed
- Front 1/3 of tongue on the roof of the mouth, lips together, teeth slightly apart
Pressure Biofeedback Unit (PBU):
- Placement: behind the suboccipital spine
- Inflate to 20 mm Hg
Look/palpate for any compensations…
- Substitution outer unit: SCM, anterior scalene
- Lost of Cx spine neutral position
- If cannot talk or swallow while holding the contraction
- Look for any rigidity (can do some wiggle!!!)
Cx spine hypermobility biomechanical Ax - test 2
Pht:
Look for any compensations
-Outer Unit muscle substitution
- Suboccipital muscle substitution
- Lost of Cx spine neutral position
- Look for any rigidity (can do some wiggle!!!)
Cx spine hypermobility biomechanical Ax - test 3
Pht:
Look for any compensations
- Outer Unit muscles
- Flexor ms will be activated but should not dominate
- Substitution: SCM, Scalene
Progression:
- Can change the head angle….be as functional as possible…
- Can be given as an exs…
Cx spine hypermobility biomechanical Ax - test 4
Pht:
Look for any compensations
- Outer Unit muscles
- Extensor ms will be activated but should not dominate
- Substitution: Levator scapulae
- Ext Cx, Tx or Lx spine
Progression:
- Can change the head angle….be as functional as possible…
- Can be given as an exs…
Cx spine objectuve exam, rep movements - pt guided retraction and extension lying supine
Cx spine retraction in supine with clinician OP
- Is the essential procedure for the reduction of posterior derangements in the lower Cx
- Also used for the treatment of extension dysfunction in the lower Cx
- Is an essential precursor to other movements required to effectively treat the Cx
- Treats cervical headaches and flexion dysfunction of the upper Cx
Cx spine retraction with extension and clinician OP
Extension principle
Retraction and extension
- Retraction and extension in sitting
- Retraction and extension with rotation in sitting
- Retraction and extension with rotation in supine
- Retraction and extension with rotation and clinician traction in supine
Wrist mobs of lateral column
The carpal bones should be mobilized in flexion.
Wrist mobs of medial column
mobs should be done in wrist flexion
Wrist mobs of mid column
mobs should be down with wrist in flexion
Thumb (CMC) traction/compression
Thumb (CMC) dorsal glide
Thumb (CMC) palmar glide
Thumb (CMC) radial glide
Thumb (CMC) ulnar glide
Elbow combined flexion/abduction
FLEXION/ADDUCTION Ulna ANT GLIDE + LAT GLIDE
EXTENSION/ABDUCTION Ulna POST GLIDE + MED GLIDE
whitmore 204
elbow combined flexion/adduction
FLEXION/ADDUCTION Ulna ANT GLIDE + LAT GLIDE
EXTENSION/ABDUCTION Ulna POST GLIDE + MED GLIDE
whitmore 204
elbow combined extension/adduction
FLEXION/ADDUCTION Ulna ANT GLIDE + LAT GLIDE
EXTENSION/ABDUCTION Ulna POST GLIDE + MED GLIDE
whitmore 203
elbow combined extension/abduction
FLEXION/ADDUCTION Ulna ANT GLIDE + LAT GLIDE
EXTENSION/ABDUCTION Ulna POST GLIDE + MED GLIDE
whitmore 203
ULNT1
Move almost all the nerves btw neck & hand – median, radial & ulnar n, brachial plexus, spinal ns & Cx n roots
Indications:
- Should be performed when a neural component to U/Q pain/sy is present or when pht want to exclude a neural component
- This test is particularly relevant in cases where symptoms are localized to the median nerve
Good inter & intra reliability
Normal Responses:
- Similar areas of response in both ULNTs
- Sensory response was more frequent in ULNT2m than ULNT1
- The nature of the response was more neurogenic (tingling, burning, P&N) in ULNT2m than ULNT1
ULNT2m
It Ax the median n, brachial plexus, related spinal ns & low Cx n roots
Indications:
- When pt’s symptoms are provoked by scap depression
- Symptoms are localized to the median nerve
- Can be used in preference to the ULNT1 when shoulder problem & want to avoid abd
Distal Manoeuvre:
- Cx spine ipsilat side flex or
- Releasing scapula depression or
- Wrist flexion
Normal Responses:
- Similar areas of response in both ULNTs
- Sensory response was more frequent in ULNT2m than ULNT1
- The nature of the response was more neurogenic (tingling, burning, P&N) in ULNT2m than ULNT1
ULNT2r
Indications:
- This test is particularly relevant in cases where symptoms are localized to the radial nerve
- Posterior shoulder pain
- Lateral elbow pain
- Dorsal F/A pain (radial tunnel syndrome, de Quervain’s disease)
Distal Manoeuvre:
- Cx spine ipsilat side flex or
- Release a small amount of pressure from scapula depression or
- Wrist extension
Normal Responses:
- Posterior/lateral FA & wrist deep pain/stretch
- Painful stretch post aspect of hand, lat arm & biceps
ULNT3
Indications:
- This test is particularly relevant in cases where symptoms are localized to the ulnar nerve
- Anterior shoulder
- Axilla
- Along the medial aspect of the arm & elbow to the hypothenar eminence & 4-5th fingers
- C8 radiculopathy
- TOS
- CuTS
- Guyon’s canal syndrom
Distal Manoeuvre:
- Cx spine ipsilat side flex or
- Release a small amount of pressure from scap depression or
- Wrist flexion
Normal Responses:
- Stretch sensation in almost any region of the upper limbs
- But more common in ulnar distribution
- P & N and burning sensation can also occur
wrist manipulation - thrust in traction (lunate on radius)
Indications:
S/A: Mechanism of injury: full extension or flexion
O/A:
- Observation/palpation: any protuberance or dimple
- ROM: flexion or extension ↓ & hard EF & pain
- Glide: carpal bone palmar or dorsal glide ↓ NZ & hard EF
Special Considerations:
- Scaphoid fracture (< 2wks) – can have been missed on x-ray
- Carpal bones hypermobility
- Nerves & blood vessel compression
wrist manipulation - palmar glide (lunate on radius)
Indications:
S/A: Mechanism of injury: full extension or flexion
O/A:
- Observation/palpation: any protuberance or dimple
- ROM: flexion or extension ↓ & hard EF & pain
- Glide: carpal bone palmar or dorsal glide ↓ NZ & hard EF
Special Considerations:
- Scaphoid fracture (< 2wks) – can have been missed on x-ray
- Carpal bones hypermobility
- Nerves & blood vessel compression
wrist manipulation - dorsal glide (lunate on radius)
Indications:
S/A: Mechanism of injury: full extension or flexion
O/A:
- Observation/palpation: any protuberance or dimple
- ROM: flexion or extension ↓ & hard EF & pain
- Glide: carpal bone palmar or dorsal glide ↓ NZ & hard EF
Special Considerations:
- Scaphoid fracture (< 2wks) – can have been missed on x-ray
- Carpal bones hypermobility
- Nerves & blood vessel compression
elbow manipulation - ulnohumoral distraction
Special considerations:
- Ax ULNTs before
- Joint hypermobility
elbow manipulation - lateral thrust of ulno-humoral joint
Special considerations:
- Ax ULNTs before
- Joint hypermobility
Dysfunction: Ulna fixed in abduction
Subjective: Fall on outstretch arm
Pt’s c/o: Tennis elbow, De Quervain’s, May c/o wrist pain
Observation: ↑ carrying angle, Hand slight ulnar deviation & flexion
AROM
- ↓ Elbow flexion & supination
- ↓ Wrist extension & radial deviation
PROM
- Adduction: ↓ & hard EF
- ↓combined movt in flexion/supination (& adduction) & hard EF
Glide: lateral glide: ↓ NZ & hard EF
- Flex combined with adduction & lateral glide
elbow manipulation - medial thrust of ulno-humoral joint
Special considerations:
- Ax ULNTs before
- Joint hypermobility
Dysfunction: Ulna fixed in adduction
Subjective: secondary to trauma
Observation
- ↓ carrying angle
- Wrist in slight radial deviation & extension
AROM
- ↓Elbow extension & pronation (Hard EF)
- ↓combined movt of extension & pronation (& abduction) - ↓Wrist flexion & ulnar deviation
PROM: Abduction: ↓ & hard EF
Glide: Med glide: ↓ & hard EF
- Ext combined with abduction & medial glide
elbow manipulation - posterior thrust of proximal RU joint
Dysfunction Radius fixed in supination
- AROM/PROM: ↓ FA pronation & hard EF
- Glide: ↓ posterolateral glide & hard EF
elbow manipulation - anterior thrust of proximal RU joint
Dysfunction Radius fixed in pronation
- AROM/PROM: ↓ FA supination (Hard EF)
- Glide: ↓ anteromedial glide (hard EF)
ankle - talar swing
Ankle - Subtalar eversion ROM
Ankle - Subtalar inversion ROM
ankle - subtalar medial glide (ant and post facet)
ankle - subtalar lateral glide (ant and post facet)
ankle/foot - calcaneo-cuboid glides
ankle/foot - talonavicular glides
ankle - traction thrust manip (for articular restriction of TC joint)
Whitmore p 331
ankle - J stroke and thrust manip (for TC restriction of DF)
Whitmore p 332
ankle - talus posterior thrust (for TC restriction of DF)
ankle - J stroke for PF (for TC restriction in PF)
Whitmore p 333
ankle - Talus anterior thrust (for TC restriction of PF)
Whitmore p 334
ankle - subtalar lateral glide and thrust (for articular restriction of ST joint)
whitmore p 336 and 338
ankle - subtalar medial glide and thrust (for articular restriction of ST joint)
Whitmore p 337 & 339
sciatic nerve neuromeningeal testing
tibial nerve neuromeningeal testing (tibial branch)
tibial nerve neuromeningeal testing (tibial branch)
fibular (peroneal) nerve neuromeningeal testing
sural nerve neuromeningeal testing
SI joint - Passive Accessory Motion in Innominate POST ROTATION
(ant-sup glide)
SI joint - Passive Accessory Motion in Innominate ANT ROTATION
(inf-post glide)
SI joint - Passive Accessory Motion in nutation
infero-posterior glide
SI joint - Passive Accessory Motion in counternutation
antero-superior glide
Lx spine - PPIVMs (from last semester)
- Went over PPIVMs from last semester (use superior aspect of greater tuberosity) for flexion and extension – for extension use forearm and trunk instead of hand to apply motion
- flexion = ant/inf force, ext = ant/sup force
- see last years notes
Lx spine - supine TrA test
Lx spine - prone TrA test
Lx Spine - Anterior oblique sling Ax
Lx spine - prone hip extension
Ax the strength, control & firing pattern of the lumbopelvic stabilizers & hip extensor ms
- Pt in prone with a pillow under the pelvis (for neutral position of the spine)
- Pt is asked to lift a straight leg 8-10 inches off the table
Lx spine - posterior oblique sling - LAT DORSI ms strength
Lx spine sling Ax - Hip Abduction neuromuscular control test
Lx spine sling Ax - Glut medius Isometric (brake) strength test
Lx spine sling Ax - Glut medius ms strength – Trendelenburg test
Tibio-Femoral Joint - combined movements in flexion
Tibio-Femoral Joint - combined movements in extension
Tibio-Femoral Joint - medial and lateral passive accessory glides
knee - fibular accessory glides
knee - lateral thrust of tibia
doing medial thrust to femur
whitmore p 326
knee - medial thrust of tibia
doing lateral thrust to femur
whitmore p 327
Hip - load transfer tests
Hip - dynamic stability assessment in supine
Hip - dynamic stability assessment in prone
Hip - anterior labral tear test
Hip - posterior labral tear test
