Upper extremity Flashcards
UFT
Assessment:
– can assess in either the supine or sitting position
– slowly bend the pt head and stabilise the pts shoulder
– if the side bending movement is less than 45 degrees when you feel the bind or the pt cant move it anymore then likely the trapezius is going to be in a shortened position
MET procedure:
– can do it sitting or supine:
Supine:
– slowly take the head into side bending and rotation to get as much stretch on the traps as possible
– fingers either side of the pts ear, and hand over the pts shoulder
– pt can either move head back to neutral, just move shoulder up to ear or both
RI:
– after normal movement and procedure pt asked to move arm down all the way to their lower leg as much as they can
– this will activate the lower trapezius and the upper trapezius will relax
– this is the RI of the UFT if that is desired
Levator scapulae
Assessment:
– rotate the head half way, palpate the superior angle of the scapula. Then flex the head until you feel the bind.
– when flexion is occurring, if you notice that the chin is nowhere near the chest level, then the lev scap is most likely in a shortened position
MET procedure:
– can do it in both the assessment position and the supine position
– first rotate the head half way and get the pt to rotate their head back
– then in the refractory period flex up the head and press down (depress) the shoulder this is getting the stretch into the lev scap
– then continue to do this
SCM
Assessment of SCM:
– pt supine with legs up
– get the pt to lift up their head, if their chin leads the movement it can be seen as shortened
MET procedure:
– rotate the head either side (for example left rotation will be an MET of the left SCM)
– then get the pt to resist or move their head the other way
– can add some extension as well to get an increased stretch on the SCM
Scalenes
Assessment:
– when assessing you need to be aware of the placement of the vertebral artery, if you seen any changes in the pt’s health in their eyes etc when doing this assessment, stop immediately
– CSP into extension, sidebend away
– rotate towards for anterior scalenes
– dont rotate for medial
– rotate away for posterior
– full rotation of 80 degrees should be achieved, if there is a bind before the full rotation is achieved, the right scalenes are classified as tight
MET procedure:
– pillow underneath shoulder blades to lift up
– drop pt head onto pillow (CSP will be in slight extension)
– pt’s opposite hand over their clavicle
– hand over pts hand
– rotate pts head other side
– ask pt to breath in, resist the movement from the upper rib cage by pushing down caudally
– reinforce the position of the pt’s head to stabilise
– full rotation- posterior fibres
– half rotation- middle fibres
– no rotation- anterior fibres
Overactivity of the scalenes can lead to thoracic outlet syndrome. Due to compression on the brachial plexus
Pectoralis major
Assessment:
– arm elevation test-
—- pt lift both their hands above their head, there will be a gap between the upper arm and the couch, the bigger the gap, the higher the pec major is
MET procedure:
- a number of different variations that you can do
– self MET by getting the pt to hold their arm up themselves for 10 seconds
– clavicular fibres- arm straight out to the side
– sternal fibres- arm more up over head at an angle in line with origin
—- this can be done with a straight or a bent arm
Sitting variations:
– chicken wing with both arms, pushing the arms in and the pt resisting
– abduct pt arm 90 degrees and hold cubital fossa and with arm bent push the pt shoulder back (retract) they have to resist and try to protract the shoulder
Pectoralis minor
Assessment:
– look at the levels of the shoulders, if one is protracting more it could be due to pec minor
– as it draws the scapula forward as one of it actions
MET procedure:
– sidelying or supine
– retract the pts shoulder and get them to put resistance
– each time move the shoulder back a little bit more
Latissimus dorsi
Assessment:
– arm elevation test- practitioner passively moves the arms over head to see if there’s any bind, or if the arm wants to adduct
MET procedure:
– sidelying or sitting
- sidelying:
—- sidelying with hips slightly flexed
—- hold onto pt ASIS
—- grab arm and pull above head to create the stretch
– pt resist by pulling elbow downwards towards body
– can use this in refractory period as an active release STT
Sitting:
– pt horizontally flex across chest
– round pt body like in a sitting thoracic rotation mobil
– grab the arm and pull it round until you feel the bind
– get pt to try and pull their arm back as resistance 20%
– in the refractory period can use this as a thoracic rotation technique
Shoulder rotators
Subscapularis- internal rotator
Assessment:
– just externally rotate the shoulder while shoulder is abducted 90 degrees to see if there is a bind
– should see about 90 degrees of movement
MET procedure:
– externally rotate the shoulder with shoulder abducted 90 degrees
– traction the shoulder
– get pt to internally rotate activating the subscapularis
– when pt exhales traction the joint even more (to prevent an impingement) and externally rotate it more
– RI- can do an RI if the subscap is too painful to contract, externally rotate against a resistance of internal rotation to contract the infraspinatus in tern relaxing the subscap
Infraspinatus- external rotator
Assessment:
– internally rotate to stretch until you find a bind
MET:
– internally rotate
– traction shoulder
– pt resist with external rotation to contract infraspiantus, teres minor and posterior deltoid
RI- if infraspinatus is too painful to contract, pt can internally rotate as a resistance to a passive external rotation movement, to activate the antagonist of subscapularis and in tern relax the infraspinatus