Upper And Lower MFR

Question 1

Layer palpation includes what layers

Answer 1

Skin

Adipose tissue

Superficial fascia

Muscles

Tendons/ligaments

Deep fascia

Bones

Question 2

Rotator cuff muscle actions and innervation reminder

Answer 2

Supraspinatus

• C5 (Suprascapular nerve)
• function is abduction

Infraspinatus

• C5 (Suprascapular nerve)
• function is external rotation

Teres minor

• C5 (axillary nerve)
• function is external rotation

Subscapularis

• C6 (subscapularis nerve)
• function is internal rotation

Question 3

Indications for indirect scapular release

Answer 3

Shoulder restriction in ROM

Shoulder pain

Minor rotator cuff sprains/strains

Upper thoracic pain

Cervical pain

Somatic dysfunction present

Question 4

Positioning for scapular MFR

Answer 4

Caudad hand

• place thumbs on lateral border
• place fingers on medial border
• inferior angle of scapula is in the palm

Cephalad hand

• thumbs on lateral border
• place fingers on medial border
• scapular spine is in the palm

Motions are

• superior/inferior
• medial/lateral
• clockwise/counterclockwise

Question 5

Indications for direct upper extremity MFR

Answer 5

Shoulder pain

Adhesive capsulits (frozen shoulder)

Elbow/hand pain

Non-cardiogenic rib/chest pain

Question 6

Contraindications for direct upper extremity MFR

Answer 6

Fractures

Recent shoulder dislocation

Question 7

Direct upper extremity MFR placement

Answer 7

Patient is prone w/ feet off table

Patients head should be turned to most comfortable side

• towards the shoulder being worked on is indirect
• away from shoulder being worked on is direct

Patient hands and arms are comfortably placed over the sides of the table

Physician hands firmly around the glenohumeral attachments w/ thumbs immediately lateral to the AC joint

• fingers of one hand is firmly contacting the pec major attachments anteriorly
• fingers of the other hand is firmly contacting the teres minor/infraspinatus attachments posterior

Motions are

• compression/ distraction
• internal and external rotation
• anterior/ posterior (w/ sheer towards floor or ceiling)

Question 8

Radius position in pronation and supination

Answer 8

Pronation:

• Distal Radius (close to the wrist) crosses over the ulna and moves ANTERIOR and MEDIALLY
• proximal radius (radial head) glides posterior

Supination

• distal radius moves under the ulna and moves posterior and lateral
• proximal radius (radial head) glides anterior

Question 9

Cubical tunnel syndrome includes what nerve?

Answer 9

Ulnar never through the guyons tunnel

• presents with numbness and tingling of the medial hand
• often associated with thoracic inlet syndrome, heavy lifting, trauma to elbow and consistently flexed elbows

Question 10

Indications for wrist/forearm and elbow release

Answer 10

Forearm, elbow or wrist pain/strain

Carpal tunnel syndrome

Cubical tunnel syndrome

Medial/lateral epicondylitis

Question 11

Hand placement for wrist/forearm and elbow MFR

Answer 11

One hand grasps the patients hand so that the fingers are on the flexor surface and the thumb is on the extensor surface

The other hand grasps the patients forearm distal to the elbow

Movements

• elbow flexion/extension
• wrist flex/extension
• wrist abduction/adduction
• wrist pronation/supination
• note also add compression/traction through forearm to tightened barrier further*