UE various treatments Flashcards
Range of motion for shoulder
Flexion: 180° Extension: 60° Abduction: 180° Horizontal Adduction: 130-140° Horizontal Abduction: 40-55
What tx is indicated with subdeltoid bursitis or frozen shoulder?
lateral recumbent, dr behind pt
pt bends elbow of sd, dr stabilizes shoulder and elbow
put the GH joint in its INDIRECT position (abduction/adduction, flexion/extension, compression/traction, IR/ER)
hold until release
What scapular motion leads to what inferior movement of sc joint? superior movement?
Scapular Elevation leads to inferior movement of SC joint
-SC ABduction
Shoulder Depression leads to superior motion of SC Joint
-SC ADduction
In 90 degrees Shoulder Flexion, what movement leads to posterior glide of the clavicle? anterior glide?
Protraction of the scapula = posterior glide of the clavicle at the SC Joint
-SC Flexion
Retraction of the scapula = anterior glide of the clavicle at the SC joint
-SC Extension
How to dx for SC Joint ABduction/ADduction?
pt supine, dr at head of bed w finger on both clavicular heads
shrugs shoulders up (ABduction)
inferior/caudal felt at SC join
pulls shoulders down (ADduction)
- superior/cephalad felt at SC joint
How to dx for SC Joint flextion and extention?
dr hands on head of clavicle
pt flexes arm to 90 degrees by reaching to ceiling
- posterior clavicle movement felt
lowers pt arm toward the table (extension)
-anterior movement felt
What would you use to prep the SC joint?
SC elevated/adducted sd ART/MET
SC joint ART
SC horizontal extension SD MET
how do you perform sc elevated/adducted sd with still’s?
pt seated w/dr behind holding sc joint w one hand, elbow w the other
elbow adducted/ extended
compress toward SC joint
move shoulder into superior glide and abduction w posterior circumduction motion
SC Depressed/ABducted SD Still Technique
pt seated w/dr behind holding sc joint w one hand, elbow w the other
elbow abducted and slightly flexed
elbow adducted/ extended
move shoulder into adduction with anterior circumduction motion
Sternoclavicular SD HVLA
pt supine, dr at head of table
thenar eminence of monitoring hand over restricted SC joint
Apply cephalad traction on arm w/ dysfunction
Apply thrust on SC joint while simultaneously inducing a rapid traction force through the patient’s arm
what type of thrust do you do for Adduction SD hvla?
Extension SD hvla?
Adduction SD
- Elevated SC
- inferior thrust
Extension SD
- Anterior SC
- posterior thrust
what type of test do you do to diagnosis AC joint?
look and feel for step off
cross arm adduction test
-Positive test = pain or increased tissue texture abnormalities
Spring inferiorly on distal clavicle (compare bilaterally)
•Resistant to springing inferiorly (Clavicle Superior)
•Presence of springing inferiorly (Clavicle Inferior)
Spring anterior to posterior (compare bilaterally)
AC Joint Separated SD Still Technique
- Patient seated, physician in front of patient
- Affected side is abducted, with slight extension to open the AC joint
- Traction is applied
- The arm is moved into adduction/flexion
- Traction is removed and arm is returned to neutral
what tx do you do for R clavicle superior glide?
AC Joint –Direct –seated ART
- Grasp elbow or forearm of SD
- Grasp clavicle w/ SD b/w thumb and fingers of free hand. (Thumb on posterior/superior surface of distal clavicle & Not on scapula)
- Apply anterior/inferior pressure with thumb on lateral (or posterior) aspect of clavicle while flexing patients elbow, extending and adducting humerus (to gap AC joint)
- move shoulder in circular motion (posterior, superior, then anteromedial while maintaining adduction and capsular tension)
Counterstrain for Supraspinatus: F Abd ER
Location: midsupraspinatus muscle just superior to spine of scapulae
Pt supine
Dr Ipsi to TP
patient’s arm is flexed 45 degrees, abducted 45 degrees, and externally rotated
Counterstrain for Levator Scapulae: IR Abd traction
Location: in levator at the superior angle of the scapula
Pt prone, head rotated away
Dr Ipsi to TP
IR pt’s shoulder, add mild-mod traction with minimal abduction
Counterstrain for Subscapularis: E IR
Location: anterolateral border of the scapula on the subscapularis muscle (press posterior and medially)
Pt supine
Dr seated ipsi
pt’s shoulder extended and IR, traction can help
Counterstrain for Biceps Brachii (Long Head): F Abd IR
Location: over long head of biceps tendon in bicipital groove
Pt supine
Dr ipsi
Positioning: elbow and shoulder flexed, arm is minimally abducted and IR
Counterstrain for Biceps Brachii (Short Head) Coracobrachialis: F Add IR
Location: inferolateral aspect of the coracoid process on short head tendon of biceps or coracobrachialis
Pt supine
Dr ipsi
elbow and shoulder flexed, arm is minimally adducted and IR
Elbow ROM
Flexion: 140-150°
Extension: 0 to -5°
When evaluating abduct/adduct of the ulna, what moves in what direction?
Ulnar adduction (varus testing): coupled with wrist abduction (radial deviation)
Ulnar abduction (valgus testing): coupled with wrist adduction (ulnar deviation)
What is elbow prep techinques?
elbow MFR
Ulnar abduction/adduction MET
Ulnar Abduction SD HVLA
Pt seated
Supinate and extend elbow to 5°. Grasp elbow with fingers of monitoring hand on either side of elbow. Other hand grasps distal radius/ulnar
Move elbow into ulnar adduction. Apply a medial to lateral thrust over the medial olecranon
Ulnar Adduction SD HVLA
Patient seated
Supinate and extend elbow to 5°. Grasp elbow with fingers of monitoring hand on either side of olecranon. Other hand grasps distal radius/ulnar
Move elbow into ulnar abduction. Apply a lateral to medial thrust over the lateral olecranon
how does the radial head move in relation to the wrist?
Radial head anterior glide: coupled with supination
Radial head posterior glide: coupled with pronation
radial head prep techinques?
RH MET, anterior = supination
RH MET, posterior = pronation
Anterior Radial Head SD HVLA
Pt seated, dr standing facing the pt
Put thumb of one hand into the crease of the patient’s elbow on the anterior radial head. The other hand flexes elbow and pronates forearm
Exert a rapid hyperflexion force while simultaneously thrusting the radial head posteriorly
Posterior Radial Head SD HVLA
Pt seated, dr standing facing the pt
Extend and supinate elbow. Place thumb over posterior aspect of radial head.
Exert a rapid hyperextension force while simultaneously thrusting the radial head anteriorly
how do you tart exam of the interosseous membrane
use your thumbs to feel dorsal and volar aspects of the forearm bw radius and ulna
Interosseous Membrane MFR
Palpate for tension along the ventral interosseous membrane
Place thumbs over tense areas and fingers on the dorsal forearm
Compress thumbs firmly toward fingers, adding compression (pushing thumbs together) or traction (pulling thumbs apart) until a release is felt
Interosseous Membrane BLT
Dr holds the pt’s hand/wrist with one hand. With the other hand, place index finger on the patient’s radius for monitoring. Use thumbs to monitor interosseous membrane
Perform indirect positioning of the wrist and elbow to attain point of BLT at the interosseous membrane
Add respiratory phases and make minor adjustments to maintain BLT.
Repeat until the best motion is obtained
counterstrain for Radial Head–Lateral (Supinator): E SUP Val
anterolateral aspect of the radial head at supinator attachment
Pt supine or seated
Dr ipsi
Positioning: pt’s elbow in full Extension, forearm markedly supinated, fine tune with vaLgus force
counterstrain for Medial Epicondyle (Pronator Teres): F PRO Add
near medial epicondyle of humerus associated with common flexor tendon and pronator teres
Pt supine or seated
Dr ipsi
pt’s elbow Flexed, marked pronation, forearm slightly aDducted
ROM for wrist
Flexion: 80-90°
Extension: 70°
Adduction/Ulnar Deviation: 30-40°
Abduction/Radial Deviation: 20-30°
Wrist Flexor Retinaculum MFR
dr thumb on the medial and lateral attachments of the transverse carpal ligament, fingers around dorsal wrist
massage palm of hand outward and hold for 20-60 sec
radiocarpal prep techniques?
flexor retinacular met (clinch fist as dr holds wrist)
wrist isotonic met
radiocarpal flexion SD MET
radiocarpal extension SD MET
Radiocarpal Joint SD Articulatory with Traction
dr interlocks fingers around pt wrist, w grooves parallel to joint line
dr squeeze and traction when articulating the wrist in CC and then CCW
Wrist Extension/Ventral Carpal SD HVLA
Pt seated, dr standing facing the pt
Pronate elbow. Grasp pt’s hand, thumbs contacting dorsally at the proximal carpal bones (radiocarpal joint)
Deliver a thrust moving from extension to flexion through the carpal dysfunction
Wrist Flexion/Dorsal Carpal SD HVLA
Pt seated. Dr standing facing the pt
Pronate elbow. Grasp patient’s hand, thumbs contacting dorsally at the proximal carpal bones (radiocarpal joint)
Deliver a whip-like thrust moving from flexion to extension through the carpal dysfunction
counterstrain for Dorsal Wrist (Extensor Carpi Radialis): E Abd/rd
dorsal surface of second metacarpal associated with extensor carpi radialis muscle (may also be in any extensor muscle)
Pt supine or seated
dr ipsilateral
pt’s wrist passively Extended and aBducted
counterstrain for Dorsal Wrist (Extensor Carpi Ulnaris):E ADD
dorsal surface of fifth metacarpal associated with extensor carpi ulnaris muscle (may also be in any extensor muscle)
Pt supine or seated
dr ipsilateral
pt’s wrist passively Extended and aDducted
counterstrain for Palmar Wrist (Flexor Carpi Radialis): F Abd
palmar base of second or third metacarpal in the flexor carpi radialismuscle (may also be found in any flexor muscle)
Pt supine or seated
dr ipsilateral
pt’s wrist passively Flexed and aBducted
counterstrain for Palmar Wrist (Flexor Carpi Ulnaris): F Add
palmar base of fifth metacarpal in the flexor carpi ulnaris muscle (may also be found in any flexor muscle)
Pt supine or seated
dr ipsilateral
pt’s wrist passively Flexed and aDducted
counterstrain for First CMP (Abductor Pollicis Brevis): F (wrist) Abd (thumb)
palmar base (radial aspect) of first metacarpal in the abductor pollicis brevis muscle
Pt supine or seated•
Dr ipsilateral
pt’s wrist passively Flexed, thumb is aBducted
ROM MCP/PIP/DIP
MCP Abduction: spread fingers out
MCP Adduction: move fingers back together
Thumb abduction: moves only thumb in to make the # 4
Individual motion testing of MCP, PIP, and DIP joints (abduction, adduction)
finger art
- Lock the dysfunctional metacarpal between the thumb and index finger of one hand
- With other hand, place thumb and index finger on the dorsal and volar aspects of the dysfunctional phalanx
3.Apply long-axis extension (straight-line traction) or rotation oranteroposterior glide
aka pull finger out
Phalangeal SD HVLA
Pt seated, dr standing facing the patient
Isolate dysfunctional joint.
While stabilizing the wrist, exert traction and a hyperflexion thrust through the SD
