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Upper Extremity Flashcards

1
Q

What are Wand Exercises used for in shoulder mobility?

A

Wand exercises help maintain and increase shoulder joint mobility. They can be used as PROM or AAROM exercises. AAROM exercises assist in neurological communication and movement pattern development in the CNS.

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2
Q

What is the purpose of Codman’s Pendulum exercise?

A

Codman’s Pendulum is used to:

Decrease pain and increase circulation
Relax surrounding muscles
Increase ROM of the GH joint

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3
Q

How is Codman’s Pendulum exercise performed?

A
  1. Bend/lean forward or lie prone with the shoulder passively flexed forward and dangling.
  2. Use gravity or a weight in hand to allow joint distraction.
  3. Use body weight and momentum to create large circular motions (clockwise and counterclockwise).
  4. Ensure movement comes from body weight, not shoulder muscle strength.
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4
Q

What is the Sleeper Stretch, and what is it used for?

A

The Sleeper Stretch is used for posterior capsule issues and Frozen Shoulder. In sidelying, the affected shoulder is fixed by the body while the contralateral arm passively moves it into internal rotation as much as possible.

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5
Q

What is SCAPULAR AF exercise and its purpose?

A

SCAPULAR AF exercise involves movements of the scapula, which guide GH movement. Strengthening and stabilizing the scapula may help improve limited GH ROM.

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6
Q

How is the Ball-Wall Exercise performed, and how can it be progressed?

A

• Lean body weight slightly against a ball on the wall.
• Move the ball in circular motions or draw the alphabet.
• Easier: Stand with feet further apart.
• Harder: Stand farther from the wall.

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7
Q

What is the Arm Bar exercise, and what muscles does it engage?

A

• Performed in supine/hooklying with scapula resting on the ground.
• Hold a kettlebell/dumbbell at 90° shoulder flexion, elbow extended.
• Ensures traps are not overly engaged while activating serratus anterior.
• Progression: Press movement → Sidelying position with shoulder abduction.
• Purpose: Engages shoulder stabilizers and can be challenged in multiple directions.

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8
Q

How are Wall Slides/Wall Angels performed?

A
  1. Stand against a wall with a neutral spine, maintaining three points of contact (head, shoulder blades, sacrum).
  2. Start with shoulders and elbows at 90/90°.
  3. Maintain hand and elbow contact with the wall and slide arms up.
  4. Engages scapular retractors and improves thoracic mobility.
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9
Q

What compensations might occur during Wall Slides/Wall Angels?

A

• Excessive lumbar extension (arching back).
• Loss of head, shoulder blade, or sacrum contact with the wall.
• Overuse of upper traps instead of scapular retractors.

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10
Q

What are the primary muscles involved in scapular retraction?

A

Rhomboids and Middle Trapezius.

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11
Q

How is a passive stretch for scapular retractors performed?

A

• Position: Prone, Sidelying, or Standing.
• Therapist’s technique:
1. Hook one hand on the patient’s medial scapular border.
2. Support the anterior shoulder with the other hand.
3. Gently pull the scapula laterally to stretch the rhomboids and middle traps.

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12
Q

How is a self-stretch for scapular retractors performed?

A

• Position: Quadruped (on all fours) or Standing.
• Technique:
1. Patient pushes up from the ground, rounding/hunching the thoracic spine.
2. Focus on scapular protraction.
3. This movement is also known as Cat Pose (angry cat stretch).

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13
Q

How is isometric strengthening of scapular retractors performed in supine, standing, or seated positions?

A

• Position: Supine, Standing, or Seated.
• Technique:
1. Place a towel roll along the spine, between the shoulder blades.
2. Arms can rest at the sides or be abducted to 90° with elbows bent.
3. Action: Squeeze shoulder blades together into the towel, using the wall or floor for resistance.
4. Joint angle can be changed by adjusting the size of the towel roll.

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14
Q

How is isometric strengthening of scapular retractors performed in prone Y(T)I’s?

A

• Position: Prone.
• Technique:
1. Arms abducted to 90° or less.
2. Towel bolsters or pillows placed under the arms to modify joint angle.
3. Action: Isometric contraction, squeezing shoulder blades together.

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15
Q

How is isotonic strengthening of scapular retractors performed in a long-seated position?

A
  1. Wrap a theraband around the feet.
  2. Rest arms at sides with elbows bent at 90° (seated row position).
  3. Action: Squeeze shoulder blades together. Important:
    • Keep the movement subtle.
    • Avoid shoulder extension (to prevent lat recruitment).
    • Avoid tension in upper traps.
  4. Isometric alternative: Use a belt or strap instead of a theraband.
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16
Q

How is isotonic strengthening performed in prone Y(T)I’s with weights?

A

• Position: Prone.
• Technique:
1. Arms abducted to 90° or less.
2. Hold weights in hands.
3. Action: Contract and squeeze shoulder blades together, retracting against resistance.

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17
Q

What muscles are responsible for scapular upward rotation?

A

Upper and Lower Trapezius (Note: Serratus Anterior is listed under protractors).

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18
Q

What muscles are responsible for scapular upward rotation?

A

Upper and Lower Trapezius (Note: Serratus Anterior is listed under protractors).

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19
Q

How is isometric/isotonic strengthening for the upper trapezius (shrugs) performed?

A

• Position: Standing with arms at the sides.
• Isometric: Stand on a strap and attempt to elevate the shoulder with an isometric contraction.
• Isotonic: Use a resistance band or handheld weight to perform the shrug.

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20
Q

How is isometric/isotonic strengthening for lower trapezius (prone Y(T)I’s) performed?

A

• Position: Prone.
• Isometric:
1. Arms abducted to 120°.
2. Place towel bolster/pillows under the arms to adjust joint angle.
3. Squeeze shoulder blades together (down and in) with isometric contraction.
• Isotonic: Use handheld weights to perform the same contraction with movement.

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21
Q

What muscles are responsible for scapular protraction?

A

Serratus Anterior and Pectoralis Minor.

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22
Q

How is a passive stretch for pectoralis minor (hooklying position) performed?

A

• Position: Hooklying.
• Therapist’s technique:
1. Position the shoulder off the side of the table.
2. Therapist cradles the scapula with one hand and forward flexes the arm to about 45° with elbow flexed.
3. Therapist applies posterior pressure at an oblique angle.
4. Client may exhale fully to increase stretch sensation.

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23
Q

How is a self-stretch for serratus anterior (push-up with a minus) performed?

A

• Position: Quadruped or Standing.
• Technique:
1. Client stands facing the wall, performs a push-up with elbows extended.
2. As the client exhales, allow the torso to “sag” forward between the arms, focusing on scapular retraction.

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24
Q

How is isometric strengthening for scapular protractors (pectoralis minor, serratus anterior) performed?

A

• Position: Supine or Seated.
• Technique:
1. Secure a belt to a stable object behind you, flex the shoulder to 90° with elbows extended.
2. Perform protraction against the resistance of the belt (or weight in supine).
3. Use bolsters under the scapula to change the degree of protraction.

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25
How is isotonic strengthening for scapular protractors (pectoralis minor, serratus anterior) performed?
• Position: Supine or Seated. • Technique: 1. Secure a theraband to a stable object or anchor it under the foot. 2. Flex the shoulder to 90° with elbows extended. 3. Perform protraction with the resistance of the theraband (or weight in supine).
26
How is isotonic strengthening for serratus anterior (push-up with a plus) performed?
• Position: Quadruped or against a wall. • Technique: 1. Adopt a similar position to the "Cat Pose" (elbows extended, shoulder flexed). 2. Perform a push-up while protracting the scapula. 3. To increase intensity, change to a traditional plank/push-up position.
27
What muscles make up the rotator cuff, and what are their functions?
• Supraspinatus: Abduction of the shoulder. • Infraspinatus and Teres Minor: External rotation. • Subscapularis: Internal rotation and stabilization of the scapula. Function: The rotator cuff stabilizes the glenohumeral joint by compressing the humeral head against the glenoid during dynamic movement.
28
How is a passive stretch for the supraspinatus (adduction of the GH joint) performed?
• Position: Standing or Seated. • Technique: 1. Place a towel roll in the axilla to create slight joint distraction. 2. Internally rotate the shoulder with the arm behind or in front of the body. 3. Use the contralateral arm to pull the ipsilateral arm into adduction. 4. To increase the stretch, add a chin tuck and contralateral neck flexion.
29
How is isometric strengthening for the supraspinatus (scaption) performed?
• Position: Standing or Seated beside a wall or stationary object. • Technique: 1. Place a towel pad between the hand and the wall. 2. Abduct the arm into resistance from the wall (maintain elbow extension). 3. The abduction should not go beyond 90°; joint angle can be modified by varying the arm height.
30
How is isometric strengthening for the supraspinatus (scaption with resistance band) performed?
• Position: Standing or Seated. • Technique: 1. Tie a belt or non-elastic band to an immovable object or anchor it under the foot. 2. Abduct the arm against the resistance of the band, maintaining elbow extension. 3. Abduction should not exceed 90°; in scaption, keep thumbs neutral with slight horizontal adduction (~30°).
31
How is isotonic strengthening for the supraspinatus (scaption with theraband) performed?
• Position: Standing or Seated. • Technique: 1. Secure a theraband to an immovable object or anchor it under the foot. 2. Abduct the arm against the resistance of the band (maintain elbow extension). 3. Abduction should not go beyond 90°; in scaption, keep thumbs neutral with slight horizontal adduction (~30°).
32
Which muscles are responsible for upward rotation of the scapula?
Upper and Lower Trapezius (Serratus Anterior is listed under protractors)
33
How can you isometrically strengthen the upper trapezius?
Position: Standing with arms at the side • Isometric: Stand on a strap and attempt to elevate the shoulder without movement • Isotonic: Use a resistance band or handheld weight to perform shoulder shrugs
34
How can you strengthen the lower trapezius in a prone position?
Position: Prone (Y-T-I’s) • Arms abducted to 120° • Isometric: Place towel/bolster under arms to change joint angle • Contraction: Squeeze shoulder blades down and in • Needs to be done with a handheld weight
35
Which muscles act as scapular protractors?
Serratus Anterior and Pectoralis Minor
36
How do you passively stretch the pectoralis minor?
Position: Hooklying with the shoulder off the table • Therapist cradles the scapula while forward-flexing the arm to ~45° (elbow flexed) • Therapist applies posterior pressure at an oblique angle • Client can exhale fully to increase the sense of stretch
37
How do you perform a self-stretch for the serratus anterior?
Position: Standing or quadruped • Perform a push-up stand with elbows extended • Exhale and allow the torso to sag forward without moving elbows or GH joint • Scapula should be in retraction
38
How do you isometrically strengthen the serratus anterior?
Position: Supine or seated • Secure a belt to a stable object behind you • Shoulder flexed to 90°, elbows extended • Perform protraction against the belt’s resistance • Bolsters can be used under scapula to modify protraction angle
39
How do you isotonic strengthen the serratus anterior?
Position: Supine, seated, or quadruped • Theraband resistance: Shoulder flexed to 90°, elbows extended • Push-up with a plus: Start in cat pose with elbows extended and push up • Increase difficulty: Shift to plank/push-up position and protract scapula
40
Which muscles make up the rotator cuff, and what are their actions?
Supraspinatus: Abduction Infraspinatus & Teres Minor: External rotation Subscapularis: Internal rotation & GH stabilization
41
What is the main function of the rotator cuff?
To stabilize the glenohumeral joint by compressing the humeral head into the glenoid during movement
42
How do you stretch the supraspinatus?
Position: Standing or seated • Place a towel roll in the axilla for slight joint distraction • Internally rotate the shoulder (hand behind back or in front) • Use the opposite hand to adduct the arm across the body • Increase stretch: Add chin tuck & contralateral neck flexion
43
How can you isometrically strengthen the supraspinatus?
Position: Standing/seated beside a wall • Place a towel pad between hand and wall • Abduct the arm into resistance (keep elbow extended) • Joint angle can be changed by adjusting abduction height
44
How can you isotonic strengthen the supraspinatus?
Position: Standing/seated • Use a theraband, weight, or anchored strap • Abduct arm in scaption (~30° horizontal adduction) • Do not exceed 90° abduction
45
How do you passively stretch the infraspinatus and teres minor?
Position: Supine • Stabilize the ipsilateral shoulder to prevent anterior humeral translation • Internally rotate the humerus using the forearm as a lever
46
How do you passively stretch the infraspinatus and teres minor?
Position: Supine • Stabilize the ipsilateral shoulder to prevent anterior humeral translation • Internally rotate the humerus using the forearm as a lever
47
What are two self-stretch techniques for infraspinatus and teres minor?
• 1st Stretch: Horizontally adduct the arm across the body while stabilizing the scapula • 2nd Stretch: Internally rotate shoulders (hands tucked into waistband or back pocket), then pull elbow forward
48
What are two self-stretch techniques for infraspinatus and teres minor?
• 1st Stretch: Horizontally adduct the arm across the body while stabilizing the scapula • 2nd Stretch: Internally rotate shoulders (hands tucked into waistband or back pocket), then pull elbow forward
49
How can you isometrically strengthen the infraspinatus and teres minor?
Position: Standing/seated beside a wall • Back of forearm & hand against the wall, elbow tucked near hip • Externally rotate into resistance
50
How can you isotonic strengthen the infraspinatus and teres minor?
Position: Standing/seated (or sidelying) • Use a theraband or small weight • Externally rotate arm while keeping elbow tucked near hip
51
How do you passively stretch the subscapularis?
Position: Supine • Shoulder abducted 90°, elbow flexed 90° • Externally rotate humerus while stabilizing the shoulder
52
How do you perform a self-stretch for the subscapularis?
Position: Standing/seated • Hold a belt or strap with a wide grip, raise overhead • Engage core & avoid lumbar arching
53
How can you isometrically strengthen the subscapularis?
Position: Standing/seated beside a wall • Palmar surface of the hand against the wall • Internally rotate into resistance (keep elbow tucked near hip)
54
How can you isotonic strengthen the subscapularis?
Position: Standing/seated (or sidelying for unstable shoulders) • Use a theraband or small weight • Internally rotate the arm while keeping elbow tucked near hip
55
Which muscle is primarily responsible for shoulder extension?
Latissimus Dorsi
56
How is a passive latissimus dorsi stretch performed in supine?
The therapist gently brings the arm into flexion while stabilizing the scapula to prevent excessive abduction.
57
How is a passive latissimus dorsi stretch performed in sidelying?
• The therapist stabilizes the scapula (varies with position) and anchors the arm to the torso. • The therapist then gently moves the shoulder into flexion, abduction, and external rotation while pinning the ribs to prevent T-spine extension as compensation.
58
How is a self-stretch for the latissimus dorsi performed in supine?
• The patient lies with their head a good distance from the top of the table. • The stretch arm is forward-flexed above the head with the palm facing anteriorly. • This position can also be used to observe muscle shortness: • Pectoralis major shortness: If the arm cannot fully rest along its length. • Latissimus shortness: If there is lateral deviation of the elbow.
59
How is a self-stretch for the latissimus dorsi performed in seated or standing?
• The patient fully flexes or abducts the ipsilateral arm above and behind the head, keeping the elbow extended and palm facing anteriorly. • The contralateral hand is used to grasp the stretch arm above the elbow for assistance. • To increase the stretch, the patient side flexes the trunk contralaterally.
60
How is a self-stretch for the latissimus dorsi performed in seated or standing?
• The patient fully flexes or abducts the ipsilateral arm above and behind the head, keeping the elbow extended and palm facing anteriorly. • The contralateral hand is used to grasp the stretch arm above the elbow for assistance. • To increase the stretch, the patient side flexes the trunk contralaterally.
61
How is a latissimus dorsi self-stretch performed in quadruped or standing lean (Modified Child’s Pose)?
• Arms are outstretched (flexed) in front, reaching forward at different angles to target various muscle fibers. To increase the stretch: • Sink the buttocks back into the heels while engaging the abdominals. • Translate or shift the hips in either direction.
62
How is an isometric shoulder extension exercise performed in supine or standing?
• The patient stands against a wall with a towel pad between the wall and the ipsilateral arm. • The elbow is fully flexed to isolate the latissimus dorsi. • The patient extends the shoulder isometrically into the resistance of the wall. • Joint angles can be modified by adding towel bolsters or adjusting the patient's distance from the wall.
63
How is an isometric shoulder extension exercise performed in a long-seated position?
• The patient loops a belt around a stationary object or their feet. • Performs a seated row motion, engaging bilateral or unilateral humeral extension against resistance. • The belt length should be adjusted so the movement extends past the torso.
64
How is an isotonic shoulder extension exercise performed in a long-seated position?
• The patient loops a theraband around a stationary object or their feet. • Performs a seated row motion, engaging bilateral humeral extension against the resistance of the band. • The patient must ensure they are pulling past the torso.
65
What are the primary actions of the pectoralis major?
Glenohumeral (GH) movements: • Horizontal adduction • Flexion • Adduction • Internal rotation
66
How are different pectoralis major fibers best stretched?
• Clavicular fibers: Best stretched with humerus abducted below 90°. • Sternal fibers: Best stretched with humerus abducted to 90°. • Costal fibers: Best stretched with humerus abducted above 90°.
67
How is a passive pectoralis major stretch performed in hooklying?
• The patient lies with the GH joint off the table edge. • The therapist brings the shoulder into 90° flexion, then slowly into horizontal abduction. • The therapist may apply gentle pressure using their palm or forearm to increase the stretch. • To target different fibers: • Clavicular: Less abduction • Sternal: 90° abduction • Costal: More abduction
68
How is a passive pectoralis major stretch performed in seated/kneeling?
• The patient clasps their hands behind their occiput, engaging abdominals and tucking their chin. • The therapist stands behind and grasps the arms proximal to the elbows, moving them into horizontal abduction.
69
How is a self-stretch for the pectoralis major performed in standing or seated?
• The patient brings arms up behind them, externally rotates shoulders, and extends elbows. • Core should be engaged, and chin tucked. • Avoid anterior translation of the humeral head. • Extend shoulders until a stretch is felt in the chest or anterior shoulders/deltoids.
70
How is a doorway stretch performed for the pectoralis major?
• The patient stands in a doorway with their forearm against the doorframe. • The shoulder is abducted to a specific angle to target different muscle fibers. • The ipsilateral leg is placed forward, knee flexed. • The patient leans forward, moving the torso away from the doorway.
71
How is an isometric bench press performed in hooklying?
• The patient loops a belt behind their body, holding each end in their hands. • The patient pushes toward the ceiling, resisting against the belt. • Bolsters under the elbows can adjust the angle of horizontal abduction. • Ensure no back arching or elbows locking in extension.
72
How is an isometric pectoralis major exercise performed in a doorway?
• The patient stands in a doorway with their forearm against the doorframe. • The shoulder is abducted to a specific angle to target different fibers. • The ipsilateral leg is placed forward, knee flexed. • The patient horizontally adducts into the doorframe’s resistance. • Joint angle can be adjusted by turning the body toward or away from the arm.
73
How is an isotonic bench press performed in supine or hooklying?
• The patient loops a theraband behind the body (preferably under the table). • Holds each end of the theraband in their hands. • Pushes up so arms are directly over shoulders, palms facing forward. • Slowly lowers hands, with elbows slightly below shoulder level. • Ensure no back arching or elbows locking in extension.
74
How are flys performed for pectoralis major strengthening?
• The patient holds one or both dumbbells. • Arms are externally rotated. • Moves slowly from horizontal abduction to maximum horizontal adduction. • Maintains slight elbow flexion throughout the exercise.
75
What are the actions of the anterior deltoid fibers?
Flexion and medial rotation.
76
What is the primary action of the middle deltoid fibers?
Pure abduction.
77
What are the actions of the posterior deltoid fibers?
MExtension and external rotation.
78
What are the passive and self-stretches for the anterior deltoid?
Seated or standing, refer to Pectoralis Major Stretch C & D.
79
How can the middle or group deltoid be stretched?
Seated or standing, refer to Supraspinatus Stretch A.
80
What is the recommended stretch for the posterior deltoid?
Seated or standing, refer to Infraspinatus Stretch B.
81
Describe an isometric strengthening exercise for the deltoid using a wall.
Stand or sit beside a wall with a towel pad between the hand and wall; abduct the arm into the resistance of the wall while maintaining elbow flexion.
82
How can the joint angle be changed in isometric strengthening for the deltoid?
By placing the arm higher or lower into abduction.
83
How can a belt or strap be used for isometric strengthening of the deltoid?
Tie a belt to an immovable object or anchor it under the foot; abduct the arm against the resistance of the band while maintaining elbow flexion.
84
Describe an isotonic strengthening exercise for the middle deltoid.
Use a theraband anchored under the foot or to an immovable object; abduct the arm to 90 degrees with the shoulder in a neutral position. Weights can also be used.
85
How can the anterior deltoid be strengthened?
Use a theraband anchored under the foot; forward flex the arm against the resistance of the band.
86
Describe an isotonic strengthening exercise for the posterior deltoid.
In prone, quadruped, or standing lean positions, use a theraband anchored to a table leg or weights; take the humerus into an extended position against the resistance.
87
What muscles primarily perform shoulder adduction?
Pectoralis Major, Latissimus Dorsi, and Teres Major.
88
What muscles are involved in elbow flexion?
Biceps Brachii, Brachialis, Brachioradialis.
89
Describe a passive stretch for the elbow flexors in standing, seated, or sidelying.
The therapist stabilizes the ipsilateral scapula, extends the humerus while maintaining elbow extension and forearm pronation.
90
How can elbow flexors be passively stretched in supine or hooklying?
With the arm positioned close to the edge of the table, the therapist abducts the humerus to 90 degrees, slowly extends the elbow, and pronates the forearm.
91
Describe a self-stretch for elbow flexors in standing or seated positions.
Bring arms up behind, externally rotate shoulders, extend elbows, maintain core engagement, and extend shoulders until a stretch is felt in the chest/anterior shoulders.
92
How can a wall be used for self-stretching elbow flexors?
Stand close to the wall, extend the stretch arm along the wall, keep forearm pronated, and slowly peel away.
93
How can elbow flexors be isometrically strengthened?
Use a belt anchored under the foot or resist with the contralateral arm to flex the elbow.
94
How does forearm positioning affect isometric strengthening of elbow flexors?
• Biceps Brachii: Forearm in supination. • Brachioradialis: Forearm in neutral. • Brachialis: Forearm in pronation.
95
Describe an isotonic strengthening exercise for elbow flexors.
Use a theraband anchored under the foot and flex the elbow against the resistance.
96
What muscle is primarily responsible for elbow extension?
Triceps Brachii (long, lateral, and medial heads).
97
Describe a passive stretch for elbow extensors.
Fully flex the shoulder and elbow; grasp the elbow with one hand while stabilizing the ipsilateral scapula.
98
How can elbow extensors be self-stretched?
Use the contralateral arm to hold the ipsilateral elbow down and back.
99
Describe an isometric strengthening exercise for elbow extensors.
Extend the elbow against a wall, chair, or table; alternatively, use the contralateral arm for resistance.
100
How can elbow extensors be isotonic strengthened in standing, seated, or hooklying?
Use a theraband anchored under the foot; begin with the shoulder and elbow fully flexed and extend the elbow against resistance.
101
How can wrist flexors be passively stretched?
Therapist stabilizes the forearm, extends the elbow, and supinates the forearm while gently taking the wrist into extension.
102
Describe a self-stretch for wrist flexors in a standing, seated, or quadruped position.
Extend the stretch elbow, supinate forearm, and pull on the palmar surface of the hand.
103
How can wrist flexors be isometrically strengthened?
Rest the forearm on a table, supinate forearm, and use the contralateral arm or a strap for resistance.
104
How can wrist flexors be isotonic strengthened?
Use a theraband anchored under the foot; flex the wrist against the resistance.
105
How can wrist extensors be passively stretched?
Therapist stabilizes the forearm, extends the elbow, and pronates the forearm while gently taking the wrist into flexion.
106
Describe a self-stretch for wrist extensors.
Extend the elbow, pronate forearm, and pull on the dorsal surface of the hand.
107
How can wrist extensors be isometrically strengthened?
Rest the forearm on a table, pronate the forearm, and use the contralateral arm or a strap for resistance.
108
How can wrist extensors be isotonic strengthened?
Use a theraband anchored under the foot; extend the wrist against the resistance.

Therapeutic Exercise (6 decks)

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