Upper Extremity Lab Flashcards
Glenohumeral ROM
[Shoulder ROM]
Flexion: 180 Extension: 60 Abduction: 180 Horizontal Abduction: 40-55/ 130-145 Adduction: 40-50/ 130-140 IR: 90 ER: 90
Glenohumeral (GH) SD BLT
Indications: sub deltoid bursitis or frozen shoulder
Patient- Lateral recumbent and dysfunctional side up
- Grasp olecranon process of dysfunctional arm and flex elbow. Use the other hand to stabilize the shoulder
- Use the elbow as a lever, put the GH joint in its indirect position (abd/add, flexion/extension, compression/traction, IR/ER)
Normal SC Joint Motion
SC Abduction- Scapular elevation leads to inferior movement of SC joint
SC Adduction- Shoulder depression leads to superior motion of SC joint
SC Flexion- protraction leads to posterior glide of the clavicle at the SC joint
SC Extension- retraction leads to anterior glide of the clavicle the SC joint
Distal clavicle follows shoulder
SC Elevated/Adduction SD Still Technique
Patient- seated
Physician- behind the patient monitoring SC joint with one hand and grasping the elbow with the other
Start with elbow adducted and slightly extended
Add compression toward the SC joint
Move the elbow into superior glide and abduct –> posterior circumduction motion
Remove compression and return to neutral
SC Depressed/Abducted SD Still Technique
Patient- seated
Physician- behind patient monitoring SC joint with one hand and grading the elbow with the other
Start with elbow abducted and slightly flexed
Add compression toward the the SC joint
Move the shoulder into adduction with anterior circumduction motion
Remove compression and return to neutral
Sternoclavicular (SC) SD HVLA
Patient-supine
Physician- standing at the head of the table
Place their thenar eminence of monitoring hand over restricted SC joint
Apply a cephalic traction on the arm on the side of dysfunction
Apply a thrust on the SC joint while simultaneously inducing a rapid traction force through the patient’s arm
Adduction SD- inferior thrust
Extension SD- posterior thrust
AC Joint Evaluation
Inspect for asymmetry
Palpate
Motion Screen-
Cross-arm adduction test: positive test- pain or increased TTA
Spring inferiorly on distal clavicle (compare bilaterally)- Clavicle Superior/Clavicle Inferior
Spring anterior to posterior
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
AC Joint- Direct Seated ART
Patient- seated
Physician- standing behind patient
Grasp the elbow or forearm of dysfunction side
Grasp dysfunctional clavicle between thumb and fingers of free hand
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)
Doctor holds clavicle antero-inferior (with thumb). Shoulder is extended into a circulatory sweep, posterior, superior, then anteromedial while maintaining adduction and capsular tension
Elbow ROM
Flexion: 140-150
Extension: -5-0
Supination: 90
Pronation: 90
Ulnar Abduction/Adduction
Reference point for naming dysfunction is distal ulna
Ulnar adduction- coupled with wrist abduction (radial deviation)
Ulnar Abduction- coupled with wrist adduction (ulnar deviation)
Ulnar Abduction SD HVLA
Patient-seated
Physician- in front of patient
Supinate and extend elbow to 5 degrees. 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 thrust over the medial olecranon
Ulnar Adduction SD HVLA
Patient- seated
Physician- in front of patient
Supinate and extend elbow to 5 degrees. 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
Radial Head
Anterior Glide- coupled with supination
Posterior Glide- coupled with pronation
Anterior Radial Head SD HVLA
Patient- seated
Physician- standing the facing the patient
Place thumb of one hand into the crease of the patient’s elbow contacting directly over the anterior radial head. The other hand flexes elbow and pronates forearm
Exert a rapid hyper flexion force while simultaneously thrusting the radial head posteriorly
Posterior Radial Head SD HVLA
Patient- seated
Physician- standing facing the patient
Extend and supinate elbow. Place thumb over posterior aspect of the radial head
Exert a rapid hyperextension force while simultaneously thrusting the radial head anteriorly. Be sure not to go past the anatomic barrier
Interosseous Membrane Examination
Use thumbs to evaluate dorsal and solar aspects of the forearm between the radius and ulna
Evaluate for tissue texture abnormalities, asymmetry, and/or tenderness to the interosseous membrane
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
Physician holds the patient’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
Wrist and Hand ROM
Flexion- 80-90 degrees (posterior carpal glide)
Extension- 70 degrees (anterior carpal glide)
Abduction- 20-30 degrees
Adduction- 30-40 degrees
Wrist flexor Retinaculum MFR
Patient: seated or supine with palm facing up
Physician: in front of patient
Physician’s thumbs are placed on the medial and lateral attachments of the transverse carpal ligament, with the fingers wrapped around the dorsal wrist
Exert tension on the flexor retinaculum by pressing thumbs into the solar surface of the hand and pushing the thumbs apart
Hold for 20-60 seconds until a release is felt
Radiocarpal Joint SD Articulatory with Traction
Physician cups hands by approximating thenar and hypothenar eminences to form a groove inch hand
Physician’s hands are placed over the dysfunction with the grooves parallel to the joint line
Physician squeezes between his/her hands, producing traction as the eminences separate
Physician maintains the squeeze and traction while articulating the patient’s wrist in a clockwise, then counter-clockwise motion, carrying the dysfunction through the restrictive barrier
Wrist Extension/ Ventral Carpal SD HVLA
Patient: Seated
Physician: standing facing the patient
Pronate elbow. Grasp patient’s hand, thumbs contracting dorsally at the proximal carpal bone (radoiocarpal joint)
Deliver a whip-like thrust moving from extension to flexion through the carpal dysfunction
Wrist Flexion/ Dorsal Carpal SD HVLA
Patient: seated
Physician: standing facing the patient
Pronate elbow. Graps patient’s hand, thumbs contacting dorsally at the proximal carpal bones (radoiocarpal joint)
Deliver a whip-like thrust moving from extension to flexion through the carpal dysfunction
Wrist Flexion/ Dorsal Carpal SD HVLA
Patient- seated
Physician- standing facing the patient
Pronate elbow. Grasp patient’s hand, thumbs contacting dorsally at the proximal carpal bones (radoiocarpal joint)
Deliver a whip-like thrust moving from flexion to extension through the carpal dysfunction
Hand and Finger Joints
MCP Abduction- moving away from the long finger
MCP Adduction- moving toward the long finger
Thumb Abduction- Moves anterior from the anatomical position (supinated)
Individual Motion Testing: Abduction/adduction of MCP, PIP, and DIP joints
Finger Articulatory Treatment
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
Apply long-axis extension
Phalangeal Dysfunction HVLA
Patient- seated
Physician- standing facing the patient
Isolate dysfunctional joint
While stabilizing the wrist, exert traction and a hyper flexion thrust through the SD
Supraspinatus Tender Point
F Abd ER
patient- supine
Levator Scapulae Tender Point
Abd IR Traction
Patient- prone
Subscapularis Tender point
E IR
Patient- Supine
May apply some traction
Biceps Brachii (Long head) Tender point
F Abd IR
Patient- Supine
Elbow and Shoulder Flexed
Biceps Brachii (Short head) Tender points
F ADD IR
Patient- supine
Radial Head- Lateral (Supinator)
E SUP Valgus
Medial Epicondyle (Pronator Teres)
F Pro Add
Dorsal Wrist (Extensor Carpi Radialis)
E ABD
Doral Wrist (Extensor Carpi Ulnaris)
E ADD
Palmar Wrist (Flexor Carpi Radialis)
F ABD
Palmar Wrist (Flexor Carpi Ulnaris)
F Add
First CMP (Abductor Pollicis Brevis)
F (wrist) ABD (thumb)
